If you have any queries, you can contact our Mohs’ nurse
coordinator via the paging system between 8.30am and 5pm, Monday to Friday. Please telephone 08448 222 888
and give the operator the pager number for the nurse you
Once you have given the pager number, you will be asked to
leave a message. Please give your name and telephone
number and you will be contacted as soon as possible.
You can also leave a message for the Mohs’ nurse
coordinator on 020 7188 0860. The answer machine will be
checked at least once a day and we will endeavour to answer
to treat your
Alternatively call the Mohs' admin coordinator on 020 7188 skin cancer 6401, 8.30am to 5pm, Monday to Friday. PALS - To make comments or raise concerns about the
Trust’s services, please contact our Patient Advice and
Liaison Service (PALS). Ask a member of staff to direct you
to PALS or: t: 020 7188 8801 at St Thomas’ t: 020 7188 8803 at Guy’s e: [email protected] Language support services - If you need an interpreter or
information about the care you are receiving in the language
or format of your choice, please get in touch using the
Your doctor has recommended micrographic
surgery to remove your skin cancer. This
t: 020 7188 8815 e:[email protected]
leaflet explains what the procedure involves
as well as its risks and benefits. If you have
any questions or concerns, please speak to
Guy’s and St Thomas’ N HS Foundation Trust St Thomas’ Hospital, Westminster Bridge Road, London SE1 7EH Guy’s Hospital, Great Maze Pond, London SE1 9RT
Switchboard: 020 7188 7188 www.guysandstthomas.nhs.uk
2010 GUY’S AND ST THOMAS’ NHS FOUNDATION TRUST. All rights reserved.
Dermatology/Dimbleby Cancer Care/PPG 1622
What is micrographic surgery? Other sources of support or information
This is a specialised form of surgery to remove certain skin
The unit’s Macmillan nurse (skin cancer specialist) can
cancers (tumours) and is called Mohs’ surgery after the
offer support and advice from the time of your diagnosis.
Call 020 7188 6384.
Your surgeon removes the visible portion of your tumour
Dimbleby Cancer Care at Guy’s and St Thomas’ Hospital.
and then removes further tissue that may contain cancer
This service offers information and support for patients
cells, one layer at a time. This tissue is examined under a
with cancer, their relatives and friends. Please call 020
microscope while you are still in the dermatology unit. If it
7188 5918 email [email protected]
contains cancer cells, another layer of tissue is removed
and examined. This is repeated until all the cancer cells
• Guy’s Hospital – Outpatient Department, ground
have been removed, which may last several hours.
floor, Tabard Annexe (next to the Minor Injuries Unit).
• St Thomas’ Hospital – Clinical Oncology, lower
Your doctor may have recommended Mohs’ surgery
Macmillan Cancer Support (freephone)
your tumour was previously removed, but some cancer
t: 0808 808 0000 (for information on all aspects of cancer) t: 0808 801 0304 (benefits enquiry line)
• your cancer is in an area where we want to reduce the
amount of healthy tissue we remove, such as on your
Cancer Research UK (freephone)
• the edges of your tumour are not well defined.
t: 0808 800 4040 (for information on all aspects of cancer) w: www.cancerhelp.org.uk Why should I have micrographic surgery?
Other types of surgery for skin tumours rely on the
surgeon being able to see the extent of the cancer. This
can sometimes lead to a large wound and scar if too much
healthy tissue is removed. It could also lead to too little
tissue being removed and the cancer returning.
Micrographic surgery maximises the chances of your
tumour being completely excised (removed) while
minimising the amount of surrounding normal skin that
surgery, leading to a numb area of skin. This is usually
Are there any other alternatives?
Your doctor has recommended that this is the most
Infection at the wound site. You will be given
appropriate treatment for you. Any alternatives will have
instructions on how to care for your wound to minimise
been discussed at your consultation. If you have further
questions please see the contact details overleaf.
Scarring. You will have a scar after the surgery,
although the doctors use closure techniques to
If your skin cancer is not treated, it will continue to grow and
you may need more aggressive treatment in the future.
What do I need to do after I go home? How can I prepare for my surgery?
The letter accompanying this leaflet contains information
Before you leave the hospital, please make sure you have
about how to prepare for your surgery. Please make sure
been given information about how to look after your wound
You will probably need to rest after the surgery for about
Please do not wear any make up or jewellery on or near the
48 hours. If you work, we recommend that you take at
site of your surgery. You may want to bring a packed lunch
least two days off after the surgery. We will give you more
with you on the day of the surgery, as you may be here for
Will I have a follow-up appointment?
We strongly suggest that you bring a friend or family
member with you. We strongly recommend that you do not
You will have a follow-up appointment with the team that
travel home by public transport and you should not, under
any circumstances drive yourself on the day of your surgery.
If your follow-up is with us at St Thomas’, we will usually
Asking for your consent
see you one week after your surgery to check that your
skin is healing well and to remove any stitches you may
We want to involve you in all the decisions about your care
have. If there are any changes to this, we will advise you
and treatment. If you decide to go ahead with this surgery,
on the day of your surgery. If another team repairs your
you will be asked to sign a consent form. This confirms that
wound they will give you a follow up appointment.
you agree to have the procedure and understand what it
involves. You should receive the leaflet, Helping you
We usually see you again approximately three months
decide: our consent policy, which gives you more
information. If you do not, please ask us for one.
What happens during Mohs’ surgery? What happens after the procedure?
There are several stages to Mohs’ surgery. First, your
Once all the tumour cells have been removed, there are
doctor will inject the area where your tumour is, with a
several options for repairing your resulting wound,
local anaesthetic. This numbs the area, so you will not
depending on your individual circumstances. These will be
feel any pain during surgery and will remain awake. If you
discussed with you in more detail before your surgery.
are particularly anxious, we can give you a mild sedative to
help you relax. Please discuss this with your doctor. We
• closed by the team who performed the micrographic
may also use anaesthetic eye drops if the tumour is near
surgery immediately after the tumour has been
• dressed and then repaired by a plastic surgeon at St
Once the anaesthetic has taken effect, the visible (also
called the clinically evident) part of the tumour is removed,
along with a small margin of normal skin tissue. This
• repaired at another hospital. In this case, we will renew
tissue is taken to a laboratory where your doctor will be
your dressing before you travel to your referring
able to look at it under a microscope to check for cancer
hospital. We will also give you a letter from our doctors
cells. This takes about 40–60 minutes, so a temporary
to hand to your surgeon when you arrive at your
dressing is applied to your wound and you are asked to sit
referring hospital. You will be told how to look after
your wound by the team that repairs your wound.
If cancer cells are present in this tissue, you will be
What are the risks?
brought back into theatre and more tissue will be taken
away and examined under the microscope. This will be
Your doctor will explain the potential risks for this type of
repeated until all the tumour cells have been removed.
surgery with you in more detail, but complications include:
• Bleeding at the site of the tumour.
The local anaesthetic lasts for about two hours and can be
• Pain. The local anaesthetic should last until you return
‘topped up’ if your surgery takes longer than this. Because
home. If you need to, you can buy aspirin-free pain
of the nature of this procedure, we are unable to tell you
relief (such as paracetamol) from a chemist without a
exactly how long your surgery will last.
prescription. Always check that the painkillers will not
react with any other medication you are taking and
follow the instructions on the packet. The doctor or
nurse caring for you can give you more advice.
• Nerve damage. Although your surgeon will try to avoid
this, nerves can occasionally be damaged during
INTENDED USE The Urinalysis Reagent Strips test for glucose, bilirubin, ketone, specific gravity, blood, pH, protein, urobilinogen, nitrite and leukocytes. The strips may be read visually or instrumentally, using the appropriate Urine Chemistry Analyzers such as the Clinitek family of readers. SPECIMEN COLLECTION & PROCEDURE Use a fresh urine specimen, less than 4 hours old, and
Introduction to Machine Learning Machine learning is a set of tools that, broadly speaking, allow us to “teach” computers how toperform tasks by providing examples of how they should be done. For example, suppose we wishto write a program to distinguish between valid email messages and unwanted spam. We could tryto write a set of simple rules, for example, flagging messages that contain cer