Mohs micrographic surgery: case studies
This page provides examples of Mohs surgery undertaken by Dr Bashir, for the benefit of future patients who are considering having the procedure. The images are kindly uploaded with the patient's permission for the purpose of helping others who are about to undergo the procedure. The images are cropped to protect patient confidentiality, but are not otherwise altered.
Mohs for Basal Cell Carcinoma Right Forehead
The top left image show an indistinct basal cell carcinoma on the right forehead:
- a subtle change in the texture of the skin can be felt
- the patient reported repeated scabbing and crusting of the area.
- a skin biopsy confirmed an infiltrative basal cell carcinoma, which is best removed by Mohs surgery
Mohs surgery was performed with the patient awake, with the skin numbed by a local anaesthetic injection:
- the skin growth was removed and immediately frozen sliced into 0.008mm slices for analysis
- the slides were stained with a special stain haematoxyllin and eosin to show up the tumour cells
- Dr. Bashir reads the slides to assess for the presence of tumour and mark it's location micrographically
- the final size and depth of the surgical wound can be seen in the top right image
After the tumour has been cleared from the skin, the priority is to reconstruct the surgical defect. This requires specialised reconstructive plastic/dermatological surgery skills. In this case, the major issues are to:
- keep the eyebrows and hairline in their natural position
- avoid damage to the supra orbital and supra trochlear nerves, which run adjacent to the wound
- avoid damage to the facial nerve which controls eyebrow movement
- mnimise surgical downtime - brusing, swelling and pain
In order to repair the wound, Dr Bashir contructed a flap of skin which could be advanced into position to cover the exposed muscle and fat, and to give the forehead a natural look. Importantly, the eyebrow symmetry was preserved and a natural contour obtained.
The lower left picture shows the flap of skin immediately after it was stitched into place, and the same area 5 days later when the stitches were removed is seen on the lower right. By as little as 5 days, the skin had almost covered the entire scar line and the surface stitches were removed.