Mohs Surgery at Apollo Hospitals, Lucknow

Mohs micrographic surgery is a tissue-sparing technique for skin cancers of the face, scalp, ears, nose, lips, eyelids, hands and other cosmetically or functionally sensitive sites. Apollo Hospitals Lucknow offers assessment, surgical planning and reconstruction for skin cancer through an integrated team of dermatologists, plastic and reconstructive surgeons, surgical and medical oncologists, and histopathologists.

Why Patients Choose Apollo Hospitals Lucknow for Skin Cancer Surgery

• Apollo Hospitals group legacy since 1983 ? India's first large-scale private hospital network, now more than 70 hospitals with over 10,000 beds and a cumulative experience of treating patients from more than 120 countries.
• Apollo Hospitals Lucknow is a NABH-accredited, multi-speciality quaternary care facility spread across Kanpur Road, serving Awadh, Purvanchal, Bundelkhand and adjoining Nepal border districts.
• A multidisciplinary skin cancer team ? dermatology, dermatosurgery, plastic and reconstructive surgery, surgical oncology, radiation oncology, medical oncology and histopathology reviewing cases together, rather than a single-doctor decision.
• Senior consultants with decades of pooled surgical experience, supported by resident medical officers and dedicated oncology nursing. The exact team allotted to your case, and each consultant's individual experience, is shared with you at the time of consultation.
• On-site histopathology and frozen-section capability, which is the single most important requirement for margin-controlled excision ? the tissue does not have to travel to an outside laboratory.
• Full reconstructive ladder available in-house ? primary closure, skin grafts, local flaps and regional flaps, so a defect on the nose, eyelid or ear can be repaired without a second referral.
• Apollo Cancer Centres protocols, including tumour board discussion, staging imaging where indicated, and sentinel node or adjuvant therapy pathways for high-risk or melanoma cases.
• Separate pathways for adults, elderly patients with multiple comorbidities, and the rare paediatric case, with pre-anaesthetic assessment, diabetes and anticoagulation management, and day-care scheduling wherever safe.
• 24x7 emergency and critical care backup, blood bank, and an insurance and TPA desk that handles cashless pre-authorisation for most major insurers and government schemes.
• Structured follow-up and skin surveillance, because skin cancer patients carry a lifelong risk of a second primary lesion.

Overview

Mohs Surgery is a specialised surgical technique designed to treat skin cancer with a high degree of precision. At Apollo Hospitals Lucknow, we aim to provide advanced, evidence-based care and current technology so that patients have the best realistic chance of a good outcome. Our team of dermatologists and surgeons prepares individualised treatment plans based on each patient's tumour type, site and general health. With a focus on clinical quality and patient trust, Apollo Hospitals Lucknow supports people facing a skin cancer diagnosis from first biopsy through reconstruction and follow-up.

It is important to be clear about terminology. True Mohs micrographic surgery requires a fellowship-trained Mohs surgeon who acts as both surgeon and pathologist, with an on-site Mohs laboratory processing horizontal frozen sections. In India, formal Mohs facilities are concentrated in a small number of centres. Many Indian hospitals, including large tertiary centres, achieve comparable margin control using frozen-section-guided staged excision or "slow Mohs" with paraffin sections read by a histopathologist. Before you book, ask our dermatology or plastic surgery desk exactly which technique is available for your lesion at Apollo Hospitals Lucknow, so your expectations and consent are accurate.

Why Mohs Surgery is Necessary

Mohs Surgery is particularly relevant for non-melanoma skin cancers such as basal cell carcinoma and squamous cell carcinoma. The technique involves meticulous removal of cancerous skin, layer by layer, while preserving as much healthy tissue as possible. The main advantages include:

• High cure rates: Published five-year cure rates for primary basal cell carcinoma treated by Mohs surgery are reported at approximately 99 per cent, and around 94 per cent for recurrent tumours ? among the highest reported for any skin cancer treatment. Individual results depend on tumour type, size and site.
• Tissue preservation: By removing cancerous tissue and sparing surrounding healthy skin, the technique tends to minimise the size of the defect and helps preserve appearance and function.
• Immediate margin assessment: The excised tissue is examined while the patient waits, so further layers can be taken the same day if cancer cells remain at the margin, before the wound is repaired.

At Apollo Hospitals Lucknow, the surgical team uses current techniques and on-site pathology support to maintain high standards of margin control.

Risks of Delay

Delaying treatment for skin cancer can lead to significant complications. Skin cancers can grow and spread, becoming more difficult to treat and sometimes requiring more extensive surgery or additional treatment. Risks of postponing surgery include:

• Increased tumour size: As the cancer grows it may invade deeper layers of skin, cartilage, bone or nerves, complicating treatment and reconstruction.
• Metastasis: Uncommonly, untreated skin cancer ? particularly squamous cell carcinoma and melanoma ? can spread to lymph nodes or distant organs, leading to more serious illness.
• Higher treatment costs: A delayed, larger tumour often needs a bigger operation, flap reconstruction, longer stay, or added radiotherapy or systemic therapy, which raises total cost.
• Loss of function: Tumours on the eyelid, nose or lip that are allowed to enlarge may destroy structures that cannot be fully restored even with expert reconstruction.

Apollo Hospitals Lucknow emphasises timely intervention. Our team can guide you through biopsy, staging where needed, and scheduling without unnecessary delay.

Benefits of Mohs Surgery

• Minimised scarring: Precise margin control usually allows a smaller defect and a less conspicuous scar than wide conventional excision at the same site.
• Quick recovery: Many patients return to routine, non-strenuous activity within a few days, though this depends on the size of the wound and the type of repair.
• Comprehensive care: A multidisciplinary team provides ongoing support, reconstruction and follow-up.
• Psychological relief: Clearing the tumour with confirmed margins often reduces the anxiety that accompanies a cancer diagnosis and allows patients to refocus on recovery.
• Usually done under local anaesthesia: Most cases avoid general anaesthesia, which is an advantage for elderly patients and those with cardiac or respiratory disease.

Apollo Hospitals Lucknow aims to provide a supportive environment that helps healing and recovery.

Preparation and Recovery

Preparation tips

• Consultation: Meet our dermatology or plastic surgery team to discuss your medical history, biopsy report and all current medicines, including Ayurvedic, homeopathic and over-the-counter supplements.
• Blood thinners: Do not stop any blood thinner on your own. Aspirin, clopidogrel, warfarin or newer anticoagulants prescribed for a heart valve, stent, atrial fibrillation or previous stroke are usually continued, because the bleeding risk of Mohs surgery is generally manageable while the clotting risk of stopping is not. Non-essential agents such as ibuprofen, vitamin E or fish oil may be paused about a week before, only if your doctor advises it.
• Plan for transportation: Arrange for someone to bring you home after the procedure, particularly if sedation is used or the wound is near the eye.
• Eat, hydrate and carry your medicines: The day can be long. Unless told otherwise for anaesthesia reasons, have a normal meal and bring your regular tablets, insulin, snacks, reading material and a companion.

Recovery tips

• Follow post-operative instructions: Adhere to the dressing and wound care instructions given to you, to promote healing and reduce infection risk.
• Limit physical activity: Avoid strenuous work, heavy lifting and vigorous exercise for at least a week, or longer if a graft or flap was used.
• Monitor the surgical site: Watch for increasing redness, swelling, pus, spreading pain or fever, and contact your doctor promptly if these occur.

Apollo Hospitals Lucknow prioritises your comfort and recovery and provides the resources and support you need through the process.

Timing of the Procedure and the Pre-Procedure Phase

Mohs and staged margin-controlled excision are planned procedures, not emergencies ? but they should not be postponed indefinitely. A practical sequence is:

1. Clinical assessment and dermoscopy: the lesion is examined, photographed and measured.
2. Diagnostic biopsy: a punch, shave or incisional biopsy confirms the tumour type and subtype. This is essential ? Mohs is not performed on an unbiopsied lesion.
3. Histopathology report: usually available within a few working days. Aggressive subtypes such as morphoeic or infiltrative basal cell carcinoma and poorly differentiated squamous cell carcinoma are strong indications for margin-controlled surgery.
4. Pre-operative workup: blood counts, blood sugar and HbA1c, coagulation profile where relevant, viral markers, and a cardiac or physician clearance for older patients or those on anticoagulants.
5. Imaging, when indicated: ultrasound of the draining nodes, or CT/MRI if there is suspicion of deep, bony or perineural invasion.
6. Surgery scheduling: most centres aim to operate within a few weeks of the confirmed report. Rapidly enlarging, ulcerating or bleeding lesions are prioritised.

Plan the surgery day as a full day. Layer processing, microscopic reading and repair take time, and it is normal to spend several hours in the department.

Treatment Options Compared

Mohs surgery is not the right answer for every skin cancer. The choice depends on tumour type, subtype, size, site, whether it is primary or recurrent, and the patient's fitness and preference.

Procedures Sometimes Performed at the Same Sitting

• Reconstruction of the defect ? primary closure, full or split thickness skin graft, or a local flap such as a bilobed, rotation, advancement or forehead flap. This is planned only after clear margins are confirmed.
• Cartilage or perichondrial grafting for nasal and ear defects requiring structural support.
• Eyelid reconstruction with oculoplastic input when the lid margin, canthus or lacrimal drainage is involved.
• Excision of adjacent actinic keratoses or a second suspicious lesion, if identified on full skin examination.
• Sentinel lymph node biopsy or nodal assessment for melanoma and selected very high-risk squamous cell carcinomas ? usually planned as a separate oncology procedure under general anaesthesia.
• Temporary dressing or delayed repair, where the surgeon prefers final paraffin-section confirmation before definitive reconstruction.

Phase-by-Phase Recovery

Returning to Work, Exercise and Daily Life

• Desk and computer work: usually within 1?3 days for a small facial wound closed directly.
• Field work, teaching, travel by two-wheeler: after the swelling settles and the dressing is secure, commonly at 5?7 days; wear a helmet only when it does not press on the wound.
• Gym, running, cricket, gully sports: restart after suture removal and full wound closure, typically 2?3 weeks for direct closures and 4?6 weeks after grafts or flaps.
• Swimming, river or pond bathing, temple tank immersion: only after the wound is fully epithelialised, usually 3?4 weeks, because of infection risk.
• Farm work, construction, exposure to dust, smoke or chulha heat: delay until the surgeon confirms the wound is stable, and cover the site.
• Indian-specific points: avoid heavy squatting, sitting cross-legged for long periods and straining on an Indian-style toilet if you have had a lower limb, buttock or groin excision ? use a Western commode or a commode chair for two weeks. If you sleep on the floor, arrange a firm mattress and an extra pillow so a facial or scalp wound is not pressed at night. Head bath, oil champi, threading, waxing, shaving over the site and beauty parlour treatments should wait until sutures are out and the surgeon agrees.
• Religious and social events: exposure to smoke from havan, agarbatti or Holi colours, and long hours in the sun during a wedding, should be avoided in the first few weeks.

Preventing Recurrence and New Skin Cancers

Anyone who has had one skin cancer carries a raised lifetime risk of another. Prevention is a permanent commitment.

• Use a broad-spectrum sunscreen of SPF 30 or higher on exposed skin daily, reapplied every 2?3 hours in strong sun. This matters even for brown Indian skin, which is protective but not immune.
• Avoid direct sun between roughly 10 am and 4 pm; use a wide-brimmed hat, gamcha or dupatta, full sleeves and UV-protective sunglasses.
• Farmers, construction workers, traffic police, drivers and street vendors in and around Lucknow have high cumulative UV exposure ? sun-protective clothing is more practical and reliable than sunscreen alone.
• Do not use fairness creams or unlabelled steroid creams on chronic patches; they can delay diagnosis.
• Stop tobacco in all forms, including khaini, gutkha and paan masala, which contribute to lip and oral squamous cell carcinoma.
• Treat chronic non-healing ulcers, old burn scars (Marjolin's ulcer) and scarring conditions ? these can turn malignant.
• Patients on long-term immunosuppression after an organ transplant, or with HIV, chronic arsenic exposure from contaminated groundwater, xeroderma pigmentosum or albinism, need scheduled skin surveillance rather than symptom-driven visits.
• Perform a monthly self-check of the face, ears, scalp, neck, arms and hands, and report any lesion that bleeds, ulcerates, itches persistently or fails to heal in four weeks.

Children, Older Adults and Special Situations

Older adults

Most skin cancer patients are elderly. Local anaesthesia makes surgery feasible even with diabetes, hypertension, coronary disease or COPD. Practical planning matters: bring the full list of medicines, plan for a longer sitting period, arrange a companion, and inform the team about hearing impairment, dementia, Parkinson's tremor or a pacemaker, since electrocautery settings may need adjustment. Anticoagulants are usually continued after physician review.

Children and adolescents

Skin cancer in children is rare and usually linked to a genetic condition such as xeroderma pigmentosum, basal cell naevus (Gorlin) syndrome, albinism or a large congenital naevus. These children need paediatric dermatology input, genetic counselling, sedation or general anaesthesia for surgery, and lifelong photoprotection and surveillance.

Transplant recipients and immunosuppressed patients

Squamous cell carcinoma is far more common and more aggressive after organ transplantation. These patients often need margin-controlled surgery, close six-monthly screening, and coordination with the transplant physician about adjusting immunosuppression.

Pregnancy

Local anaesthetic excision can usually be performed safely in pregnancy when the lesion warrants it, with obstetric consultation and avoidance of unnecessary imaging and systemic drugs.

If You Choose Not to Have Surgery

Declining surgery is your right, and it is a decision that should be made with clear information rather than fear or misinformation. What tends to happen:

• Basal cell carcinoma rarely spreads but is locally destructive. Left alone on the nose, eyelid or ear it can erode cartilage, bone and the eye over months to years, eventually causing a defect that no reconstruction can fully restore.
• Squamous cell carcinoma can invade nerves and spread to lymph nodes, converting a curable local problem into advanced disease needing radiotherapy or systemic therapy.
• Melanoma is the most dangerous and the most time-sensitive; delay materially reduces survival.
• Bleeding, foul discharge, pain, maggot infestation in neglected ulcers, and social isolation are common consequences of long-neglected facial tumours in our region.
• Alternatives exist. If surgery is refused because of age, frailty or fear, discuss radiotherapy, topical therapy or, for very frail patients, palliative wound care with symptom control. Do not simply disappear from follow-up.
• Home remedies, unregulated "cancer-removing" pastes, black salve and unverified herbal applications can cause chemical burns and mask tumour growth. They are not a substitute for treatment.

What Influences the Cost of Treatment

Apollo Hospitals Lucknow does not publish a fixed price for this procedure, because the cost is determined by the individual case. A written estimate is provided after consultation. Please confirm all figures with the reception, billing counter or insurance desk.

Insurance, Cashless Treatment and TPA Process in India

• Cancer surgery is generally covered by indemnity health insurance policies once the waiting period is over, because it is a medically necessary treatment and not cosmetic. Reconstruction performed to close a cancer defect is usually covered as part of the same treatment; purely aesthetic revision may not be.
• Waiting periods matter. Most Indian policies have a 30-day initial waiting period and a 2?4 year waiting period for specified illnesses, plus a 36?48 month exclusion for pre-existing diseases, depending on the insurer and the year the policy was issued. Cancer diagnosed after these periods is normally payable.
• Planned versus accident cover: Mohs surgery is a planned admission, so pre-authorisation must be obtained before the date. Accident-related emergency cover and personal accident policies do not apply here. Some critical illness and cancer-specific policies pay a lump sum on diagnosis of a covered cancer stage ? check whether early-stage or non-melanoma skin cancer is included, as many such policies exclude it.
• Day care procedures: if the surgery is completed without a 24-hour admission, it may be claimed under the day care procedure list of your policy. Confirm this in advance, as older policies had a restricted list.
• Cashless process: submit your health card, policy number, photo ID and the doctor's treatment plan to the insurance or TPA desk at least 3?5 working days before surgery. The hospital raises a pre-authorisation request; the insurer or TPA usually responds within 24?72 hours for planned cases. Non-medical consumables, room upgrades above your eligibility, and proportionate deductions under co-payment or room-rent-linked clauses remain payable by you.
• Reimbursement route: if cashless is denied or your insurer is not empanelled, pay and claim later. Keep the discharge summary, biopsy and histopathology reports, itemised bill, payment receipts, investigation reports and implant or consumable invoices.
• Government schemes: Ayushman Bharat PM-JAY, CGHS, ECHS, State Government and PSU schemes have their own empanelment status and approved package rates. Whether a particular scheme is accepted for this procedure at Apollo Hospitals Lucknow must be confirmed with the hospital's insurance desk before admission.
• Ask the desk directly about co-payment percentage, sub-limits, room rent eligibility and estimated out-of-pocket amount. Getting this clarified before surgery avoids disputes at discharge.

Planning Your Visit and What to Bring

• All previous biopsy reports, slides and paraffin blocks ? slides and blocks are essential if the biopsy was done elsewhere, as our pathologists may need to review them.
• Clinical photographs of the lesion if it has changed over time, plus any earlier prescriptions.
• A complete list of current medicines with doses, including blood thinners, insulin, steroids and immunosuppressants.
• Recent blood reports, ECG, and any physician or cardiologist clearance.
• Government photo ID (Aadhaar), insurance card or policy document, TPA details, and PM-JAY or CGHS or ECHS card if applicable.
• A responsible adult attendant for the whole day; joint families should nominate one primary caregiver who will hear the instructions and manage dressings at home.
• Loose, front-open clothing that does not have to be pulled over the head if the surgery is on the face, scalp, ear or neck.
• Spectacles, hearing aid, walking stick, regular medicines, water, light food and a phone charger for the waiting period.
• Avoid wearing makeup, kajal, mehndi, heavy jewellery or nail polish on the day of surgery.

Warning Signs That Need Prompt Medical Review

Contact the hospital or attend the emergency department if you notice:

• Bleeding that soaks through the dressing and does not stop after 15 minutes of firm, continuous pressure.
• Rapidly increasing pain, or pain not controlled by the prescribed painkiller.
• Spreading redness, warmth, hardness or a red streak extending from the wound.
• Pus, foul-smelling discharge, or wound edges coming apart.
• Fever above 100.4?F (38?C) with chills.
• A graft or flap turning dusky, dark, black or cold.
• Sudden swelling or a tense, painful bulge under the wound, suggesting a haematoma.
• Numbness, weakness, drooping of the eyelid or corner of the mouth, or inability to close the eye.
• Visual disturbance, eye pain or excessive watering after surgery near the eyelid.
• Chest pain, breathlessness or calf swelling ? seek emergency care immediately.
• A new nodule at or near the scar, or a lump in the neck, armpit or groin during follow-up.

For Patients Travelling from Nearby Districts and Cities

Apollo Hospitals Lucknow regularly receives patients from across Uttar Pradesh and neighbouring states, including Kanpur, Unnao, Barabanki, Sitapur, Hardoi, Rae Bareli, Sultanpur, Amethi, Ayodhya, Gonda, Bahraich, Basti, Balrampur, Shravasti, Lakhimpur Kheri, Pratapgarh, Jaunpur, Azamgarh, Gorakhpur, Varanasi, Prayagraj, Banda, Fatehpur, Bareilly, Shahjahanpur, Moradabad, and from parts of Bihar, Uttarakhand, Madhya Pradesh and the Nepal border districts.

• Getting here: Lucknow is connected by Charbagh and Gomti Nagar railway stations, Chaudhary Charan Singh International Airport, the Agra?Lucknow, Purvanchal and Lucknow?Ghaziabad expressways, and long-distance bus services from all divisional headquarters.
• Combine your visits: ask the appointment desk to schedule consultation, blood tests and imaging on the same day so an outstation family makes fewer trips.
• Send reports ahead: share biopsy reports and photographs by email or WhatsApp before travelling so the team can advise whether the case is suitable and what to carry.
• Plan a local stay: budget for 2?4 days around the surgery. Wound review, dressing change and suture removal are best done under the operating team's eye. Guest houses, lodges and serviced apartments are available near Kanpur Road, Alambagh and Charbagh; the hospital help desk can guide you on nearby options.
• Follow-up close to home: for routine dressing changes, we can send written instructions and a wound photograph protocol so a local doctor or nurse can help between visits, with teleconsultation for review.
• Bring a second attendant if the patient is elderly, so one person can manage paperwork and