Mohs micrographic surgery is a detailed surgical procedure to treat aggressive non-melanoma skin cancers, mainly on the face and neck. Mohs surgery is not done as a routine procedure. For most routine skin cancers, simple cutting out (excision) or scraping is done. Patients who come for a Mohs procedure have been selected as having unusual or more difficult tumours because of its type, size, location, or failure of other techniques to produce a cure.
DR. CHRISTIAN MURRAY
Dr. Murray is a graduate of McGill University, Dalhousie University, the University of Toronto and the University of British Columbia. He is Dermatology board certified in Canada and the United States and completed an accredited fellowship in Mohs Micrographic Skin Cancer Surgery. Dr. Murray and his colleagues, Dr. Solish and Dr. Chan are the only Mohs surgeons recognized by the Canadian Association of Mohs Surgeons, practicing in Toronto.
As a full-time Associate Professor of Medicine at the University of Toronto he teaches resident physicians within the well known Dermatology centre at Women’s College Hospital. He is also the program director for all dermatology fellowships across the University of Toronto. Dr. Murray is an invited lecturer at National and International conferences, at Universities abroad and continues to publish journal and textbook articles. His key area of research and practice is skin cancer, with a particular focus on cost-effectiveness and quality of life.
Dr. Murray is an active member of the Canadian Dermatology Association (CDA), a founding member of the Canadian Association of Mohs Surgeons (CAMS) and past president of the Canadian Society for Dermatologic Surgery (CSDS). Dr. Murray runs as director the American College of Mohs Surgery (ACMS) accredited fellowship at the University of Toronto and has trained Plastic Surgeons and Dermatologists who are now practising Mohs surgery in Canada and internationally.
DR. NOWELL SOLISH
Dr. Nowell Solish, M.D., FRCP (C), graduated as a dermatologist from the University of Toronto, and subsequently specialized in surgical dermatology, training at the University of Toronto and the University of British Columbia. During this time, Dr. Solish focused on cosmetic and skin cancer dermatologic surgery. Today, Dr. Solish is a recognized specialist in the field of cosmetic dermatology and dermatologic surgery.
Dr. Solish is an Assistant Professor at The University of Toronto, as well as the co-director of the Non-Melanoma Skin Cancer clinic at Women’s College. He is the past president of The Canadian Society of Dermatologic surgery and a founding board member of the International Hyperhidrosis Society. He is a member of the American and Canadian Societies for Dermatology and Dermatologic Surgery.
Academically, he is the director of Dermatologic surgery at the University of Toronto. He was the co-director of undergraduate dermatology, responsible for planning the curriculum and teaching surgical dermatology to all medical students and doctors at various levels of training at the University of Toronto. He is also published in peer-reviewed journals, and lectures regularly on dermatologic surgery techniques at local, national and international medical meetings.
Dr. Solish is also a widely quoted media spokesperson on issues of surgical and cosmetic dermatology. His interviews include appearances on ABC news, CBC news, Global Television, The National, CBC Radio, and Citytv to name a few.
DR. AN-WEN CHAN
Dr. An-Wen Chan (MD, DPhil, FRCPC) is the Phelan Senior Scientist at Women’s College Research Institute and Professor of Medicine at University of Toronto. After obtaining his DPhil as a Rhodes Scholar at University of Oxford, Dr. Chan completed his dermatology residency at University of Toronto, and Mohs micrographic surgery fellowship at Mayo Clinic, Rochester.
Dr. Chan is currently the research director for the University of Toronto dermatology residency program. His research interests include clinical trials as well as the prevention, detection, and treatment of high-risk skin cancers. His work has been widely cited in the medical literature and popular media. Dr. Chan has served as a director of the International Transplant Skin Cancer Collaborative; Special Advisor to the Canadian Institutes of Health Research; and coordinating scientist for the World Health Organization’s International Clinical Trials Registry Platform.
Dr. Murray, Dr. Chan and Dr. Solish are fully affiliated with the University of Toronto and are accredited by the American College of Mohs Surgery.
University of Toronto – Mohs Surgery Fellowship
The University of Toronto program is an official fellowship accredited by the American College of Mohs Surgeons (ACMS). It follows all the rules and regulations outlined by the ACMS fellowship guidelines and also falls within the rules of University of Toronto post-graduate training. We are academic Dermatologists and Mohs Surgeons who work at Women’s College Hospital within the University of Toronto.
Read more information on deadlines and the application process.
Moh’s Centre
Women’s College Hospital
76 Grenville Street
Floor 5
Toronto, ON M5S 1B2
Phone: 416-323-7732
Fax: 416-323-6306
Hours of Service
Monday through Friday from 7:30 a.m. until all procedures have been completed.
Referrals
The Mohs Surgery team is happy to assess and treat patients for skin cancers. A physician’s referral is required. Patients are most often referred to our centre by a dermatologist or plastic surgeon, but other physicians may refer if appropriate.
Referrals may be faxed to 416-323-6306.
Please note: the Women’s College general dermatology unit manages all referrals for general dermatology and pigmented lesions including melanoma and dysplastic nevi.
They can be reached by fax 416-323-6236 or phone 416-323-7546.
Our Mohs surgeons (Drs. Chan, Murray, and Solish) see patients with biopsy proven non-melanoma skin cancer in consultation at Women’s College. Please include pathology results with all referrals. A detailed description or photograph may be included and if we can accurately assess the tumour’s size, we will book the consultation and surgery on the same day to reduce travel.
Your Care
Skin surgery can mean a lot of different things. To understand how complicated your procedure may be you may read some general information on the most common forms of skin surgery: Skin cancer surgery, removal of benign but unpleasant lesions like moles or cysts, and non-invasive procedures like treatment of excessive sweating.
Skin Cancer Surgery
For patients with skin cancer this often means part of the skin is cut out and sent to the pathology laboratory to be tested to ensure it is all removed. In this case, the procedure is performed after the area is frozen with local anesthetic (a needle). The cancerous area is removed and the site is either closed with stitches or bandaged to heal. In some cases, if the cancer is complicated or in a very important area like the face, Mohs surgery is used. This procedure involves more time to ensure the cancer is carefully removed.
Surgery to remove non-cancerous moles, cysts or similar skin lesions: Careful removal of the skin lesion is performed on non-cancerous spots using local anesthesia (freezing with a needle). Every effort is made to reduce the size of the final scar. Information on expected healing times and techniques are available, but individual information during discussions with your skin doctor is crucial to understanding how the surgery will affect you.
Non-Surgical Treatments
Various procedures like injections to reduce excessive sweating or wrinkles are available. Although the risks of these procedures are small, it is important to understand all aspects of the treatment through discussions with your skin doctor.
Excessive sweating (hyperhidrosis) is a common condition, affecting almost a million Canadians. For those affected, this condition can be extremely debilitating with significant effects on social and work activities. Many effective therapies exist to treat this disorder, ranging from strong anti-perspirants to surgery. Recently, a new treatment has been shown to be both safe and effective. Injections of Botox, known for its safety in treating children with muscle disorders and for treating healthy people for cosmetic concerns, is also very good at reducing sweat production in limited areas like the armpits, hands and feet.
To make an appointment to discuss treatment of excessive sweating with Botox injections, you may contact our clinic (below) to meet with a specialist. Please note that Botox is a prescription medication that may cost several hundred dollars a treatment. Extended health plans usually cover the costs of this prescription if used for excessive sweating in certain areas like the armpits.
Excessive sweating (hyperhidrosis) is a common condition, affecting almost a million Canadians. For those affected, this condition can be extremely debilitating with significant effects on social and work activities. Many effective therapies exist to treat this disorder, ranging from strong anti-perspirants to surgery. Recently, a new treatment has been shown to be both safe and effective. Injections of Botox, known for its safety in treating children with muscle disorders and for treating healthy people for cosmetic concerns, is also very good at reducing sweat production in limited areas like the armpits, hands and feet.
To make an appointment to discuss treatment of excessive sweating with Botox injections, you may contact our clinic (below) to meet with a specialist. Please note that Botox is a prescription medication that may cost several hundred dollars a treatment. Extended health plans usually cover the costs of this prescription if used for excessive sweating in certain areas like the armpits.
- Video about the Mohs surgery (from the ACMS)
- Video about the Mohs technique (from the ACMS)
- Excessive Sweating
Pre-Operative Instructions
- What is Mohs surgery (.doc)
- Pre-op instruction (.doc)
- Pre-op questionare (.pdf)
- Hotel information (.pdf)
Post-Operative Care
Mohs Micrographic Surgery (named after Dr. F. Mohs) refers to the surgical removal of skin cancer using microscopic examination to ensure, as much as possible, that the cancer is completely removed.
What are the Advantages of Mohs Surgery?
There are two primary advantages. First, by using the microscopic examination of the tissue as a guide, the Mohs surgeon is better able to remove all of the skin cancer (highest cure rate). Secondly, by carefully mapping out the tumor, the surgeon removes cancerous tissue and leaves as much normal skin as possible (best chance at a small scar).
When is it done?
Mohs Micrographic Surgery is not done as a routine procedure. For most routine skin cancers, simple cutting out (excision) or scraping is done. The patients who come for Mohs Micrographic Surgery have been selected as having unusual or more difficult tumours because of their type, size, location, or failure of other techniques to produce a cure.
How does it work?
Your procedure begins in the morning. The area around the skin cancer is frozen using local injection. The affected area is tested to ensure it is numb, then the skin and tissue around the obvious cancer is removed with a scalpel. This tissue is divided into smaller specimens which are prepared in our laboratory for examination. A map of the cancer site is made showing the relationship of the specimens which are then viewed under the microscope. During this preparation of specimens for microscopic examination, a bandage is applied and you await the results in the waiting room (usually one half to one hour).
The doctor studies the specimens for the presence of cancer at the edges. You then return to the operating area where any area of remaining cancer is cut out exactly as before. The process is repeated until no residual cancer can be found. Here
How long does it take?
Cancers may be present in skin, fat, muscle and, less frequently, in nerves, arteries, cartilage and bone. In more difficult cases, more time is required to remove all the cancer. It is not uncommon to stay for the full morning and part of the afternoon. Some patients will require less time, and some more. You should plan no other activities for the day. Remember, a large portion of the time spent is waiting while your cancer is examined in the laboratory. Family members can telephone in the mid-morning to get a better estimate of how much more time is required. Bring reading materials, needlework, etc., with you to help pass the time. Also, bring a snack or lunch with you on the day of surgery.
What happens once the cancer is removed?
Once the skin cancer is removed, the area of removed tissue is attended to. In most cases, the surgery to stitch up the wound is done following the excision and you return home the same day. In larger more difficult cases, arrangements may be made for any of the following: referral to another specialist for the reconstruction, admission to hospital or surgery requiring a general anesthetic.
Will I be put to sleep for the surgery?
No. The surgery is well tolerated with local anesthesia. Because the surgery may be time-consuming, the risk of prolonged general anesthesia is thus avoided.
What if I live far away from The Skin Surgery Center?
If your travel distance is great you might want to spend the night before surgery in Toronto. There are several moderately priced motels nearby. A list of these is available under the Patient Resources tab.
Should I bring someone with me?
Yes. It is a good idea to bring someone along as you will be very likely be unable to drive after surgery. Someone other than the patient may need to assist with postoperative wound care. The nurse can give this person direct instructions, demonstrate wound care, and answer any questions after the surgery.
What should I wear?
Men should wear a shirt, which buttons down the front and pants. Women should wear a blouse, which buttons down the front and a skirt or slacks.
Should I eat breakfast before surgery?
Yes. Breakfast is recommended.
Should I take my regular medications on the morning of the surgery?
Yes. Take your regular medications as they have been prescribed.
Are there any prescription medications I should avoid prior to surgery?
No. Please bring a list of all of your medications with you on the day of surgery.
Will my activity be limited after surgery?
Yes. Consider being out of work for several days after surgery. If your work requires significant physical exertion, you may be out of work longer. An excuse or note for your absence will be provided if necessary. If possible, consider avoiding any long trips within the first ten days following surgery in case you develop some complications.
What are the potential complications of surgery?
Bleeding and infection are the two primary complications. Both of these are uncommon. We will discuss how to recognize and deal with these problems when you come for your surgery.