Mohs Surgery for Basal Cell Skin Cancer: What to Expect on the Day

Basal cell carcinoma is a common skin cancer that grows slowly and rarely spreads, but it can grow deep, so early treatment matters. When found early and treated properly, it’s highly treatable.¹ If your biopsy came back positive, here is what Mohs surgery involves, based on information from the American Academy of Dermatology (AAD)¹.

What basal cell carcinoma can look like

The AAD lists a firm, round, raised growth; a spot that dips in the center; a scaly patch; a sore that doesn’t heal or keeps coming back; a scar-like mark; or a cluster of shiny bumps.¹ Most appear on the head and neck, including the ears, nose, eyelids and scalp.¹

Excision or Mohs?

Standard surgical excision, cutting out the tumor with a margin of skin, is the most common treatment.¹ Mohs surgery is a specialized technique often used when the cancer:¹

• is on an area with little tissue underneath, such as the ear, eyelid, nose, hand or foot
• is near or in a scar, or on skin treated with radiation
• is likely to grow deep or spread
• has come back after earlier treatment

Mohs has the highest cure rate of skin cancer treatments, but it isn’t right for everyone or every cancer.¹

How the day goes

1. Numbing. Most people stay awake.¹
2. First layer. The surgeon removes the visible tumor and a thin layer of skin around it.¹
3. You wait while that tissue is processed and checked under a microscope.¹
4. More layers if needed, taken only where cancer cells are seen, until the edges are clear.¹
5. Closing the wound. It may heal on its own, be stitched, or need a skin flap or graft.¹

Because the time depends on how many layers are needed, plan for a long appointment. Bring a book, a snack if allowed, and a ride home if the site is near your eye.

Before your appointment

The AAD suggests bringing a list of:¹

• your medicines and doses, including blood thinners such as aspirin, warfarin and clopidogrel
• vitamins and supplements
• any past skin cancers and their treatment

Ask whether to keep taking your blood thinner. Don’t stop it on your own.

After surgery

Scars can take more than a year to mature.¹ You’ll also need a full-body skin check at some point after diagnosis.¹ Daily sun protection helps; see our guide to choosing sunscreen. Our article on actinic keratosis treatments covers precancerous spots you may also be treated for.

Try: “My biopsy showed basal cell carcinoma on my nose. Is Mohs the right choice here, how long should I plan to be there, and what will the repair look like?”

Skin, Head to Toe includes a short-shelf planner and a 12-week SkinLog. Use them to photograph healing, track wound care and note spots to show at your next skin check. See the book.