Bristol Mohs service update Feb 2025
Dear SWAG Network Skin Cancer Colleagues,
I am pleased to let you know that the Bristol Mohs service will soon be at its greatest ever capacity. Dr Will Hunt has just been appointed as a new full time substantive Consultant at NBT to start in April. He will be joining the Mohs team of myself, Dr Kimberlee Lim, and Dr Nina Natafji. We are also happy to be celebrating the 10th anniversary of the service this month (see infographic).
It has been a challenging period. However things are improving and the waiting list is now reducing steadily. Routine BCC patients are currently waiting about 6 weeks to be seen in clinic here at Southmead, and then about 6 months for treatment.
We should now be able to accommodate more referrals from around the network again, and hope to develop a quicker service to facilitate treating more urgent tumours that could benefit from the tissue sparing or real-time pathology results. We also have plans to expand our laboratory space to enable us to be more efficient and increase throughput.
So thank you for your support and referrals over the last 10 years, and please continue to consider referring to Bristol for Mohs surgery for any patient who you think could benefit, as per standard criteria.
Please contact me if you are unsure about what types of cases to refer.
Please direct tertiary referrals to Southmead Mohs team via my secretary, Carole.Wathan@nbt.nhs.uk (or dermatologysecretaries@nbt.nhs.uk).
Best wishes,
Adam
Dr Adam Bray
Consultant Dermatologist
Dermatological & Mohs Surgeon
Contact me: adam.bray@nbt.nhs.uk
Send a referral: Carole.Wathan@nbt.nhs.uk (or dermatologysecretaries@nbt.nhs.uk)
Southmead Hospital, North Bristol Trust
Bristol Dermatology Centre, University Hospitals Bristol & Weston NHS Foundation Trust
Strongest indications for Mohs:
Primary BCC threatening important anatomy (or position limits reconstruction options)
Poorly defined edges/infiltrative BCC in H zone of face
Any incompletely excised BCC in H zone of face
Any head/neck BCC incompletely excised more than once (including once by experienced skin cancer surgeon)
Re-excision with wide margins will be excessively disfiguring or force unsatisfactory reconstruction/delayed repair
Rarer aggressive infiltrating tumours in the H zone e.g. MAC
Also consider Mohs for:
Any BCC where delayed repair is considered
Well-defined primary nodular BCC on lower third of nose
Well-defined primary nodular BCC on lower eyelid but away from lacrimal punctum
Primary infiltrative BCC on face/scalp but away from H zone and well-defined edges
Other tumours
Many follicular/appendageal tumours can be treated with normal fresh frozen Mohs (if meeting the same sorts of indications as BCCs)
We do not currently treat DFSP with Mohs in Bristol (neither fresh frozen or paraffin fixed). However colleagues in other centres do (e.g. London -St John’s) so do consider it. Some colleagues have asked us to look into developing a Bristol service, so if you feel this may be useful please let me know, or if you refer elsewhere and are happy that would also be helpful to know)
We do not currently treat Lentigo Maligna with Mohs, but we can offer peripheral margin-controlled excision of Lentigo maligna (or LMM) with paraffin fixed tissue (similar to Mohs i.e. ‘spaghetti technique’) where tissue sparing or clearance is important and delayed repair is being considered.
Best email for advice: adam.bray@nbt.nhs.uk
Archived updates are available on request: helen.dunderdale@uhbw.nhs.uk
Useful Links:
The West of England Clinical Research Network
http://www.crn.nihr.ac.uk/west-of-england/
The Somerset Cancer Register (SCR)
http://nww.cancerreg.somersethis.nhs.uk/default.aspx
The National Cancer Research Institute Clinical Studies Group (NCRI) – Portfolio Maps
http://csg.ncri.org.uk/portfolio-maps/
