Mohs Micrographic Surgery: What's the Process?

 Mohs Micrographic Surgery: What's the Process?

Mohs micrographic surgery is known to be the gold standard for treating the most common skin cancers. While surgery for skin cancer can sound scary, the reality is that the process for Mohs is simple, one of the most non-invasive surgeries, and enormously effective in eliminating cancer. Read on to find out what you can expect from your Mohs surgery, from surgery prep to post-op care.

The Gold Standard

Mohs skin cancer surgery was developed in the early 20th century by Frederich Mohs, then improved in the 1970s by Perry Robins, the founder of the Skin Cancer Foundation. It remains the most successful and least invasive surgery in treating common skin carcinomas, such as basal and squamous cell skin cancers. Mohs surgery can also be a treatment for melanoma skin cancer.

The Skin Cancer Foundation reports that Mohs surgery has a 99% cure rate for skin cancer that has not been treated before and a 94% cure rate for cancers that have received previous treatment. Mohs micrographic procedure involves the painstaking removal of layers of skin until only healthy tissue remains. After each layer of the cancerous growth is removed, the doctor examines it for cancerous cells. The procedure continues until there is no more sign of cancer.

Because Mohs is so exact in removing only the cancerous tissue, it is an ideal procedure for highly visible and functional areas of the body (like the face, hands, and genitalia). Due to its precision in removal of cancerous tissue, Mohs is also recommended for large cancers, fast-growing tumors, lesions with indistinct edges, and cancers with high rates of recurrence.

The care taken in Mohs surgery is especially helpful for removal of cancers like basal cell carcinoma that tend to grow downward and outward, under the visible lesion. The layer-by-layer removal ensures that all of the cancer is removed, even cells deeper in the tissue.

Preparing Yourself for the Procedure

There are a few things you can do at home to prepare for your Mohs procedure. First, make sure your doctor knows what medications or supplements you are taking. Your doctor might request that you stop taking certain medications, like blood thinners, that might increase your bleeding during the procedure.

You should also clear your schedule for the day of your surgery. While most Mohs surgeries only take two or three hours, your procedure might take longer, and your doctor won’t know its duration until the procedure is underway. Pack a bag with some things to do during the periods where your doctor is examining the removed tissue. You should also bring something to drink and some snacks in case your surgery lasts longer than a couple hours.


Mohs is an outpatient procedure that only uses local anesthetic. You will be awake the entire time, so there is a minimal amount of medical preparation needed before the surgery. Your doctor will start by examining and cleaning the area to be treated and then inject the local anesthetic to numb the area.

During the Surgery

Once the area is numb, your doctor will use a scalpel to remove the first layer of tissue. This only takes a couple minutes. A temporary bandage will be put over the area while the doctor goes to the lab to microscopically examine the tissue for cancerous cells. Your doctor will make a map of the area being treated so that he/she is sure to know where malignant tissue remains.

This process is repeated as the doctor continues to painstakingly remove layers until all of the skin cancer has been eliminated. This careful procedure ensures that none of the cancerous cells remain while also minimizing scarring and the unnecessary removal of healthy skin. If the duration of your surgery is longer, more anesthetic may be injected to ensure you are comfortable and pain-free.

Post-Surgery and Recovery

Your doctor will decide how to treat the wound based on how extensive the tissue removal is. If very little skin needed to be removed, your doctor may opt to let the wound heal on its own. For a slightly larger wound, you may need stitches.

The next level of wound care is using a skin flap from an adjacent area to cover the wound. Or your doctor may use a skin graft from another part of your body to cover the treated area. Sometimes plastic surgery is necessary to cover the wound. If so, your doctor will temporarily cover the wound and then refer you to a plastic surgeon for further treatment.

Plan to take it easy after your surgery. You will have a bandage on the treated area for 24-48 hours. You may be prescribed antibiotics to prevent infection and advised to use ice packs and mild painkillers to decrease any discomfort.

While one of the amazing benefits of Mohs surgery is that you usually know when you leave the doctor’s office that all of the cancer has been removed, you will probably still have a follow-up visit for your doctor to monitor the healing of your wound. You should also schedule regular exams with your dermatologist to make sure you don’t have any other cancerous spots.

Make an Appointment with Vanguard Today

Vanguard Dermatology has a number of experienced practitioners who have been trained in the Mohs surgical procedure. Contact Vanguard Dermatology, located in the greater New York City area, to schedule your consultation and begin the journey of a cancer-free you.

Request an Appointment

To request an appointment, please call one of our locations or click the "Book Online" button through ZocDoc.

Book Online
About Us Forms

Call Us

(718) 332-3454

Areas We Serve