Skin Cancer Surgery Choices

Can’t take credit of info below - I asked ChatGPT

1. What makes Mohs surgery different?

Mohs is a precise, staged procedure where:

• The visible cancer is removed

• 100% of the surgical margins are examined under a microscope

• Additional tissue is removed only where cancer cells remain

• This repeats until margins are completely clear

Key advantages

• Highest cure rates

• Basal cell carcinoma (BCC): 97–99%

• Squamous cell carcinoma (SCC): 94–97%

• Tissue-sparing – critical on face, nose, eyelids, lips, ears, scalp, hands

• Lower recurrence rates

• Ideal for aggressive, recurrent, or poorly defined cancers

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2. Why not just do a wide local excision?

Wide excision:

• Removes the tumour plus a predetermined margin (e.g. 4–10 mm)

• Only a small sample of margins is checked by pathology (not 100%)

Limitations

• May remove more healthy tissue than necessary

• Or miss cancer at the margins (especially with “roots” or finger-like extensions)

• If margins aren’t clear → second surgery needed

Wide excision works well for:

• Low-risk cancers

• Trunk, arms, legs

• Well-defined, non-aggressive lesions

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3. Why not curettage & cautery?

Curettage involves scraping the tumour and cauterising the base.

Limitations

• No margin control

• Cannot detect deeper or infiltrative spread

• Higher recurrence rates

• Poor cosmetic outcomes in visible areas

Best suited for:

• Small, superficial BCCs

• Low-risk areas (not face or ears)

• Patients who cannot tolerate surgery

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4. When Mohs is specifically recommended

Mohs is usually advised when one or more of the following apply:

Cancer on high-risk areas (face, nose, eyelids, lips, ears, scalp, hands, genitals)

Recurrent cancer

Aggressive subtypes (infiltrative, morpheaform, poorly differentiated SCC)

Large or ill-defined borders

Cancer in immunosuppressed patients

Prior incomplete excision

Need to preserve function and appearance

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5. In practical terms (why your doctor chose Mohs)

Your dermatologist is weighing:

• Complete cancer clearance

• Lowest chance of recurrence

• Best cosmetic and functional outcome

• Minimizing repeat surgeries

If any of your cancers are on the face or are aggressive/recurrent, Mohs is usually the gold standard.

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Bottom line

Mohs surgery is chosen when accuracy matters more than speed — especially in high-risk locations or aggressive cancers — because it offers the best balance of cure rate, tissue preservation, and cosmetic outcome.