Treating skin cancer requires careful consideration and a practical approach to removing cancerous cells while preserving the greatest amount of healthy structure. For many cases, that comes down to comparing Mohs surgery vs excision. According to Dr. Juan Pinto of U.S. Dermatology Partners Houston, “While Mohs surgery gets a lot of attention, both Mohs surgery and traditional surgical excision are effective ways to remove cancerous skin cells. The right treatment option will depend on a number of variables that you should discuss with your dermatologist.” In this blog, Dr. Pinto explores the differences between Mohs surgery and traditional excision.
What Is Mohs Surgery?
If you’re newly diagnosed with skin cancer, you may be wondering, what is Mohs surgery? This specialized treatment was developed to remove cancerous tumor cells while preserving the maximum amount of healthy surrounding skin tissue. The procedure involves removing thin layers that are then examined in-office under a microscope. The process is repeated until no more cancer cells are present. Because the margins are checked as the procedure is conducted, Mohs surgery is one of the most precise skin cancer solutions, and it’s often recommended for skin cancer in sensitive areas like the face, scalp, hands, feet, and genitals.
What Is Standard Excision?
The other top dermatologist-recommended skin cancer removal options are standard excisions. This surgical treatment involves using a scalpel to remove the tumor and a small margin of healthy surrounding tissue to ensure all cancerous cells are removed. The excised tissue is sent to an outside lab for analysis. It’s most often recommended for the removal of low-risk skin cancers, especially when they’ve been diagnosed in early stages.
Key Differences Between Mohs Surgery and Excision
While both Mohs surgery and surgical excision involve surgically removing the tumor and a small amount of surrounding skin, there are a number of key differences that should be considered before moving forward with treatment, including:
- Tumor location – for sensitive areas like the eyelids, nose, lips, and hands, Mohs may be the best option. For less sensitive areas, standard excision may be recommended.
- Precision – Mohs preserves a greater amount of healthy tissue while standard excision removes wider margins.
- Recurrence rates – Mohs surgery includes examination of 100% of the margins surrounding the tumor, leading to a lower recurrence compared with excision. Standard excision requires the removal of a small amount of surrounding skin, but it’s not examined immediately to ensure all remaining margins are healthy. This increases risk for recurrence.
- Pathology – tissue removed during Mohs surgery is examined immediately and results are returned on the day of surgery. Surgical excision requires tissue be sent to a lab, and it can take several days to get results back.
Why Your Dermatologist May Recommend One Over the Other
According to Dr. Pinto, “Choosing between Mohs surgery and standard excision requires a comprehensive discussion with your dermatologist. They will walk you through your diagnosis, risk for recurrence, and a variety of other factors before making a recommendation. At the end of the day, the decision should only be made after careful consideration and addressing any concerns. It’s important for patients to enter the procedure feeling confident they chose the best option.” Below, Dr. Pinto outlines when dermatologists recommend each of these two skin cancer treatments.
Mohs Surgery Is Recommended When:
- Cancer is in a sensitive area like the face.
- The type of cancer is aggressive, recurrent, or there is a family history of skin cancer.
- The border of the tumor is unclear.
- Cosmetic results are important.
Excision Is Recommended When:
- Tumors are very small and well-defined.
- The cancer type is low-risk and less likely to spread or recur.
- The cancerous cells are on less sensitive parts of the body.
- Insurance won’t cover other options.
What to Expect from Each Procedure
In addition to the reasons above, Dr. Pinto says, “Patient comfort is critical when it comes to making the final decision between Mohs surgery and excision. That’s why I walk my patients through what to expect from both procedures before scheduling treatment, and we review it again on the day of the procedure.”
What to Expect from Mohs Surgery Procedures
Mohs surgery visits can take longer than standard excision because it involves removing layers of skin, examining tissue under the microscope, and repeating the process as needed until all margins are clear. While it may take a little longer, it results in the patient getting immediate confirmation that their margins are clear. Additionally, the less invasive nature of the procedure often allows dermatologists to start reconstructive treatments on the same day.
What to Expect from Standard Excision Treatments
This process is straightforward. A single surgical excision is performed to remove the tumor and a surrounding margin of healthy tissue. This can usually be done quicker than Mohs surgery. However, the tissue isn’t examined the same day. Instead, it’s sent to the lab, which means there aren’t immediate results. If pathology discovers the margins aren’t clear of cancer cells, an additional excision may have to be performed. This means reconstruction won’t start until after the final all clear from the pathology lab.
Benefits of Early Treatment
There are numerous benefits to exploring skin cancer removal options early and starting treatment right away, including:
- Treatment is more likely to be successful when performed in the early stages of skin cancer.
- Procedures are less invasive as the skin cancer is unlikely to have progressed to the interior layers of skin.
- Diminished risk for scarring and other cosmetic concerns.
- Less chance for skin cancer to recur.
When to See a Dermatologist
Not every lump or bump is skin cancer, but it never hurts to reach out to your dermatologist for an evaluation if you notice any new or changing lesions. However, it’s essential that you consult with your dermatologist if you notice any of the following, especially if you have a personal or family history of skin cancer:
- New or changing growths or lesions.
- Irregular looking or feeling growths.
- Sores that don’t heal or that repeatedly develop in the same spot.
The Right Skin Cancer Treatment Depends on Your Needs & Goals
When deciding between these two skin cancer surgery types, Dr. Pinto says, “Both Mohs surgery and traditional surgical removal are highly effective options for skin cancer treatment. However, the size and location of the tumors, individual goals, and other risk factors should all be factored in by your dermatologist before moving forward with one or the other. Finding a dermatologist you trust to provide effective care is essential.”
Schedule a Professional Skin Exam
Annual skin exams with a dermatologist help ensure skin cancer is diagnosed in the earliest stages, while also allowing dermatologists to pinpoint other skin health concerns and offer treatment and skincare recommendations. If you’re interested in scheduling an annual skin cancer screening or a consultation at U.S. Dermatology Partners, take a few moments to complete our online scheduling request form, and a local team member will be in touch soon.
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