Mohs Vs. Excision: Which Skin Cancer Surgery Is Best?

Receiving a skin cancer diagnosis—and deciding which treatment to pursue—can leave you feeling overwhelmed. If you’ve been researching Mohs surgery vs excision, know that it’s completely normal to have questions or worries. Both approaches effectively remove cancerous tissue, yet they differ in how they achieve that goal.

To help shed light on the options, we spoke with Dr. Bhuvanesh Singh, surgical director of the Skin Cancer Program at Northwell Health’s Cancer Institute.

Below, we’ll walk through what Mohs and standard excision look like, who might benefit most from each, and how to figure out which path may align best with your needs.

Mohs surgery is renowned for its meticulous, tissue-sparing approach. A surgeon removes very thin “layers” of skin, examining each under a microscope until they’re confident that all cancer cells are gone. Other factors to keep in mind:

It preserves healthy tissue: By removing only what’s absolutely necessary, Mohs aims to conserve as much normal skin as possible—particularly helpful around the face, ears, or neck where scarring can feel more worrisome.

There’s a high success rate for certain cancers: Basal and squamous cell carcinomas often respond quite well to Mohs, particularly in high-visibility areas because it removes only what’s necessary while offering a strong cure rate.

It’s a multi-stage process: Because each layer is checked in real time, you may have waiting periods during the procedure. The idea is to ensure you leave knowing all cancerous cells have been removed.

You could be a good candidate for Mohs surgery if:

• You’re concerned about preserving appearance, like on the nose, eyelids, or lips.
• You have smaller or less aggressive tumors.
• You feel comfortable receiving local anesthesia—sometimes multiple times in one visit.

Standard excision takes a more traditional route, removing the visible tumor along with a set margin of tissue. Pathology is analyzed afterward (rather than between each “layer”). This procedure works best for:

• Larger or more complex tumors: If the cancer covers a bigger area or has deeper roots, standard excision’s wider initial margin might be more reliable.
• Melanoma cases: Invasive melanoma often requires a broader margin, making excision the usual choice.
• Patients who want a one-step approach: Some people appreciate that it’s a singular surgery, often requiring only one round of anesthesia.

• Anyone with an extensive or aggressive form of skin cancer.
• Those who prefer general anesthesia or don’t wish to undergo multiple local injections.
• Individuals who’d rather get everything done in one definitive operation.

Technique: Mohs tackles the tumor layer-by-layer with on-the-spot pathology, while excision removes both the lesion and a surrounding margin in a single pass.

Procedure time: Mohs can involve several hours and multiple “checkpoints,” whereas excision tends to be one continuous procedure.

Tissue preservation: Mohs aims to conserve healthy skin; excision is inclined to remove a bit more upfront for extra certainty.

Who benefits most: Mohs is often favored for basal and squamous cell carcinomas in cosmetically sensitive locations, while excision is popular for melanoma and larger growths.

Throughout this process, be sure to share any worries you have with your surgeon. Don’t hesitate to ask about scarring, anesthesia preferences, or potential follow-up procedures. If you still feel uncertain, seeking a second opinion can be invaluable. Feeling seen and supported can make a real difference in how you approach treatment.

Which procedure has a quicker recovery?
Recovery times vary. With Mohs, you may spend extra time in the clinic on the day of surgery, but both Mohs and excision generally require similar post-op care. Your individual healing process also depends on the size and location of the incision.

Is one method less likely to scar?
Any surgical incision will likely leave some mark. The skill of the surgeon in closing the wound (and how you care for it afterward) can have a bigger impact on scarring than the removal method alone.

How do I decide between Mohs and excision?
Factors like tumor type, location, size, and your personal preferences (e.g., multiple injections vs. one-time anesthesia) all play a role. Consider chatting with your dermatologist or surgeon, and don’t shy away from a second opinion if it helps you feel more at ease.

• How to spot skin cancer before it gets worse.
• My experience with Mohs surgery.
• What you should know about skin biopsies.