Lancashire Teaching Hospitals’ plastic surgery department has opened the first service in the region – and one of only a small number nationwide - offering the ‘gold-standard’ Mohs Micrographic Surgery and Plastic Surgical Reconstruction for NHS skin cancer patients.
Based at Chorley and South Ribble Hospital, the service offers patients with high-risk skin cancers in high-risk locations - such as the face, nose, ears, eyes and mouth - treatment with real-time histological analysis of the tumour and reconstruction of the wound, all in one sitting.
Mohs surgery is a method for treating skin cancer, named after Dr Frederic Mohs who invented the procedure in the 1930s. The main difference between Mohs surgery and conventional surgery is that histology – the microscopic study of tissues – is analysed in ‘real-time’ and results are available whilst patients are still at the hospital. Any remaining tumour can be completely removed, and the resulting defect reconstructed and repaired, in a single admission in the vast majority of cases.
The procedure aims to preserve as much normal skin and tissue as possible and has the highest cure rate (up to 99%) and lowest recurrence rates. It is classed as the ‘gold-standard’ treatment for removal of BCCs (Basal Cell Carcinoma) and some other skin cancers.
The Trust have been working towards making the service available for around a decade, and feedback from patients and staff has been extremely positive. The service is provided by two consultant plastic surgeons, Mr Sofiane Rimouche and Mr Richard Wain, and is supported by a team of specialist pathologists, technicians, nurses, and theatre staff.
Consultant Plastic & Reconstructive Mohs Surgeon Richard Wain said: “It gives reassurance to patients that their tumour has gone – on the day they are admitted they have a skin cancer, and after the procedure they can go home confirmed cancer-free with an appropriate reconstruction. That’s really great for patients.
“It’s the only NHS Mohs service for Lancashire and South Cumbria, so we are now the regional centre for this type of surgery. We’re also one of very few Mohs units in the country, led by plastic surgeons.
“Liverpool was the closest service to us, and we referred patients there for several years. Now this isn’t necessary as we can perform the procedures ourselves, which is great for our patients. Liverpool’s Mohs service, based at St Helens, have been a valuable source of advice and guidance to us during the process of establishing our service.”
Richard added: “I believe that Mohs surgery is the best way of ensuring we only surgically remove what is necessary to ensure tumour clearance. Patients therefore get the best cancer care and the most appropriate reconstruction at the same time.”
Kevin Hunter, from Tarleton, had a basal cell carcinoma of the nose, and, having initially been prepared for an 18-month wait for surgery, underwent treatment at Chorley within three weeks.
He said: “I had been told there was a significant waiting list to be seen, but I received a call from Mr Wain and got in at Chorley inside three weeks. I was tested and was lucky, the cancer was removed that day, I received stitches and was on my way.
“The staff were amazing. It takes a lot of the anxiety away. I was really pleased with the outcome.”
Carol Bristow of Lancaster added: “I thought I had a spot on my nose which kept going away and coming back. I ended up having a private biopsy, where I was told there were two options, a normal skin graft, or Mohs. I was referred to Mr Wain at Chorley for Mohs, where I had a consultation and surgery.
“They got rid of the cancer in two stages, and I had reconstructive surgery after that. I was there all day. I have another appointment in November to have a look at it, where I can have further surgery if necessary.
“I’ve been through it a bit, but Mohs was certainly the best option. The whole team at Chorley were fabulous, the nurses, Mr Wain and his team.”
The Plastic Surgery Mohs service will accept referrals from skin cancer specialists across Lancashire & South Cumbria either directly to the Mohs Team, or via the Specialist Skin MDT.
