Excisional surgery vs Mohs surgery

Excisional surgery removes a lesion with a planned margin, while Mohs surgery checks tissue edges during the procedure.

With standard excision, the specimen is sent for laboratory assessment after the procedure. Mohs surgery removes tissue in mapped layers and examines each layer before more tissue is taken, which can guide how far surgery needs to extend.

Excisional surgery may be considered when a clinician can define an appropriate treatment margin from the lesion type, its location, and the examination findings. It can also provide a complete specimen for pathology when a lesion needs diagnosis or removal.

Closure may be straightforward for some sites, but the planned scar direction, skin tension, and nearby structures still influence the approach.

Mohs surgery may be considered when preserving uninvolved skin is especially relevant, such as around delicate facial features, or when the visible border does not clearly show the full extent of a diagnosed skin cancer. The mapped examination process can help direct further removal only where tumour cells remain.

The procedure and repair may be coordinated on the same visit once the surgical edges have been assessed.

Both procedures create a wound and can lead to bleeding, bruising, swelling, infection, wound separation, altered sensation, or a noticeable scar. The chance and impact of these issues depend on the body site, wound size, medicines, healing history, and reconstruction needed.

Follow wound-care instructions closely and contact the treating team promptly for increasing pain, spreading redness, pus, fever, persistent bleeding, or a wound that opens.

A changing or uncertain lesion may first need a focused skin examination and sometimes a biopsy to establish the diagnosis. Some non-cancerous concerns can be observed, treated differently, or removed for a reason that does not require Mohs surgery.

Do not delay assessment for a spot that is changing, bleeding without a clear injury, repeatedly crusting, or failing to heal.

The recommendation is built from the confirmed or suspected diagnosis, the lesion’s size and borders, its body site, previous treatment, and the likely repair after removal. Your clinician may also review your medical conditions, regular medicines, pregnancy status where relevant, and preferences about scar placement and visit logistics.

Bring a list of medicines and mention prior reactions to local anaesthetic, dressings, or surgery so the plan can be tailored safely.