Mohs surgery is covered by most medical aids in South Africa. You can confirm with your Mohs surgeon before the surgery if he or she will charge any co-payments.
Mohs surgery is most frequently performed on Basal Cell Carcinoma and Squamous Cell Carcinoma. While highly effective for most skin cancer, Mohs Surgery may not be appropriate for all skin cancer types. Consultation with a specialist is essential to determine the best treatment approach.
In South Africa a Slow Mohs approach is taken, where melanoma is excised with recommended margins, according to international guidelines, followed by complete margin analysis. This is done on permanent sections, using special stains to identify the melanoma cells, and evaluated by a pathologist. This approach is associated with a higher cure rate when competed to traditional wide local excision with random vertical section analysis.
The duration varies depending on the tumour’s size and depth and number of stages needed to clear the tumour. The whole process, including excision, tissue examination and reconstruction of the wound often takes several hours.
Mohs Mohs Surgery offers cure rates up to 99% for certain skin cancers, which is higher than any other treatment modality.
Post-operative care includes keeping the wound clean, following specific care instructions, and attending follow-up appointments to monitor healing and removal of stitches. You will be provided with information on wound care by your Mohs surgeon.
The Royal College of Pathologists advises against using vertical frozen sections to assess margins, as they do not adequately represent the entire surgical margin. They highlight that such random sections are insufficient for ensuring complete tumour removal and are not considered reliable for determining the full extent of the margin. This limited sampling increases the risk of cancer cells being missed, which can lead to cancer recurrence.
The excised tissue is immediately processed in an on-site laboratory, where it’s frozen, thinly sliced, stained, and examined under a microscope to check for remaining cancer cells.
In Mohs surgery, horizontal frozen sections are taken, allowing for a more thorough evaluation of the entire margin, ensuring that no cancerous tissue remains. This precision significantly reduces the likelihood of recurrence and ensures the highest standard of care for patients undergoing skin cancer removal.