It removes cancer in stages.
Each layer is mapped and examined under the microscope.
Mohs Surgery vs Surgical Excision
Mohs Surgery: Skin cancer is removed one thin layer at a time, and each layer is checked under a microscope during the appointment before the next one is taken. It has the highest cure rate and removes the least normal skin, and it takes most of a day.
Surgical Excision: The growth is cut out along with a measured border of normal-looking skin, and the wound is stitched closed. The whole piece goes to a laboratory and the result comes back in about a week. The scar is a line, and it is longer than the spot was.
Choose Mohs Surgery if…
Choose for skin cancer on the face or other high-risk sites, where the highest cure rate and smallest scar matter most.
- Cancer on the face, ears, hands or genitals
- A cancer that came back
- You can set aside most of a day
Choose Surgical Excision if…
Choose to remove a skin cancer or suspicious growth completely with lab-checked edges — the scar is a line, longer than the spot.
- Melanoma or a suspicious mole
- Skin cancer on the trunk or limbs
- You want the whole growth checked
Alternatives, not combined
Can you have both?
Both remove skin cancers. Mohs checks every edge during surgery and suits the face; standard excision suits low-risk spots on the body.
Key differences
● Mohs Surgery
● Surgical Excision
DowntimeNone → 2+ weeks
1–2 weeks
1–2 weeks
PainMinimal → Needs anesthesia or sedation
Mild
Mild
Results showImmediately → 3+ months
Immediately
Immediately
How long it lastsWeeks → Years or permanent
Years or permanent
Years or permanent
Visits neededOne → Every few months
One
One
Cost per visit$ → $$$$$
$$$
$$
ReversibleYes, can be undone → No, permanent
No, permanent
No, permanent
What is it?
Mohs Surgery
Surgical Excision
What is it?
It conserves healthy tissue.
Further tissue is removed only where cancer remains.
Not every cancer needs Mohs.
Type, size, site and recurrence determine suitability.
The wound can be larger.
The final defect may exceed the visible lesion.
It removes a lesion surgically.
A planned incision removes the lesion and a rim of tissue.
It diagnoses or treats.
It provides tissue or removes a known lesion.
Margins depend on the diagnosis.
They should not be chosen from a generic chart.
Mohs is different.
Standard excision and Mohs assess tissue differently.
What it treats
Evidence level
Mohs Surgery
Surgical Excision
Strong evidenceMost established uses
Basal Cell Carcinoma
About 99% cure rate for first tumors.
Squamous Cell Carcinoma
Precise removal on the face.
Basal Cell Carcinoma
High cure rates.
Squamous Cell Carcinoma
Removes the cancer with margins.
Melanoma
The main treatment.
Epidermal Inclusion Cyst
Removes the sac.
Little evidence
—
Acne Scarring
Punch excision is used for small scars instead.
Not effective
Actinic Keratosis
Too much for precancers.
Moles
Not for benign moles.
—
Can make it worse
—
Keloids
Keloids often return larger alone.
Treatment areas
Treatment areas
The specific lesion, scar or affected patch determines the treatment site; there is no fixed body distribution.
The specific lesion, scar or affected patch determines the treatment site; there is no fixed body distribution.
Skin tones
Skin tone
● Mohs Surgery
● Surgical Excision
Lighter skin
Low risk
A fine scar that fades over a year.
Low risk
A fine line scar.
Medium skin
Low risk
Scars usually settle well.
Low risk
Scar fades over a year.
Deeper skin
Some risk
Raised or darker scars possible; ask about scar care.
Some risk
Raised or keloid scars possible, especially on chest, back and shoulders.
How it works
Mohs Surgery
Surgical Excision
How it works
Diagram explanation
A thin tissue layer is removed: The surgeon removes visible cancer and a surrounding layer. Margins are mapped and examined: The tissue edges are checked under a microscope. Only involved areas are treated again: Stages continue as needed before planning wound repair.
Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.
The area is planned: Diagnosis and location guide the removal border and depth. The lesion is cut out: The clinician removes the selected tissue as a specimen. Closure and tissue review follow: The wound heals, while pathology helps guide further care.
Schematic illustration. Technique and response vary. This explains a mechanism and does not specify treatment settings.
Before your treatment
Mohs Surgery
Surgical Excision
The week before
Supplements and alcohol: Blood-thinning supplements you do not need, such as fish oil, vitamin E and ginkgo, are commonly stopped about a week before, and alcohol the night before.
Smoking and vaping: Stop from at least a week before through the first two weeks after if you can.
Supplements and alcohol: Non-essential blood thinners such as fish oil, vitamin E and ginkgo are commonly stopped about a week before, and alcohol the night before.
Smoking and vaping: Stop for a week before and two weeks after if you can.
Day of treatment
Mohs Surgery
Surgical Excision
Before you arrive
Eat, dress and plan: Eat a normal breakfast and take your usual morning medicines unless told otherwise.
Eating and clothes: Eat normally and take your usual morning medicines.
Arrival & prep
The site is confirmed against the biopsy report and photographed, and you will be asked to point to the spot yourself.
The site is confirmed against the biopsy report and you point to it yourself.
Treatment
The surgery: The tumor and a narrow margin come out in minutes.
The surgery: You then wait 45 minutes or more while the tissue is frozen, sectioned and read. If tumor remains at a mapped edge, another layer is taken there only; most finish in one to three stages. The wound is then closed with stitches, a flap or a graft, or left to heal, in 30 to 90 minutes. The injections sting; nothing else does.
The surgery: The skin is cleaned and draped.
The surgery: The ellipse is cut out in one piece, bleeding points sealed, and the edges freed so they meet without tension. Closing is in layers — dissolving stitches deep, stitches on the surface. You feel pressure and tugging and hear instruments, but nothing sharp. Most take 20 to 45 minutes, and the site feels tight afterward rather than sore.
Before you leave
A firm pressure dressing stays on 24 to 48 hours, with written wound-care instructions and a suture removal appointment.
A dressing, written wound care, a stitch removal appointment, and a plan for how the pathology result reaches you.
After your treatment
Mohs Surgery
Surgical Excision
First 24 hours
First 24 to 48 hours: Keep the dressing dry and in place, your head elevated including overnight, and ice over the dressing in short spells.
Not specified
Days 2–7
Days 2 to 14: Bruising and swelling are worst around day two and can spread around the eyes.
First week: Keep the dressing dry and in place for 24 to 48 hours, then start daily care — gentle wash, petrolatum, non-stick dressing.
Days 5 to 14: Stitches come out — face at 5 to 7 days, trunk and arms at 10 to 14, legs and back sometimes longer.
Weeks 2–4
Week 2 to Month 12: The scar becomes a hard, raised, pink ridge.
From week 2: The scar is hardest, pinkest and most raised at around three to six weeks.
Time to results
Same day
Lab result in about a week
How long results last
About 99% cure for first basal cell cancers
Permanent
Risks
Risks
- A thick or raised scar
- Numbness or tingling that is not improving
- A graft or flap turning black
- A stitch that surfaces months later
- Pulling at an eyelid or lip
- When to contact your provider
- A thick, raised or widening scar
- Numbness or a firm cord under the skin
- A stitch that surfaces months later
- A margin that was not clear
- A pucker at one end of the line
- When to contact your provider
Cost
Per session
Mohs is the most expensive of the standard skin cancer treatments, and the day shows why: a surgeon who is also reading the pathology, a laboratory and technician in the building, and hours of appointment time.
An excision costs more than a scrape-and-burn and less than Mohs surgery.
Insurance
It is generally covered by health insurance when the tumor meets accepted criteria for Mohs, which is why the location, size and subtype are documented before it is booked.
In the US the surgical charge is priced by the size of the excision and the body site, with a separate charge for a more complex layered closure.
Questions
Mohs Surgery
Surgical Excision
Individual Questions
Why does it take all day?
Mostly waiting. Removing a layer takes minutes; freezing, slicing, staining and reading it under a microscope takes 45 minutes to well over an hour, and that happens once for every stage. One to three stages plus a repair fills most of a day.
Will I be asleep?
No — Mohs is done under local anesthetic while you are awake. You will be numb but able to talk, eat between stages and walk to the waiting room. General anesthesia is used only in unusual cases.
How big will the scar be?
Not knowable in advance, which is uncomfortable and honest. The wound ends up as large as the tumor's roots turn out to be. Mohs removes less normal skin than any other method, so the wound is usually smaller than an excision would have produced for the same tumor, and a tumor that looked like a small spot on the surface can still be considerably wider underneath.
Should I stop my blood thinner first?
Not unless the doctor who prescribed it tells you to. Blood thinners are usually continued through Mohs. Extra bleeding during surgery is manageable; a stroke or a clot is not.
Why is Mohs recommended for the cancer on my face but not the one on my back?
Location, mainly. On the face there is little spare skin and recurrence rates are higher, so removing the least tissue with the highest certainty is worth the time and the cost. On the back a straightforward excision achieves the same result more simply. Size, an aggressive subtype under the microscope, unclear borders and a tumor that has come back before all push toward Mohs anywhere on the body.
Am I cured when I leave?
Almost certainly, and follow-up still matters. Cure at 5 years for a previously untreated basal cell carcinoma is commonly quoted around 99 percent. The bigger reason to keep coming back is that having had one skin cancer makes a new one elsewhere substantially more likely.
Why is the scar so much longer than the spot?
Because a round hole cannot be closed flat. The piece taken out is an ellipse roughly three times as long as it is wide, so the edges meet evenly instead of puckering at each end. A spot the size of a pencil eraser becomes a line an inch or more long. It is geometry, not technique, and no surgeon avoids it.
How long until I get the result?
Usually 3 to 10 days, depending on the laboratory. Ask before you leave how and when you will be told, and call if you have heard nothing after about two weeks.
What happens if the margins are not clear?
A further procedure — a re-excision with a wider border, or a referral for Mohs surgery — usually within a few weeks. It is not a mistake. It is the reason the specimen went to a laboratory in the first place.
When can I exercise again?
About 2 weeks for most sites, longer for the back, shoulder and shin. The visible stitches come out sooner, and the deep stitches are still carrying the tension. Lifting or straining is what stretches or splits a wound.
Should I have Mohs surgery instead?
On the face, particularly the nose, eyelids, ears and lips, or for a tumor that is large, has vague borders, has an aggressive subtype on the biopsy, or has come back before, Mohs is often better. For a small low-risk cancer on the trunk or limbs, an excision achieves the same result in a fraction of the time and cost. Ask which category yours is in.
Will the scar fade?
It flattens and pales substantially over about a year, with most of the change in the first six months. Keeping it out of the sun and using silicone gel or sheeting once it is closed are the two things with reasonable evidence behind them. Scars on the chest, shoulders and upper back stay red and raised longest and are the likeliest to widen.
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