Mohs Surgery & Reconstruction
Mohs micrographic surgery removes skin cancer layer by layer, with 100% of the removed margin examined under the microscope the same day – so the cancer is traced to its roots and removed completely, while healthy skin is preserved.
Why Mohs?
- For appropriate skin cancers, Mohs offers the highest reported cure rates of any treatment approach
- It removes the least healthy tissue possible – which matters most on the face, nose, eyelids, lips, ears, and hands
- The margins are checked the same day, so you leave knowing the cancer is out
- Reconstruction is typically performed the same day, immediately after clearance
When Mohs is used
Mohs is most commonly used for basal cell carcinoma and squamous cell carcinoma – particularly in cosmetically or functionally sensitive locations, for larger or recurrent tumors, or where tissue preservation matters. Certain melanomas and rarer skin cancers are treated with Mohs or staged excision in selected cases; your specific diagnosis guides the recommendation.
The day of surgery
- Numbing: the area is anesthetized with local injections – you are awake and comfortable, and can eat, take your usual medications, and drive yourself home in most cases
- Removal: a thin layer of tissue is removed and processed in the on-site lab while you relax in the waiting area
- Margin reading: the surgeon examines the entire margin under the microscope; if any roots remain, only that precise area is removed in the next stage
- Reconstruction: once margins are clear, the wound is repaired the same day – from simple closures to flaps and grafts, tailored to the location and to you
Reconstruction
Reconstruction is where surgical craftsmanship shows. As a fellowship-trained Mohs surgeon with additional fellowship training in cosmetic dermatologic surgery, Dr. Farmer designs each repair around function and appearance – meticulous closures, dissolvable sutures when possible, and advanced repairs including flaps and grafts for complex defects. For selected wounds, evidence-supported advanced healing options such as skin-substitute grafts may be used when they meaningfully improve healing.
One-visit surgical care
When clinically appropriate, consultation and surgery are completed in a single visit – with no separate preoperative appointment and no routine in-person postoperative visit unless needed or desired. This matters especially for patients traveling from a distance.
Comfort and procedural anxiety
Surgery on your face is a big deal, and nervousness is normal. Comfort is planned in advance – and for patients with significant procedural anxiety, options to ease the day can be discussed before surgery.
Frequently asked questions
Does Mohs surgery hurt?
The numbing injection stings briefly; after that, most patients feel pressure but not pain. Discomfort afterward is usually modest and manageable.
How long does it take?
Plan for a half day. Each stage takes time to process in the lab – bringing a book, a snack, and patience is the standard advice. For an hour-by-hour account of what the day actually involves, see what actually happens during Mohs surgery.
Will I need multiple appointments?
Usually not. Consultation, surgery, margin clearance, and reconstruction are typically completed the same day, and follow-up can often be handled remotely when appropriate.
Who performs the reconstruction?
Dr. Farmer performs the reconstruction in nearly all cases, immediately after clearance. For selected defects – for example, some eyelid repairs – care is coordinated with plastic, oculoplastic, or other surgical colleagues.
What will the scar look like?
Every surgery leaves some scar. The goal of Mohs plus careful reconstruction is the smallest possible wound and a repair designed to heal as inconspicuously as your anatomy allows – and scars continue to improve for months.
Magnolia Forge Dermatology is coming to Raleigh, North Carolina. We are not yet scheduling appointments.
Medical content: William S. Farmer, MD · Last reviewed: July 2026
