Posted by: Skin And Cancer Institute in Skin Cancer
Hearing the words “skin cancer” can be overwhelming, but modern dermatology offers highly effective, precise treatments. If your dermatologist has recommended Mohs surgery (Mohs micrographic surgery), you are likely wondering what the procedure entails, how long it takes, and what the recovery looks like.
Widely considered the gold standard for treating certain types of skin cancer, Mohs surgery offers the highest cure rate while leaving as much healthy tissue intact as possible. Here is everything you need to know about this highly specialized procedure.
What is Mohs Surgery?
Mohs surgery is a precise surgical technique used to remove skin cancer one microscopic layer at a time.
Unlike a standard local excision—which removes the visible tumor along with a wide margin of surrounding healthy tissue “just in case”—Mohs surgery is incredibly targeted. Your dermatologist removes a single, thin layer of tissue and immediately examines it under a microscope. If cancer cells are found at the edges, the surgeon knows exactly where they are and only removes tissue from that specific area.
The Mohs Advantage: This layer-by-layer process continues until no cancer cells remain. It ensures that the cancer is entirely removed while preserving the maximum amount of healthy skin, resulting in the smallest possible scar.
Who is a Candidate for Mohs Surgery?
Mohs surgery is most commonly used to treat the two most frequent types of skin cancer: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
Your dermatologist at the Skin and Cancer Institute may recommend this technique if your skin cancer:
- Has a high risk of recurrence: Or if it is a cancer that has already come back after previous treatments.
- Is located in cosmetically sensitive areas: Such as the face, nose, lips, ears, scalp, neck, or hands, where preserving healthy tissue is crucial.
- Is large or aggressive: Tumors that are growing rapidly.
- Has hard-to-define borders: Where it is difficult to tell where the cancer ends and healthy tissue begins.
What to Expect on Surgery Day
Is Mohs surgery an outpatient procedure? Yes. The surgery is performed right in your dermatologist’s office under local anesthesia. You remain awake and comfortable, and you get to go home the same day.
How long does it take? Because the tissue is mapped, processed, and examined in real-time while you wait, it is difficult to predict exactly how long the surgery will take. It depends on how many layers need to be removed to clear the cancer. While the actual surgical removal only takes minutes, the laboratory analysis for each layer takes time. Plan to be at the clinic for several hours, or potentially the entire day. Bring a book, an iPad, or something to keep you entertained!
The Step-by-Step Process:
- Preparation: The area is numbed with local anesthesia.
- Removal: The visible tumor and a thin margin of underlying tissue are removed.
- Lab Analysis: The tissue is color-coded, mapped, and examined under a microscope by your surgeon.
- Targeted Removal (if necessary): If cancer remains, the surgeon returns to remove another layer only from the precise area where cancer cells were detected.
- Closure: Once the margins are 100% clear of cancer, the wound is closed and bandaged.
Leaving With Confidence: Unmatched Cure Rates
The greatest advantage of Mohs surgery is peace of mind. Because the surgeon examines 100% of the tumor margins (compared to only about 1% in standard pathology), Mohs boasts up to a 99% cure rate for skin cancers that have not been treated before. You leave the office confident that the cancer has been completely removed.
Aftercare and Minimizing Scars
Any surgical procedure leaves a scar, but the fundamental goal of Mohs is to keep that scar as small as possible by sparing healthy tissue.
Before you go home, your dermatologist will provide detailed wound care instructions. To ensure the scar heals beautifully and becomes as unnoticeable as possible, they may recommend specific aftercare protocols, including the use of silicon dioxide gel or silicone scar pads once the initial healing phase is complete.
A Brief History: Where Did Mohs Get Its Name?
The procedure is named after its inventor, Dr. Frederic E. Mohs, a general surgeon who developed the technique in the 1930s. The procedure gained widespread recognition in the 1960s and has since been continuously refined. Today, it is practiced by specially trained dermatologic surgeons across the country.
The Bottom Line
If you are facing a skin cancer diagnosis, Mohs surgery offers the highest chance for a complete cure with the best cosmetic outcome. By removing the cancer layer by layer and checking the margins in real-time, your dermatologist ensures the cancer is gone while protecting your healthy skin.