Mohs Surgery vs. Other Skin Cancer Treatments: Key Comparisons
Skin cancer is the most common form of cancer in the United States, affecting more than 5 million people each year. Fortunately, when detected early, skin cancer is highly treatable. A wide range of treatment options are available depending on the type, location, size, and behavior of the cancer. From topical medications to surgical procedures, your dermatologist can tailor a plan suited to your specific diagnosis and needs.
One of the most precise and effective treatments is Mohs surgery—a specialized technique with high cure rates and excellent cosmetic outcomes. However, it is not suitable for every patient or every type of skin cancer. This blog post is designed to help you understand when Mohs surgery may be the best choice—and when alternative treatments might be more appropriate.
What is Mohs Surgery?
Mohs micrographic surgery is a highly specialized technique used to treat certain types of skin cancer. Named after Dr. Frederic Mohs, who developed the procedure in the 1930s, the technique involves removing cancerous tissue layer by layer. After each layer is removed, it is immediately examined under a microscope to check for remaining cancer cells. This process continues until no cancer cells are detected.
The primary goal of Mohs surgery is to remove all cancerous tissue while preserving as much healthy tissue as possible. This makes it particularly beneficial in areas where conserving skin is important for both appearance and function—such as the face, hands, and genitals.
Mohs surgery is typically performed in a dermatologist’s office or outpatient surgical center under local anesthesia. The entire procedure can often be completed in a single visit, with pathology and surgical steps occurring on the same day.
Factors to Consider When Deciding on Mohs Surgery
1. Type of Skin Cancer
Mohs surgery is especially effective for:
- Basal Cell Carcinoma (BCC): The most common form of skin cancer. Mohs surgery boasts cure rates of approximately 99% for primary BCCs.
- Squamous Cell Carcinoma (SCC): The second most common type of skin cancer. Mohs offers a cure rate of about 97% for recurrent cases.
- Rare or Aggressive Non-Melanoma Skin Cancers: Includes dermatofibrosarcoma protuberans (DFSP), sebaceous carcinoma, and extramammary Paget’s disease, which benefit from the precise nature of Mohs.
Less commonly used for:
- Superficial or Low-Risk Tumors: For example, superficial BCCs or SCCs in non-sensitive areas may respond well to simpler treatments such as topical medications or cryotherapy.
- Melanoma: Mohs is not the first-line treatment for melanoma due to its potential for deeper invasion. However, it may be used in select cases by trained Mohs surgeons utilizing special immunohistochemical stains to detect melanoma cells (e.g., MART-1 staining).
2. Tumor Location
Tumors located in cosmetically and functionally critical areas are prime candidates for Mohs surgery. These include:
- Face
- Ears
- Nose
- Lips
- Eyelids
- Scalp
- Hands
- Genitals
In these areas, tissue preservation is key. Mohs allows surgeons to remove the cancer while minimizing the amount of healthy tissue taken, which helps reduce scarring and maintain function.
3. Tumor Size and Behavior
Mohs is particularly suited for:
- Larger tumors, where complete removal is critical without sacrificing excessive tissue.
- Recurrent tumors, especially those previously treated with excision, topical therapy, or radiation.
- Cancers with poorly defined borders, which are difficult to fully remove using standard excision.
- Aggressive or fast-growing lesions, such as infiltrative or morpheaform BCCs.
These high-risk characteristics make complete margin control essential, and Mohs provides the most thorough method of ensuring clean margins.
4. Risk of Recurrence
Mohs surgery offers the highest cure rates among all skin cancer treatments:
- Up to 99% for primary BCCs
- About 97% for recurrent BCCs (American College of Mohs Surgery)
This makes it the preferred choice for patients with a high risk of recurrence, particularly in previously treated tumors or those in critical locations.
5. Your Cosmetic Goals
One of the most appealing benefits of Mohs is its ability to preserve healthy tissue, resulting in:
- Smaller scars
- Better cosmetic outcomes
- More options for precise reconstruction
Especially in visible areas like the face, where appearance matters most, Mohs often results in superior aesthetic results compared to standard excision or other treatments.
Mohs Surgery vs. Other Skin Cancer Treatments: Key Comparisons
1. Cure Rate
| Treatment Type | Cure Rate (Primary Tumors) | Cure Rate (Recurrent Tumors) |
| Mohs Surgery | ~99% | ~97% |
| Excisional Surgery | ~90–93% | ~85% |
| Topical Therapy (5-FU, Imiquimod) | ~80–85% | Lower |
| Cryotherapy | ~85–90% | Lower for deeper/larger tumors |
| Radiation Therapy | ~90% | Varies by case |
2. Downtime & Recovery
| Treatment Type | Downtime | Recovery Notes |
| Mohs Surgery | 1–2 weeks | Healing depends on wound size and reconstruction |
| Excisional Surgery | 1–2 weeks | Stitches typically required |
| Topical Therapy | Redness/irritation for weeks | No surgery, but prolonged application needed |
| Cryotherapy | Minimal | Blistering, pigment changes possible |
| Radiation Therapy | No surgical downtime | Multiple sessions; delayed skin irritation possible |
3. Cost Considerations
| Treatment Type | Cost Factors |
| Mohs Surgery | Higher upfront cost; fewer recurrences make it cost-effective long-term |
| Excisional Surgery | Lower initial cost; may need follow-up procedures |
| Topical Therapy | Affordable for small, superficial tumors |
| Cryotherapy | Inexpensive; most suitable for very small lesions |
| Radiation Therapy | Expensive due to multiple visits and need for specialized equipment |
4. Cosmetic Outcomes
- Best: Mohs, due to minimal tissue removal and tailored reconstruction
- Good: Excision, especially with skilled surgical closure
- Variable: Topical therapies may cause pigment changes or incomplete removal
- Less Predictable: Cryotherapy and radiation may result in scarring, texture changes, or hypopigmentation
What to Discuss with Your Dermatologist
Before deciding on a treatment, have an in-depth conversation with your dermatologist that includes:
- Your pathology report: Type, grade, and aggressiveness of your cancer
- Tumor location and depth: Areas with cosmetic or functional importance may favor Mohs
- History of prior treatments: Recurrences may indicate a need for a more precise approach
- Medical history and medications: Some conditions or blood thinners may affect surgical healing
- Your personal goals: Prioritize what matters most—cosmetic results, downtime, cost, or long-term outcomes
- Comfort with surgical procedures: Mohs is performed under local anesthesia but does involve cutting and wound care
Mohs surgery is a gold-standard treatment for many types of skin cancer, offering unparalleled cure rates and excellent cosmetic outcomes. However, it’s not always the right solution for every patient or every diagnosis. Factors such as tumor type, size, location, and your personal preferences all play a role in determining the best course of action.
A consultation with your dermatologist is the best way to weigh your options and develop a personalized treatment plan. Whether or not Mohs surgery is right for you, the goal is the same: complete cancer removal with the best possible outcome for your health, function, and appearance.
Lauren Rimoin, MD is a Board-Certified Dermatologist and Board-Certified, Fellowship Trained Mohs surgeon at Westlake Dermatology. She earned her medical degree at University of California, Los Angeles where she was elected to the prestigious honors society Alpha Omega Alpha. She trained at Emory University in Atlanta, Georgia for her Dermatology residency, as well as her fellowship in Mohs Micrographic Surgery and Cutaneous Oncology. Dr. Rimoin is a member of American Academy of Dermatology, the American Society for Dermatologic Surgery, the American College of Mohs Surgery, the Texas Medical Association, and the American Medical Association.
Disclaimer: The contents of the Westlake Dermatology website, including text, graphics, and images, are for informational purposes only and are not intended to substitute for direct medical advice from your physician or other qualified professional.