Updated 15 November 2014
Surgery is indicated for the removal of many cutaneous malignancies. If the surgical excision of any skin malignancy is expected to produce a significant cosmetic deformity (especially of the face), or if the patient is medically unfit for surgery, radiation therapy is usually considered to be the treatment of choice. Similarly, if a skin malignancy should recur locally after apparent adequate surgery, radiation therapy or microscopically controlled surgery (Mohs technique) may be the treatment of choice. In these instances, patients can be referred to the Skin Management Clinic.
This surgery consists of the removal and immediate examination of serial slices of the edges and base of a malignant tumour site. Slices are examined microscopically for presence of tumour and if tumour is present, a further slice is taken from the surrounding skin. This is continued until the histology indicates that all tumour is removed. This technique is far more comprehensive than a standard frozen section examination of a rush specimen.
Mohs micrographic surgery is particularly indicated for the treatment of recurrent tumours, especially those recurrent after radiation therapy. In addition, large tumours, tumours with ill-defined margins and those close to important anatomic structures such as the eyelids and nasal alar rim will have a higher cure rate if treated by Mohs micrographic surgery, compared to conventional surgery.
Referral should be made to a dermatologist trained in this technique.
In cases where surgery, including Mohs sugery, is expected to result in complex wound repair, significant cosmetic or functional defect of the tumor site, or cancers recurring after surgery, consideration should be made to explore radiation therapy as an alternative, especially for elderly patients. Similarly, when patients are medically unfit to go for surgery, radiation therapy should be considered.