What Is Mohs Surgery? Procedure, Recovery and Costs

If you've been diagnosed with skin cancer, your doctor may have suggested Mohs surgery as a treatment option. But what is Mohs surgery, and what can you expect from the procedure?

Read on for an overview of this specialized surgery, including recovery, risks and benefits, and associated costs.

What Is Mohs Surgery?

Mohs surgery — originally called chemosurgery — was first developed by Dr. Frederic Mohs in the late 1930s.¹ In 1985, the name of the procedure was officially changed to Mohs micrographic surgery, but many people just call it Mohs surgery.²

Mohs surgery is used to remove various types of skin cancer, including:³

• Basal cell carcinoma
• Squamous cell carcinoma
• Melanoma

Mohs surgery is considered an optimal treatment for skin cancer because it offers the highest cure rate of any skin cancer treatment option currently available, as well as an extremely low complication rate.⁴ On average, one in four cases of skin cancer is treated with Mohs surgery.⁵

Since Mohs surgery is a specialized surgical procedure in the field of dermatology, it is only performed by doctors who are trained Mohs surgeons. Most Mohs surgeons are dermatologists who have completed extensive training in the Mohs technique^.6

Who Can Get Mohs Surgery?

Mohs surgery is considered the gold standard for treating many basal and squamous cell carcinomas.¹ This surgery may also be used to treat rare skin cancers like dermatofibrosarcoma protuberans (DFSP), extramammary Paget's disease and Merkel cell carcinoma.⁶

In addition, Mohs surgery may be used successfully on certain cases of melanoma,¹ including lentigo malignant melanoma — a type of early melanoma that stays close to the surface of the skin for a while.⁶

While Mohs surgery is not necessary for all skin cancers,³ it may be recommended when the following criteria have been met:

• The skin cancer is near a functionally or cosmetically important area (e.g., eyes, nose, lips, ears, scalp, fingers, toes, genitals).¹
• The tumor is large or aggressive.¹
• You have one skin cancer or a few skin cancers that are very close together.⁶
• Regular surgery is less likely to remove the cancer.³
• Previous skin cancer treatments have not worked.³

What to Expect During Mohs Surgery

Mohs surgery is an outpatient procedure that can last all day, but in most cases it takes less than four hours.⁷ The surgery is usually done while you're awake and alert.⁶ You will either wear your regular clothes or a hospital gown, depending on the location of the skin cancer.¹

Before surgery, your medical team will inject the tumor area with a local anesthetic so you won't feel discomfort during the procedure. The anesthetic can be readministered as necessary.⁷

4 stages of Mohs surgery⁶

1. The surgeon removes the visible tumor and a thin layer of surrounding skin.
2. A pathologist examines the tissue under a microscope to see if any cancer cells remain at the edges.
3. If any cancer cells remain, the surgeon removes additional skin and examines it under the microscope.
4. The process continues until no more cancer cells are found at the edges.

Since this procedure is done in stages, typically all in one visit, you will be waiting between each stage.¹ Your incision will be bandaged so you can wait comfortably while your tissue is examined.⁶ Removing tissue only takes a few minutes, but laboratory analysis typically takes the longest amount of time — about an hour or so.⁷ In most cases, Mohs surgeons can clear the roots of a tumor by removing just one or two layers of tissue.⁸

If you have melanoma, you may be treated with a modified type of surgery called slow Mohs. With slow Mohs, you will be bandaged and sent home after tissue removal instead of staying in a waiting room or procedure room. That's because more time is needed to examine the removed skin and determine whether it contains cancer cells. You will typically return the next day to learn whether more skin must be removed or the wound can be closed.⁶

Wound repair after Mohs surgery

Once all the cancer has been removed, you and your surgeon can discuss the best way to repair the wound.3 Your options will depend on the wound's size and location.¹

Wound repair options include:⁴

• Self-healing. If the wound is small and relatively shallow, it can heal on its own. It heals from the bottom up, just like a scrape on the skin.
• Stitches. Putting stitches in the wound brings the sides of the wound together, leaving a linear-type scar.
• Skin flap. This option involves using the surrounding skin to cover the wound.
• Skin graft. Grafting involves borrowing skin (most commonly from around the ears or collarbone) and transplanting that skin to the wound.

The wound is often closed the same day by the Mohs surgeon, but sometimes it is repaired by another surgeon on the same day or on a different day.³ If the surgical area is extensive or complex, your surgeon may temporarily close the wound and refer you to another specialist for reconstructive surgery.⁷

Mohs surgery recovery tips

Keep in mind that the wound created during surgery may be bigger than you thought it would be. There may be roots of the cancer that aren't visible from the surface, requiring the removal of more tissue. And note that, on average, the wounds from melanoma surgery — and thus the scars — are about twice as large as those from other skin cancers.⁸

Here are five tips for a good scar outcome:⁸

1. Follow post-op care instructions. These include when to remove any bandages, wash the wound and return for a follow-up appointment.
2. Keep the wound moist. Since dry wounds heal slower and tend to scar more, use a neutral ointment (non-antibiotic) to keep the wound moist.
3. Limit activity. For about two weeks after surgery, the wound only has a fraction of its original strength. Any movement can stretch the scar and affect the way it heals.
4. Protect your scar from the sun. New scars tend to darken and discolor when exposed to ultraviolet light, so use sunscreen religiously and keep the area covered, if possible.
5. Consider a silicone patch or gel. Silicone has been shown to reduce the thickness of some scars, so you may apply an over-the-counter silicone sheet or gel to the scar as directed.

After Mohs surgery, ask your doctor to create a schedule for follow-up exams to spot any new skin cancer. You can expect to see the dermatologist at least once or twice a year, or more often if your skin cancer was aggressive or is more likely to recur.⁷

Benefits of Mohs Surgery

Mohs surgery is highly effective at removing skin cancer because the edges of the removed tissue are checked much more thoroughly under the microscope than during regular surgery.³ During Mohs surgery, the surgeon can see where the cancer stops, which isn't possible with other types of skin cancer treatment.6 This allows you to keep as much healthy skin as possible, which is particularly important in areas with little tissue beneath, such as the eyelids, ears or hands.⁶

Take a look at three key advantages of Mohs surgery:¹

1. Efficient treatment. Mohs surgery is generally a single-visit outpatient procedure done under local anesthesia, with lab work performed on-site.
2. Precise results. Your doctor will examine 100% of the tumor margins, spare as much healthy tissue as possible and leave the smallest scar possible.
3. High cure rate. The cure rate for Mohs surgery is up to 99% for a skin cancer that hasn't been treated before, and up to 94% for a skin cancer that has recurred after previous treatment.

Plus, with Mohs surgery, you know your results right away. And you typically don't leave your appointment until all the skin cancer has been removed.⁷

Risks of Mohs Surgery

While the complications associated with Mohs surgery are very low, risks are unique to each individual. Consider the following possible risks:⁹

• Bleeding
• Itching or shooting pain
• Infection
• Larger than expected wound
• Loss of nerve function if the tumor invades a nerve
• Regrowth of tumor after removal (more common with previously treated tumors and large, longstanding tumors)

Keep in mind that infections rarely happen before the fifth day following surgery, and any redness and oozing before day five are often related to allergic reactions.⁸ Be sure to discuss your individual health issues and any concerns about the procedure with your Mohs surgeon.⁹

Average Cost of Mohs Surgery

In general, the average cost of Mohs surgery is $2,575, though the cost without insurance can be up to $12,000.¹⁰

Note that other skin cancer treatment methods might require additional surgeries and pathology readings to treat the cancer if it's not completely removed — and all of these require separate fees. A single Mohs surgery procedure, on the other hand, includes everything in one fee.¹¹

In fact, compared with another common skin cancer treatment (wide local excision), Mohs surgery was deemed less costly and more effective in treating intermediate-risk squamous cell carcinoma. In one Boston hospital, the average cost of Mohs surgery was $4,366, while the average cost of excision was $4,699.¹²

The cost of Mohs surgery will also vary according to who performs the surgery, their location, the type of surgical facility, the size and location of the treatment area, and the complexity of your case. Mohs surgery in a doctor's office is typically the most affordable facility option, while doing the procedure in a surgery center or a hospital operating room is generally more expensive.¹⁰

Is Mohs surgery covered by insurance?

Because it's considered medically necessary, private insurance providers usually cover a large portion of the cost of Mohs surgery.¹⁰ But if the skin cancer is too small and straightforward — like a pencil eraser-sized basal cell carcinoma on the back — insurance is unlikely to pay for the procedure.⁴

CareCredit Financing for Mohs Surgery

If your doctor recommends Mohs surgery for skin cancer removal, you can use the CareCredit credit card to cover your deductible or pay for the entire treatment, if necessary.* Apply for CareCredit as a payment option, and use the CareCredit Acceptance Locator or Mobile App to find a participating dermatologist near you.

Author Bio

Robyn Tellefsen is a freelance writer and editor with nearly 20 years of experience covering health and wellness, finance, and more. Her work has appeared on sites such as LoopNet, Beachside Rehab, First Horizon Bank, SoFi, A Place for Mom, American Express, Chase and more.