Mohs Micrographic Surgery

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Every skin has
a story.

Every plan at TLC Skyn starts with the person, not the procedure.

Dermatologist: Dr Swathy Krishna
Clinic: TLC Skyn, Kollam

Mohs micrographic surgery is a precise, tissue-sparing technique for removing certain skin cancers, most commonly basal cell carcinoma and squamous cell carcinoma. The procedure removes cancer layer by layer while examining each layer under a microscope during the same visit, allowing the surgeon to map and remove the entire tumour while preserving as much healthy surrounding skin as possible.

For patients in Kollam dealing with skin cancers on the face, ears, nose, lips, or other cosmetically sensitive areas, this approach offers a meaningful advantage: the highest cure rates for high-risk tumours without unnecessarily sacrificing healthy tissue. TLC Skyn provides assessment and guidance for patients considering Mohs surgery, helping them understand whether this technique is appropriate for their specific diagnosis and circumstances.

What Makes Mohs Surgery Different

What Is Mohs Micrographic Surgery?

Mohs micrographic surgery was developed by Dr. Frederic Mohs in the 1930s and has since become the standard of care for selected basal cell carcinomas and squamous cell carcinomas. The defining feature is complete microscopic margin control. Unlike standard excision, where a surgeon removes a tumour with a margin of normal-looking skin and sends it to a pathologist, Mohs surgery examines 100 percent of the surgical margin while the patient waits.

Here is how the process works:

The visible tumour is removed along with a thin layer of surrounding tissue
The tissue is divided into sections, colour-coded, and mapped to the surgical site
Frozen sections are prepared and examined under a microscope
If cancer cells remain at any margin, another thin layer is removed only from that specific location
The process repeats until no cancer cells are detected

This step-by-step approach means the surgeon removes only what is necessary. For a basal cell carcinoma on the nose or eyelid, that precision matters enormously.

Who May Benefit

Mohs surgery is particularly recommended for skin cancers that are:

Located on the face, ears, scalp, genitals, hands, or feet
Large or aggressive tumours
Recurrent cancers that have returned after previous treatment
Tumours with ill-defined borders
Cancers in areas where preserving healthy tissue is functionally or cosmetically important

Not every skin cancer requires Mohs surgery. Small, low-risk tumours on the trunk or limbs may be treated effectively with standard excision or other methods. A professional assessment is important because the decision depends on tumour type, location, size, and whether the cancer is primary or recurrent.

Treatment Options & Advantages

Treatment Options

The treatment approach at TLC Skyn begins with accurate diagnosis. A dermatologist examines the lesion, often with dermoscopy, and a biopsy confirms the type of skin cancer before any surgical decision is made.

For patients who are candidates for Mohs surgery, the process involves:

Preoperative assessment to review the biopsy results and plan the procedure
Same-day surgical removal with on-site microscopic margin analysis
Reconstruction of the wound, which may be performed by the Mohs surgeon or coordinated with a plastic surgeon depending on the defect size and location

For patients who are not candidates for Mohs surgery, alternatives may include standard surgical excision, curettage and electrodesiccation, radiation therapy, or topical treatments for superficial lesions. The appropriate option depends on the tumour characteristics and the patient’s overall health.

Treatment Advantages

The benefits of Mohs micrographic surgery are well documented:

Complete margin examination: The entire surgical margin is evaluated, not just a sampling, which reduces the chance of leaving cancer behind
High cure rates: For primary basal cell carcinoma, cure rates are typically around 99 percent; for recurrent tumours, the rates remain high compared to standard excision
Tissue conservation: Only cancerous tissue is removed, preserving healthy skin that would otherwise be sacrificed with wider margins
Same-day results: The procedure and microscopic analysis happen in one visit, reducing the waiting period for margin confirmation
Cost-effectiveness over time: Fewer recurrences mean fewer additional surgeries and treatments

The main trade-off is time. A Mohs procedure can take several hours because of the repeated freezing, sectioning, and microscopic examination. Patients should plan for a longer appointment than a standard excision.

Frequently Asked Questions

Is Mohs considered a major surgery?

Mohs surgery is not considered major surgery in the traditional sense. It is performed under local anaesthesia, usually in an outpatient clinic setting, and does not require general anaesthesia or hospital admission. However, it is a meticulous procedure that demands significant time and expertise. The wound reconstruction can sometimes be extensive, but the surgery itself is localised to the skin.

What are the negatives of Mohs surgery?

The primary drawbacks are the duration of the procedure and the need for specialised facilities. Each layer takes time to process and examine, so patients may spend several hours at the clinic.

Can basal cell carcinoma come back after Mohs surgery?

Recurrence after Mohs surgery is uncommon but possible. For primary basal cell carcinoma, the five-year recurrence rate is approximately 1 percent. For recurrent basal cell carcinoma that has been treated before, the recurrence rate after Mohs is higher, around 5 to 6 percent. No surgical technique can guarantee that cancer will never return, which is why regular follow-up skin examinations remain important after treatment.

What is the Mohs surgery technique?

The technique involves removing the visible tumour, then excising a thin, saucer-shaped layer of surrounding skin. This layer is cut into sections, marked with coloured dyes, and mapped onto a diagram of the surgical site. The tissue is frozen, sliced horizontally, and examined under a microscope. If tumour cells are present at any edge, the surgeon returns only to that specific area and removes another thin layer. This continues until the margins are clear.

How long does recovery take after Mohs surgery?

Recovery varies depending on the size and location of the wound. Most patients experience mild discomfort for a few days, manageable with simple pain relief. Sutures are typically removed after one to two weeks. The wound may take several weeks to months to fully mature and fade. Patients in Kollam should be particularly mindful of sun protection during recovery, as UV exposure can worsen scarring and increase the risk of new skin cancers.

Do I need a referral for Mohs surgery in Kollam?

A referral is usually required, as Mohs surgery is performed only after a biopsy confirms the diagnosis. Your dermatologist or primary care physician can assess the lesion and refer you to a Mohs surgeon if indicated. TLC Skyn can evaluate your skin cancer and guide you through the referral and treatment pathway.

If you have a biopsy-confirmed skin cancer or a suspicious lesion that has not healed, seek a professional assessment. Early evaluation leads to more treatment options and better outcomes. Contact TLC Skyn in Kollam to book an appointment and discuss whether Mohs micrographic surgery is right for you.

Every skin hasa story.