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Mohs Micrographic Surgery The Gold Standard for Skin Cancer Treatment

What Is Mohs Micrographic Surgery?

At Dermatology Associates of the Bay Area, our board-certified dermatologists specialize in the precise and highly effective treatment of skin cancer using Mohs micrographic surgery. This advanced technique offers the highest cure rates while preserving as much healthy tissue as possible, making it the treatment of choice for head and neck basal cell carcinomas (BCC) and squamous cell carcinomas (SCC) when warranted.

Mohs surgery is a specialized outpatient procedure designed to remove BCCs and SCCs with unmatched accuracy. Unlike traditional excision, which removes a margin of healthy skin along with the tumor, Mohs surgery allows the surgeon to examine 100% of the surgical margin under the microscope in real time. This process continues layer by layer until no cancer cells remain.

Developed by Dr. Frederic Mohs in the 1930s, this technique has become the gold standard for treating these non-melanoma skin cancers. It is particularly valuable for tumors located in cosmetically sensitive areas, such as the face, ears, nose, lips, and scalp, where preserving healthy tissue is essential for both function and appearance.

Close up of basal cell carcinoma on chin during a consultation at Dermatology Associates of the Bay Area

Why Mohs Surgery Is Considered the Gold Standard

The primary goals in treating skin cancer are the complete removal of the tumor and preservation of healthy, unaffected tissue. Mohs micrographic surgery achieves both:

Highest cure rates: Cure rates exceed 99% for primary BCCs and up to 97% for recurrent tumors, significantly higher than standard excision or radiation.
Tissue preservation: By removing only layers that contain cancer, Mohs minimizes unnecessary removal of normal tissue, which is especially important in delicate areas.
Immediate confirmation: The dermatologist acts as both surgeon and pathologist, analyzing each tissue layer on the spot to ensure no cancer cells remain.

This combination of precision and effectiveness makes Mohs surgery ideal for high-risk or complex skin cancers.

Who Is a Candidate for Mohs Surgery?

Mohs surgery may be recommended for patients with:

Skin cancers on the face or cosmetically sensitive areas (nose, eyelids, lips, ears).
Recurrent tumors that have returned after prior treatment.
Large or aggressive skin cancers, particularly those with poorly defined borders.
Skin cancers in areas of scar tissue.
Patients with compromised immune systems, for whom complete tumor clearance is essential.

Your dermatologist will carefully evaluate your diagnosis, medical history, and the tumor’s characteristics to determine whether Mohs surgery is the most appropriate treatment.

Older female patient during Moh's consultation in petaluma & hercules

The Step-by-Step Process of Mohs Surgery

Patients often find reassurance in understanding how Mohs surgery is performed.

The procedure typically involves the following steps:

1. Local Anesthesia

The treatment area is cleansed with alcohol and Hibiclens and then numbed with a local anesthetic like lidocaine. You will remain awake but comfortable throughout the procedure.

2. Layered Removal of Cancerous Tissue

The visible tumor is removed along with a very thin layer of surrounding tissue.

3. Microscopic Processing and Examination

A 30-40 minute intermission is then taken for the tissue to be stained, frozen, oriented, processed, and then carefully examined under the microscope by the dermatologic surgeon to check the margins for residual cancer cells.

4.Repeat Stages as Needed

If cancer cells are seen at the margin or border, another layer of tissue is removed precisely from the affected area. This process repeats until the margins are completely clear.

5. Reconstruction

Once the cancer is fully removed, the wound is repaired. Depending on the size and location, this may involve simple suturing, allowing it to heal by secondary intention, or reconstruction using a flap or graft.

Dermatology Associates of the bay area doctors, pa, aesthetician, and staff. Group image outside.

Board-Certified Dermatologists Serving Petaluma & Hercules

Our team of board-certified dermatologists is dedicated to providing expert skin care for patients of all ages. At Dermatology Associates of the Bay Area, we combine advanced dermatology techniques with personalized care to help you achieve healthy, beautiful skin.

Choose a trusted dermatology practice committed to exceptional care and long-term skin health.

What sets us apart:

Board-Certified Dermatologists – Our dermatologists have completed rigorous training and certification to deliver the highest level of dermatologic care. Our medical colleagues recognize our expertise, and as such, we have been recipients of Castle Connolly Top Doctors – including most recently in January 2025
Comprehensive Skin Care – From medical dermatology and acne treatment to advanced acne scar solutions and cosmetic procedures, we offer a full range of services under one roof.
Patient-Focused Approach – Every treatment plan is customized to fit your unique skin type, concerns, and goals.
Advanced Technology – We use clinically proven treatments and devices for effective, safe results.

What to Expect During and After Mohs Surgery

Length of procedure: Patients should plan to spend several hours at the office to allow time for excision of the skin cancer, tissue processing and analysis, and subsequent closure of the surgical wound.
Recovery: Most patients resume normal activities within a few days, although strenuous exercise may need to be avoided for 1–2 weeks.
Scarring: All surgical wounds heal with some scarring. We strive to repair every Mohs surgical defect in the most cosmetic way possible. We provide post-operative wound care instructions and offer suggestions like focal CO2 laser to optimize the final cosmetic appearance if warranted.
Follow-up care: Regular dermatology checkups remain essential, as having one skin cancer increases the risk of developing further skin cancers in the future.

Older couple enjoying a day out with their bicycles

Advantages of Mohs Surgery

Highest cure rate available for skin cancer.
Spares as much healthy tissue as possible, improving cosmetic outcomes
Provides same-day results, eliminating waiting periods for pathology reports.
Effective for recurrent or aggressive cancers.

Why Choose Dermatology Associates of the Bay Area for Mohs Surgery?

Board-certified dermatologists with advanced training in Mohs surgery and skin cancer management.
On-site laboratory facility, allowing immediate processing and microscopic evaluation of tissue.
Comprehensive care, from diagnosis and surgery to reconstruction and follow-up surveillance.
Personalized attention: Our team understands the anxiety that comes with a skin cancer diagnosis, and we are committed to guiding you through every step with compassion and expertise.

Provider consulting with patient - dermatology office

Take the Next Step

If you have been diagnosed with skin cancer or have a suspicious lesion, schedule a consultation with Dermatology Associates of the Bay Area to review whether Mohs surgery or another surgical option is right for you. We can review with you the best diagnostic and treatment options.

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Mohs Micrographic Surgery

Frequently Asked Questions

Is Mohs surgery painful?

Patients experience little to no pain during the procedure thanks to local anesthesia. Mild pain, swelling, or bruising may occur afterward, but most patients manage symptoms with acetaminophen or ibuprofen.

Will I need stitches?

In most cases, yes. The type of closure depends on the size and location of the surgical site. We will review options to ensure the best functional and cosmetic outcome.

How should I prepare for the procedure?

Please wash up and shower the morning of surgery. Patients can eat a normal breakfast and take regular medications, including blood thinners.

What is the recovery time?

Healing varies depending on the size and complexity of the repair, but most patients return to normal daily activities quickly. Complete healing may take several weeks.

Does insurance cover Mohs?

Yes. Almost all health insurance carriers, including Medicare, cover the procedure. Our office can help verify your coverage.