Skin cancer is one of the most common types of cancer globally, and delays in its diagnosis and treatment can result in significant health risks and suboptimal care. The need for precise treatment methods, such as Mohs surgery for skin cancer, becomes even more critical when dealing with sensitive areas of the body like the face, nose, and ears.
Among these techniques, Mohs surgery for skin cancer is regarded as the most effective method for precisely identifying and removing cancer cells, all while preserving healthy tissue. This approach ensures the highest cure rates and optimal cosmetic outcomes.
What is Mohs surgery for skin cancer?
Mohs skin cancer surgery is a surgical procedure in which the doctor cuts thin layers of skin, and each layer is carefully examined for signs of cancer. The process continues until no signs of cancer remain.
Definition of technology and its origin
This technique began as chemical surgery, developed by physician Frederick E. Mohs in the late 1930s. In the mid-1960s, Dr. Perry Robbins collaborated with Dr. Mohs and discovered that the procedure held great potential in dermatology.
Mohs surgery (also known as Mohs micrographic surgery) is a method used to remove high-risk skin cancers with great precision. The surgeon cuts the tumor in layers, starting with the visible part of the tumor and a small margin of surrounding skin cells, then examines the deeper sides and edges under a microscope. If the cancer extends to any of the edges, more tissue is removed until all the cancer is removed.
The difference between traditional surgery and Mohs surgery for skin cancer
Conventional excision is a procedure in which the surgeon removes the skin cancer and a margin of surrounding skin. The sample is sent to a pathology laboratory for preparation and interpretation. Typically, less than 1% of the margins are examined in a wide skin excision.
The following table shows a comparison between traditional surgery and Mohs surgery for skin cancer in terms of:
| Classic surgery(Excisional) | Mohs surgery | point of comparison |
|---|---|---|
| removal of the tumor with a broader margin of healthy tissue to ensure complete removal of the cancer. | Removing the cancer while preserving as much healthy tissue as possible | The purpose |
| It is also highly effective, but may require additional tests to ensure that the tumor has been completely removed. | A cure rate of up to 99%, especially in high-risk cases. | Effectiveness |
| Larger scars, which may be more noticeable | More minor scars that are more consistent with the shape of natural skin. | Scars and cosmetics |
| Suitable for tumors in other areas of the body | Preferred for tumors in sensitive areas such as the face and nose | Suitability |
Advantages of Mohs surgery for skin cancer
- Effective and affordable treatment.
- One-visit outpatient surgery.
- Local anesthesia is applied to the area, allowing it to recover faster compared to general anesthesia or sedatives.
- Laboratory tests are conducted in the same place.
- Precise results.
- Allows the doctor to examine 100% of the tumor margins.
- Preserving healthy tissue.
- results in minimal scarring
When is Mohs surgery recommended for skin cancer?
- Skin cancers that have a high risk of recurrence or that have recurred after previous treatment.
- Skin cancers in cosmetically or functionally sensitive areas where it is desired to preserve as much healthy tissue as possible, such as around the eyes, ears, nose, mouth, hands, feet, and genitals.
- Cancers with margins that are difficult to identify or are not clear.
- Large or fast-growing tumors
- Some cases of melanoma are deemed suitable for Mohs surgery by the surgeon.
- Other rare types of skin cancer, such as raised dermatofibrosarcoma, microscopic cystadenoma, and sebaceous carcinoma, according to the surgeon’s assessment.
- Extramammary Paget’s disease.
How is Mohs surgery for skin cancer performed?
What happens before Mohs surgery for skin cancer?
Before a patient undergoes Mohs surgery to treat skin cancer, the dermatologist will perform a physical examination of the site and surrounding tissue together, taking into account:
- Reviewing the biopsy results
- The patient’s medical history and any medications or supplements he or she is taking
- Skin cancer is diagnosed, treatment options are discussed, and the risks and benefits associated with Mohs surgery are explained.
Depending on the patient’s general health condition and the location of the surgical site, they may be asked to take antibiotics before the procedure.
What happens during Mohs surgery for skin cancer?
Mohs surgery for skin cancer is performed according to the following steps:
- Examination and preparation: The surgeon examines the site where the biopsy was taken and may mark the site with a pen. The doctor places the patient in the most appropriate position for access, whether sitting or lying down. A surgical cap is placed over the area, and the surgeon then injects a local anesthetic that numbs the entire area, allowing the patient to remain awake throughout the procedure.
- Removal of the superficial layer: The surgeon uses a scalpel to remove a thin layer of visible cancerous tissue. Some skin cancers may be the tip of the iceberg, with roots or extensions that are not visible from the surface. Laboratory analysis will determine this. A temporary bandage is placed on the wound, and you can relax while the laboratory work begins.
- Laboratory analysis: The surgeon divides the tissue into sections, stains them with dyes, and prepares a map of the surgical site. In the lab, a technician freezes the sectioned tissue, then cuts very thin slices horizontally like layers of a cake. Slides are placed on microscope slides, stained, and coverslipped. This delicate process takes time.
- Microscopic examination: Using a microscope, the surgeon examines all the edges and undersurface of the tissue on the slides and, if cancer cells are found, marks their location on a map. The doctor then tells the patient if he needs to remove another layer of tissue.
- Removal of the second layer: In the operating room, the surgeon injects more anesthetic if necessary and carefully removes another layer of skin from where the cancer cells remain based on the map. This process is repeated as many times as necessary until the cancer cells are completely eradicated.
Mohs surgery for skin cancer may take only a few hours, or it may take all day. The length of the procedure depends on the tumor itself: larger and deeper tumors take longer to be removed entirely.
Recovery rates compared to traditional methods:
- Up to 99% for previously untreated skin cancer.
- Up to 94% for skin cancer that has recurred after previous treatment.
Risks and potential side effects of Mohs surgery for skin cancer
Problems that may occur during and after Mohs surgery include:
- Bleeding
- Pain or sensitivity at the surgical site.
- Infection
- Temporary or permanent numbness in the area of surgery. This may occur if small nerve endings are damaged or severed.
- Temporary or permanent weakness in the area of surgery. This may occur if a nerve is accidentally cut during the removal of a large skin cancer.
- Stun-like pain in the area.
- Large scar
- Poor wound healing.
- Tumor regrowth after removal (more common with previously treated tumors and large or chronic tumors).
Recovery and care after Mohs skin cancer surgery
After the cancer is completely removed, the surgeon decides the appropriate way to treat the wound, which may include:
- Allowing the wound to heal on its own (second-intention healing)
- Closing the wound with stitches
- Closing the wound with a skin flap (taking tissue from the surrounding skin) or a graft (taking tissue from another site on your body)
- A combination of the three methods mentioned above
- Involving another specialist surgeon, such as an ophthalmic plastic surgeon (around the eye) or a facial plastic surgeon (usually in the case of a larger-than-expected tumor)
In most cases, the wound is treated immediately after Mohs surgery. If the wound is large or complex, it may be closed temporarily, and a subsequent operation may be necessary to repair it. However, this is rare. After surgery, some mild pain and discomfort may persist. Over-the-counter pain medications are often sufficient. Severe pain is uncommon, and if it occurs, you should contact the doctor responsible for the operation. It is expected that a bandage will be placed on the wound for a week or more, and the bandage may need to be changed daily, depending on the wound’s condition and the type of closure used.
How long does it take to recover from Mohs surgery for skin cancer?
Scars resulting from Mohs surgery for skin cancer continue to heal for 12 to 18 months after the procedure, depending on the size of the tumor removed, the method of closing the wound, and its location. The scar matures and then fades.
When should I contact the doctor after Mohs skin cancer surgery?
After any surgery, patients should feel comfortable contacting their doctor with questions about the procedure or recovery. You should also contact your surgeon if any of the following occur:
- Bleeding: It is normal for minor bleeding or discharge to occur from the wound, especially in the first few hours after surgery. Bleeding can be stopped by applying pressure on the wound, but you should contact your surgeon if the bleeding does not stop.
- Pain: The patient may experience mild to moderate pain after Mohs surgery. You should contact your surgeon if:
- The pain could not be controlled with acetaminophen
- The pain lasted for days
- The pain started to improve, and then came back and got worse.
- Signs of infection: An infected wound may prolong recovery time and interfere with optimal scar healing. The patient may need topical or oral antibiotics. You should contact your surgeon in cases such as:
- If a fever appears
- The appearance of a thick, yellowish, or foul-smelling discharge
- There is bright redness around the wound
- The skin around the wound was swollen and hot to the touch
Cost of Mohs Skin Cancer Surgery in Türkiye
The cost of Mohs skin cancer surgery in Türkiye ranges between $ 2,500 and $ 7,600 per site, and may reach $ 12,000 in some complex cases or in the absence of health insurance.
Cost comparison between conventional surgery and Mohs surgery for skin cancer
| approximate cost(USD) | procedure |
|---|---|
| 2,500 – 7,600 USD | Mohs surgery |
| 1,500 – 5,000 USD | conventional surgery |
Cost of Mohs surgery for skin cancer in Türkiye and other countries
Large differences in prices appear when comparing the cost of Mohs skin cancer surgery in Türkiye and other countries, as the following table shows:
| approximate cost(USD) | The country |
|---|---|
| 2,500 – 7,600 USD | Türkiye |
| 3,000 – 8,000 USD | The United States of America |
| 5,400 – 8,700 USD | Germany |
| 11,800 – 15,400 USD | The United Kingdom |
In conclusion, Mohs surgery for skin cancer stands out as the most precise and effective treatment for high-risk and sensitive skin cancers, offering the dual benefit of cancer cell removal and excellent cosmetic results. If you notice any changes in your skin or observe suspicious signs, it’s crucial to consult a specialist promptly for an early diagnosis and to determine the best treatment approach.
Sources:
- Prickett, K. A. (2023). Mohs micrographic surgery. In StatPearls. StatPearls Publishing. Retrieved September 5, 2025
- National Cancer Institute. (n.d.). Mohs surgery. In cancer.gov dictionary. Retrieved September 5, 2025.
