Mohs Micrographic Surgery

What is Mohs Surgery?

Mohs micrographic surgery is a highly specialized technique used to remove certain types of skin cancer with precision and minimal tissue loss. It is most commonly recommended for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), especially those located in cosmetically or functionally important areas like the face, scalp, ears, or hands.

Unlike traditional excision, Mohs surgery removes skin cancer layer by layer, with each layer examined under a microscope in real time. This process continues only until no cancer cells remain, ensuring complete removal while preserving as much healthy skin as possible.

Overview

This outpatient procedure is used to remove and examine tumors of the skin to ensure that the entire cancer is eliminated and none of the "roots" of the cancer are left behind.

The Mohs technique is often used to treat cancers of the face and neck.

why mohs?

Mohs surgery is a conservative treatment designed to leave as much healthy tissue as possible, while eliminating the cancerous cells completely.

It is often the surgery of choice for patients who have recurrent, aggressive, or unusual tumors, or for patients who have tumors in highly sensitive areas.

Removal

The skin is first sterilized and local anesthetic is administered. The dermatologist then carefully cuts away the section of tissue that contains the cancer.

The surgeon charts the way it was oriented in the skin so that the cancer can be accurately mapped.

Examination

The wound is dressed, and the patient waits while the tissue sample is examined in the lab.

The tissue is divided into sections, then frozen and studied under a microscope. The dermatologist looks for any traces of cancer that extend beyond the section of skin that was removed.

Additional Removal

If the dermatologist sees that traces of cancer may remain, the procedure is repeated until no traces are detected.

The wound is uncovered, and additional tissue is removed from the questionable area. The new sample is examined microscopically, and the process is repeated until the dermatologist is sure that all of the cancer has been removed.

End of Procedure

Once the removal is complete, the surgical site is closed.

In some cases, a plastic surgeon or reconstructive specialist may be needed to finish the procedure.

The patient is monitored during future visits.

How Mohs Surgery Works

Mohs surgery is typically performed in the office as an outpatient procedure. Though meticulous, it is well-tolerated by most patients and delivers unmatched precision in skin cancer removal.

The process unfolds like this:

• Tumor Mapping & Local Anesthesia: The visible tumor is carefully mapped to ensure full tracking during the procedure. A local anesthetic is used to numb the area, keeping you comfortable throughout.
• Layered Removal: A thin layer of tissue is surgically removed and prepared for immediate microscopic analysis.
• Microscopic Examination: The removed tissue is examined on-site by the Mohs surgeon to determine if any cancer remains.
• Repeat as Needed: Additional layers are removed only where cancer cells are still present. This cycle continues until the area is clear.
• Wound Repair: Once the margins are free of cancer, the site is closed or reconstructed using a technique tailored to your anatomy and the location of the lesion.

Why Choose Mohs Surgery?

If you’ve been diagnosed with skin cancer in a sensitive or visible area, Mohs surgery offers several distinct advantages. It is widely regarded as the gold standard for removing non-melanoma skin cancers while preserving healthy tissue.

Benefits of Mohs surgery include:

• Highest cure rate: Up to 99% for certain non-melanoma skin cancers
• Tissue-sparing precision: Removes only affected areas, preserving healthy skin
• Outpatient convenience: Done under local anesthesia in a single visit
• Immediate pathology: Cancer margins analyzed on-site during surgery
• Cosmetically ideal: Especially effective for facial and sensitive areas

The images here are from a patient of ours that had skin cancer on her nose. Board-certified dermatologist Dr. Neil Shah performed Mohs surgery to clear the carcinoma on the nose (seen in image I.). Dr. Shah then performed a bilobed flap surgery to repair the mid-sized off-center distal nasal defect left behind after the carcinoma was cleared. After the bilobed flap, the normal contour of the nose was reconstructed (seen in image II.).

Skin Cancers Treated with Mohs Surgery

Mohs isn’t used for every skin cancer, but it’s highly effective for tumors in sensitive areas or those with aggressive behavior. Your dermatologist will help determine if it’s appropriate for your diagnosis.

Common cancers treated with Mohs include:

• Basal cell carcinoma (BCC)
• Squamous cell carcinoma (SCC)
• Melanoma in situ (including lentigo maligna, in select cases)
• Recurrent skin cancers (tumors that have returned after previous treatment)
• Aggressive or poorly defined tumors
• Cancers in functionally or cosmetically sensitive areas

What to Expect on the Day of Surgery

Mohs surgery is a safe and efficient outpatient procedure, but it can take several hours depending on the tumor. Knowing how to prepare and what to expect can help the day go smoothly.

Here’s what to expect:

• Preparation: Eat normally and wear comfortable clothing. Bring something to pass the time, as there may be waiting periods.
• Procedure duration: The entire process can take several hours, depending on how many layers are needed.
• Local anesthesia: You’ll be awake, but the area will be completely numb.
• Waiting between layers: Each tissue layer is analyzed on-site, which may involve short breaks.
• Aftercare instructions: You’ll receive guidance on wound care, medications, and activity limitations before you leave.

Reconstruction & Cosmetic Outcomes

Once all cancerous tissue has been removed, attention turns to repairing the wound. At Clarus Dermatology, we approach reconstruction with both functionality and cosmetic appearance in mind, especially when operating on delicate areas like the nose, eyelids, or lips.

Reconstructive options may include:

• Direct closure with sutures for smaller wounds
• Local skin flaps that reposition nearby healthy skin
• Skin grafts for larger or more complex areas

Our dermatologic surgeons are trained in advanced closure techniques to achieve the best cosmetic result possible. We’ll also provide scar care strategies tailored to your skin type and healing response.

Why Choose Clarus Dermatology for Mohs Surgery

Not all Mohs procedures are the same. At Clarus Dermatology, you’re in the hands of an experienced, detail-focused surgical team with access to state-of-the-art tools and facilities.

What sets our Mohs surgery program apart:

• Board-certified Mohs surgeon with specialized training in skin cancer surgery and reconstruction
• On-site pathology lab for immediate tissue processing and diagnosis
• Extensive experience treating high-risk, recurrent, and cosmetically complex skin cancers
• Coordinated care from biopsy to post-op follow-up

Personalized scar prevention and aftercare guidance to optimize healing

Schedule Your Mohs Consultation Today

A skin cancer diagnosis can feel overwhelming, but you don’t have to navigate it alone. Mohs micrographic surgery offers a safe, effective, and highly precise treatment option for many patients.

Let’s take the next step. Schedule your Mohs consultation today to receive a personalized evaluation and care plan built around your diagnosis.