A new clinic has been introduced at Forth Valley Royal Hospital to provide gold standard treatment for patients with certain skin cancers.

Mohs Micrographic Surgery is a highly specialist surgical technique to remove skin cancers while preserving as much healthy tissue as possible. It is most often used to remove skin cancers on the scalp, face, lip, ear and neck area and has a very high cure rate.

Mohs Laboratory Team – (L-R) Calum Granger (Specialist Biomedical Scientist), Jayne Duncan (Deputy Pathology Department Manager), Lorraine Hunter (Specialist Biomedical Scientist), Forth Valley Royal Hospital

It requires the expertise of plastic surgeons, pathologists and healthcare scientists who work together to remove, prepare and examine skin tissue to ensure all the cancerous cells have been removed. The specialist treatment is currently only available in only four centres in Scotland (Forth Valley, Dundee, Glasgow and Edinburgh) and there are only 8 consultant Mohs surgeons in Scotland who can carry out the highly specialist procedure, including two at Forth Valley Royal Hospital.

The new Mohs Clinic operates in the Day Surgery Unit, equipped with a treatment room and dedicated laboratory. This enables skin tissue to be removed under a local anaesthetic, then prepared and examined in the same area. Patients undergo the procedure at a single outpatient appointment and return home on the same day, normally after a few hours.

The technique involves a consultant plastic surgeon removing skin tissue from the patient’s face or neck. This is then taken to the on-site laboratory and cut into thin sections which are then stained and mounted onto glass slides. The slides are then examined under a microscope by a consultant pathologist for the presence of cancer cells at all edges of the tumour. If cancer cells are seen, another thin layer of tissue is removed and checked and the process is repeated until no more cancer cells are seen.

Patient Wanda Charles is pictured at home shortly after undergoing the Mohs procedure.

One of the first patients to be treated at the new Mohs clinic, Wanda Charles, had cancerous skin on her nose removed seven years ago using traditional surgical methods but unfortunately the cancer returned. She said: “At the first treatment a few years ago I was told that it was not possible to remove all of the cancerous tissue so it could come back. After noticing my nose bleeding, I contacted my GP and was initially refereed to dermatology who made arrangements for me to be seen at the new Mohs Clinic.”

“I attended a morning clinic and, after several rounds of removing tissue from my nose, the consultant was able to confirm that all the cancerous cells had been successfully removed, so it’s unlikely I will have to return for more treatment in the future.

“I can’t praise the team at the new clinic highly enough for the quality of care I received. The treatment was very quick, they explained everything very thoroughly. I now have the peace of mind that all of the cancerous cells have been removed.”

Mohs Team Forth Valley Royal Hospital – (L-R) Mr Richard Clark, Consultant Plastic Surgeon; Dr Laura Maclean, Consultant Pathologist, Dr Imran Ahmed, Consultant Pathologist, Jayne Duncan, Deputy Pathology Department Manager, Calum Granger, Specialist Biomedical Scientist and Leanne Moir, Specialist Biomedical Scientist

Mr Richard Clark, Consultant Plastic Surgeon, said: “The Mohs clinic allows us to deliver the gold standard service in skin cancer. We target the service to those most likely to benefit and the treatment means that we can remove as little tissue as possible while ensuring that no cancerous areas remain. This is particularly important for patients with cancer in very visible areas such as their face, ears, nose and neck to avoid disfigurement and causing potential issues with day-to-day functions such as eating and swallowing.

“All of the treatment can now be delivered during a single morning or afternoon session, whereas before patients may have required to undergo multiple surgeries over several months and more tissue may have had to be removed.”

The Mohs clinic at Forth Valley Royal Hospital takes place every other week to provide treatment for local patients from across Forth Valley as well as suitable patients referred by NHS Lanarkshire.

Additional Information

Mohs surgery was developed in 1938 by the general surgeon Frederic E. Mohs and is used to treat both common and rare types of skin cancer. During the surgery, after each removal of tissue and while the patient waits, the tissue is examined for cancer cells. That examination dictates the decision for additional tissue removal. Mohs surgery allows for the removal of a skin cancer with very narrow surgical margin and a high cure rate.