---
title: "Skin Cancer Surgery & Mohs Referrals"
---
[The biopsy that confirmed it](/treatments/skin-cancer-diagnosis/) also told us a great deal: what type of cancer it is, how it behaves, and how it sits in the skin. That is what decides the treatment, along with how large it is and where on the body it is. There is no single answer, and the plan is explained to you before anything is scheduled.
Many basal cell and squamous cell cancers are treated here, surgically, under local anesthetic. The cancer is removed along with a margin of healthy skin around it, the wound is closed, and the tissue that came out is examined to confirm the cancer was fully removed. It is a same-day appointment and you go home afterward.
Some cancers are better treated by Mohs micrographic surgery, in which the surgeon removes a thin layer at a time and checks each one under a microscope during the appointment, continuing until no cancer cells remain. [1] It preserves more healthy skin and has a high cure rate, and it is usually the choice for cancers that are large or aggressive, that sit on the eyelid, nose or ear, or that have come back after earlier treatment. [1] We do not perform Mohs here. We identify when it is the right call and coordinate the referral.
**What this covers**
- Surgical removal of appropriate basal cell and squamous cell cancers, in office
- Assessment of whether Mohs micrographic surgery is the better route
- Coordinating the referral to a Mohs surgeon, and staying involved afterward
- Treatment of precancerous patches found along the way
- Ongoing skin surveillance once treatment is finished
Plenty of practices treat everything they can in house. We would rather you had the operation that suits the cancer, and sometimes that means sending you to somebody else. Here is how that decision is actually made.
In-office excisionMohs micrographic surgeryHow it worksThe cancer is removed with a margin around it, and the tissue is checked afterwardThin layers are removed and checked under a microscope during the appointment, until none remain [1]AppointmentOne visit, usually under an hourLonger, with waiting between layers while the tissue is examined [1]Healthy skinA standard margin is takenThe least amount of skin needed, which matters most on a face [1]Usually chosen forCancers on the trunk and limbs where a margin is easily sparedCancers that are large or aggressive, on the eyelid, nose or ear, or that have returned [1]Who performs itYour dermatologist, hereA fellowship-trained Mohs surgeon, most of whom are dermatologists [1]
The referral is not a handoff. We arrange it, send the pathology across, and pick your care back up afterward, including the skin checks that follow. **The right operation matters more than where it happens**, and on a face that difference is measured in millimeters of skin you get to keep.
The decision that matters here is not how the surgery is done, it is which surgery you have. A practice that treats everything in house has an interest in one answer. We do not perform Mohs, which means the recommendation you get is based on the pathology in front of us rather than on what we happen to offer.
It also means you are not left to organize it. We make the referral, send the pathology and imaging across, and take your care back once the site has healed, including the skin checks that follow for years afterward. Having had one skin cancer changes what a future check is looking for, and continuity is worth a great deal at that point.
**You will leave the planning appointment knowing:**
- What type of skin cancer it is, and what that means in ordinary language
- Whether it is treated here or with a Mohs surgeon, and why that call was made
- What the appointment itself involves and how long it takes
- What the site is likely to look like while it heals, and afterward
- What the follow-up schedule looks like
**Worth telling us before surgery:**
- Any blood-thinning medication you take, including aspirin
- Any bleeding disorder
- Any history of thick or raised scars
- Any pacemaker or implanted device, which affects some instruments
- Anything you are taking, including supplements bought without a prescription
None of this needs sorting out in advance of booking. Bring it to the appointment and it will be worked through with you.
Expect the site to be tender for several days, and remember that a healing wound looks nothing like the settled result. You will go home with a dressing, written instructions and a number to call. Stitches come out at 7 to 14 days depending on the site.
**While it heals, do**
- Follow the wound care instructions exactly, in the order you were given them
- Keep the dressing dry and in place until you are told otherwise
- Take it easy with anything that stretches the area, which is what keeps a scar narrow
- Keep the healed site covered or under broad-spectrum sunscreen, SPF 30 or higher [2]
- Keep your follow-up and your future skin checks
**While it heals, don't**
- Soak the site in a bath, pool or hot tub
- Pick at a scab or pull at a stitch
- Restart a blood thinner without being told to
- Assume a change at the site months later is nothing, because it is worth a look
Call us about anything that does not match what we described: bleeding that does not settle with pressure, increasing pain, spreading redness, or any sign of infection. We would far rather hear from you early, and there is always somebody to talk to.
Confirmed skin cancers and the precancerous changes around them. Pick a concern to see how we approach it.
Skin cancer surgery is medical care rather than a cosmetic service and is handled differently from the aesthetic treatments on this site. Our office will go through what applies to you before anything is scheduled.
Where you are referred to a Mohs surgeon, that surgeon's practice handles its own side of it, and we will tell you what to expect before the referral is made rather than afterward.
**Q: Will I be awake?**
Yes. In-office skin cancer surgery is done under local anesthetic. The area is numbed, you feel pressure rather than pain, and you go home the same day.
**Q: What is Mohs surgery, in plain language?**
The surgeon removes a thin layer, examines it under a microscope while you wait, and repeats that until no cancer cells remain. [1] Because the cancer is mapped as it goes, the least possible amount of healthy skin is removed, which is why it is favored on faces. [1]
**Q: Why do you refer Mohs out instead of doing it here?**
Because Mohs is a distinct specialty with its own fellowship training, and it should be done by somebody who does it constantly. [1] We identify when it is the right operation and coordinate the referral, and your care comes back to us afterward.
**Q: Will there be a scar?**
Any surgery on skin leaves a mark. How noticeable it ends up depends on the size, the site and how the wound is closed, and you will get a realistic picture of that at your planning appointment rather than afterward. Mohs generally allows a smaller wound on the face because less healthy skin is taken. [1]
**Q: What happens after treatment?**
Ongoing skin checks. Having had one skin cancer is the strongest reason there is to keep being checked, and your dermatologist will set the interval that fits your history.
**Q: Do I need a referral?**
Yes. This is medical dermatology, and the practice is currently accepting new medical patients by referral from your primary care physician. If a biopsy done elsewhere has confirmed a skin cancer, tell us when you call and bring the pathology report.
1. American Academy of Dermatology Association. "What is Mohs surgery?" States that "during surgery, the surgeon can see where the cancer stops," describes the layer-by-layer removal and microscopic examination until no cancer cells are found, states that "Mohs has a high cure rate," that it allows the surgeon to "remove the least amount of skin needed," that it is recommended for basal cell or squamous cell carcinoma that is "aggressive or large," located on the eyelid, nose or ear, or that has recurred, and that "most Mohs surgeons are dermatologists who have completed extensive training in Mohs surgery." [https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery](https://www.aad.org/public/diseases/skin-cancer/types/common/melanoma/mohs-surgery) · Medical Organization
2. American Academy of Dermatology Association. "How to select a sunscreen." Broad spectrum, SPF 30 or higher, water resistant. [https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen](https://www.aad.org/public/everyday-care/sun-protection/shade-clothing-sunscreen/how-to-select-sunscreen) · Medical Organization
Content on this page is for educational purposes and is not a substitute for professional medical advice, diagnosis or treatment. Treatment for a skin cancer depends on its type, size, location and pathology, and the approach described here may not apply to your case. Surgery on skin leaves a scar. Tenderness, swelling, bruising and a healing wound are expected. Bleeding, infection, delayed healing, thickened scarring and changes in sensation at the site are uncommon but possible, and a skin cancer can recur and require further treatment. Tell us about any blood-thinning medication, bleeding disorder, implanted device or history of thick or raised scars. Ongoing skin surveillance is recommended after treatment. Individual results may vary.
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