Elements Skin Cancer Clinic

Margin Control Surgery

Margin Control Surgery also known a Slow MOHS surgery

When a skin cancer is removed surgically, the aim is to remove the entire cancer plus a small margin of healthy tissue. The surgical specimen is sent to the lab where it is processed and examined by a histopathologist to confirm the diagnosis and to ensure that the whole lesion has been completely removed.

Sometimes it can be difficult to define the boundaries of certain cancers and this is when ‘Margin Control Surgery’ or ‘Staged Surgical Excision’ is useful. This technique ensures that the entire cancer is removed with adequate margins without removing unnecessary skin.

It involves a 2 part surgical process as follows :

  1. The tumour is removed surgically and sent to the lab for priority reporting. It is marked in way makes it clear to the surgeon how the tumour is oriented in relation to the normal anatomy. The wound is not closed and a special dressing is applied and sutured to the wound. The tumour is looked at in the lab and a report is provided detailing the adequacy (or not) of the excision.
  2. If the histology report indicates that the tumour has been removed with adequate margins, the wound is closed appropriately. If more tissue needs to be removed, this then done and again sent for reporting. Once the tumour clearance is adequate, the wound is closed.

Margin control / Staged excision surgery is particularly useful in certain situations including :

  • Aggressive tumours or tumours with poorly defined margins.

(eg: Infiltrative, micronodular or morphoiec BCC, Lentigo maligna, aggressive SCC, Atypical fibroxanthoma)

  • Previous incompletely excised tumours.
  • Recurrent tumours
  • In situations where a complicated repair is required to close the wound particularly in a cosmetically sensitive anatomical area.

It avoids the inconvenience of finding that a tumour has not been fully cleared by the initial surgery which then results in further surgical procedures being required and often sub-optimal cosmetic results.

Margin control surgery attracts an additional surgical fee.