A diagnosis of skin cancer often initiates a series of clinical decisions, yet for many patients, an additional layer of concern emerges soon after. When skin cancer affects the face, the conversation often shifts beyond the medical plan to how treatment may influence appearance. Upcoming moments, such as a family wedding, a milestone birthday, or a long anticipated holiday, can bring understandable worries about how one will look and feel after surgery. This is when surgical skill and aesthetic awareness really matter, helping deliver successful treatment while also supporting how a person feels about their appearance.

Hamid Tehrani – Consultant Plastic & Mohs Surgeon

Rakhee Nayar – Consultant Plastic & Mohs Surgeon

What do Basal Cell Carcinomas (BCC) look like and how do they feel?

Basal Cell Carcinomas (BCC) can vary in how they appear and can look like spots that ‘come and go’, scaly/dry skin, or scar-like areas, and can have red vessels or crusts on their surface. They may itch, bleed, or present with no symptoms at all. Ultimately, if left untreated, they can ulcerate, leaving a ‘raw’ surface. 

There are different subtypes of BCC. Some of these can be quite tricky to ascertain the extent of, as they are known to have invisible roots. These BCCs are often the most challenging to remove effectively.

What are the treatment options for a Basal Cell Carcinoma?

A biopsy may be required so that your clinician can ascertain what type of BCC or skin disease is present. Superficial (thin) BCCs can be treated with cryotherapy (freeze spray) or special creams, but deeper (invasive) BCCs will usually need treatment in the form of surgery or occasionally radiotherapy. Standard surgery involves removing the BCC with a wide margin of normal-looking skin, in case there are any ‘roots’, with the laboratory results being available a few weeks later; this carries the risk of the BCC not being completely removed and requiring more surgery, or having healthy tissue removed unnecessarily. 

The “safety margin” for the face is usually recommended as at least 5 mm. Mohs micrographic surgery has emerged as the gold standard for treating common skin cancers, particularly on the face. Unlike traditional excision, Mohs surgery allows a specialist surgeon to examine 100% of the surgical margins in real-time. This ensures the highest possible cure rate, only removing the BCC while crucially sparing as much healthy tissue as possible.

What is the history of Mohs micrographic surgery, and how does it work?

Mohs surgery is named after Frederic Mohs, who described the technique in the 1930s. The BCC is carefully marked out, then removed under local anaesthetic. It is then examined in the purpose-built Mohs laboratory, giving results in 60-90 minutes. If the BCC has not been completely removed, the surgeon can precisely tell from the slides where to remove next. Very thin specimens are taken until all the BCC has been removed, and the wound can then be reconstructed (repaired); we are usually able to perform the reconstruction on the same day, again under local anaesthetic.

What are the advantages of Mohs surgery?

Mohs surgery’s precise method of examining and removing BCCs leads to higher success rates than standard surgery and often gives a smaller wound for improved cosmetic outcomes. For these reasons, it is widely regarded as a highly effective approach to BCC management.

However, removing the cancer is only one aspect of comprehensive care. The crucial work lies in the reconstruction, which influences not only medical clearance but also the patient’s comfort and confidence as they return to daily life.

Being dual trained in both Mohs and Plastic surgery, we move beyond the clinical removal of disease and towards a holistic reclaiming of confidence. No patient should have to choose between being cancer-free and feeling like the best version of themselves for the moments that matter most. This involves using meticulous surgical techniques to hide scars within natural facial lines where possible, restoring symmetry and helping patients feel like themselves again. When the aesthetic outcome is given the same level of care and precision as the medical treatment, it reinforces the patient’s entitlement to maintain confidence in how they look.

Circle Cheshire Clinic. The Courtyard, Hall Lane, Wincham, Northwich  CW9 6DG 

Tel: 01606 535500

https://www.circlehealthgroup.co.uk/hospitals/circle-cheshire-clinic