Mohs Surgery in Sydney – Dr Ilias Kotronakis

Mohs surgery was developed by Dr Frederic Mohs in the 1930s and has since evolved into a refined, evidence-based treatment for certain skin cancers, particularly high-risk basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). The technique involves removing cancerous tissue in thin layers, each of which is carefully mapped, colour-coded, and examined under a microscope by a specialist pathologist. This process continues until no cancer cells are seen, allowing for complete tumour clearance with minimal impact on surrounding healthy skin.

Mohs surgery is often recommended for high-risk non-melanoma skin cancers in areas where preserving healthy tissue is critical for appearance and function. These areas include the face (particularly the nose, eyelids, lips, and ears), scalp, hands, and other parts of the body where tissue conservation is important. It is also considered for cancers that have recurred after previous treatment or are located in areas where scar tissue is present.

1. The area is numbed using a local anaesthetic to ensure patient comfort.
2. A thin layer of visible tumour is surgically removed.
3. The removed tissue is mapped, colour-coded, and frozen for precise sectioning.
4. A pathologist examines the tissue under a microscope to identify any remaining cancer cells.
5. If cancer is still present, the process is repeated, removing only the affected areas.
6. Once all margins are clear, reconstruction is performed.

Each stage of tissue removal and examination takes approximately 30 minutes, though the actual surgical portion is often only 5-10 minutes. Most patients require two to three stages for complete removal.

After tumour removal, the surgical site may be closed using one of several reconstructive techniques:

• Direct closure with sutures
• Skin grafting
• Local tissue flap reconstruction
• Allowing the wound to heal naturally (secondary intention)

The choice of method depends on the size, depth, and location of the wound, as well as patient-specific factors. Dr Kotronakis’ experience in plastic and reconstructive surgery ensures that functional and cosmetic considerations are prioritised.

Mohs surgery is primarily used for non-melanoma skin cancers:

• Basal Cell Carcinoma (BCC): The most common skin cancer, often slow-growing but capable of causing significant local tissue damage if untreated.
• Squamous Cell Carcinoma (SCC): May grow more quickly than BCC and has a higher risk of spreading to lymph nodes if not managed early.

In selected cases, Mohs may be used for other rare skin cancers where tissue preservation is important.

Dr Ilias Kotronakis consults patients at practices in Kogarah and Miranda, with Mohs procedures performed at Chris O’Brien Lifehouse in Newtown in collaboration with a specialist dermatologist. These facilities are chosen for their high standards of surgical safety, modern equipment, and coordinated multidisciplinary care.

As with any surgical procedure, Mohs surgery carries potential risks, including bleeding, infection, delayed wound healing, scarring, or changes in sensation. These will be discussed with you during your consultation, along with post-operative care instructions to support recovery.

A consultation with Dr Ilias Kotronakis is the best way to determine whether Mohs surgery is the right treatment for your skin cancer. During your appointment, he will review your medical history, examine the lesion, and explain the benefits and limitations of Mohs surgery compared to other treatment options.