How To Know if You Are a Candidate for Mohs Surgery 

Explore Key Factors and Self-Assessment Questions to Determine Your Eligibility.

To determine if Mohs surgery is the right option for you, several factors are considered by a dermatologist or skin cancer specialist. These include the type of skin cancer, its location, size, recurrence history, and overall patient health. 

If you have a basal cell or squamous cell carcinoma, particularly if it's large, on the face, hands, or genitals, or has recurring or aggressive features, Mohs surgery may be a good choice.

Understanding Mohs Surgery Candidacy - The Foundation

Mohs surgery is a specialized technique for removing skin cancer. The surgeon removes the tumor in stages, one thin layer at a time. After removing a layer, it's immediately examined under a microscope to check for cancer cells. This process is repeated until no cancer cells remain, ensuring all cancerous tissue is removed while sparing the maximum amount of healthy tissue.

What Makes Someone an Ideal Candidate

An ideal candidate for Mohs surgery typically has a specific type of skin cancer located in an area where preserving healthy tissue is critical for both function and appearance. Factors like the tumor's size, its specific features, and the patient's overall health history are all taken into account.

Key Factors That Determine Eligibility

A dermatologist or Mohs surgeon will evaluate several key factors to determine if Mohs is the most appropriate treatment for you:

• Cancer Type: Mohs is most commonly used for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
• Location: Cancers on the head, neck, hands, feet, and genitals are often treated with Mohs to preserve tissue.
• Tumor Characteristics: Large, aggressive, rapidly growing, or recurrent tumors are strong candidates for Mohs.
• Patient Health: An individual's immune status can influence the decision, as those with suppressed immune systems may be at higher risk for aggressive or recurring cancers.

Why Candidacy Assessment Matters for Outcomes

Properly identifying who is a good candidate for Mohs surgery is crucial for achieving the highest possible cure rates and the best cosmetic and functional results. When performed on the right patient for the right tumor, Mohs surgery minimizes the amount of healthy tissue removed, which leads to smaller scars and better preservation of important structures like eyelids, lips, and the nose.

Self-Assessment Questions to Help Evaluate Your Candidacy

While only a qualified surgeon can make a final determination, this self-assessment can help you understand how your situation aligns with the standard criteria for Mohs surgery.

Cancer Type and Characteristics Evaluation

Consider the specifics of your diagnosis.

• Have you been diagnosed with Basal Cell Carcinoma (BCC) or Squamous Cell Carcinoma (SCC)?
• Has the cancer returned after a previous treatment?
• Does the tumor have aggressive features noted on the biopsy report?
• Is the tumor growing rapidly?

Location and Anatomical Risk Assessment

The location of the skin cancer is a primary factor in determining candidacy.

• Is the cancer located on your face, scalp, neck, hands, feet, or genitals?
• Is it near a functionally important or cosmetically sensitive feature, such as your eyes, nose, lips, or ears?

Personal Health Factors Checklist

Your overall health plays a role in treatment decisions.

• Do you have a condition or take medication that suppresses your immune system (e.g., organ transplant recipient)?
• Do you have a history of previous high-risk skin tumors?
• Has the cancer developed in an area of a previous scar or radiation treatment?

Medical Criteria Deep Dive - What Doctors Look For

A Mohs surgeon's evaluation is based on established medical guidelines. Here is a more detailed look at the clinical factors they consider.

Skin Cancer Types Best Suited for Mohs

Basal Cell Carcinoma (BCC) Considerations BCC is the most common type of skin cancer and the most frequently treated with Mohs surgery. The procedure is especially effective for BCCs that are large, have aggressive growth patterns, have returned after previous treatment, or are located in high-risk areas.

Squamous Cell Carcinoma (SCC) Factors SCC is the second most common skin cancer, and Mohs is a primary treatment for it, particularly for high-risk tumors. This includes SCCs on the head and neck, those that are large or growing rapidly, and those occurring in immunosuppressed patients.

Melanoma and Rare Cancer Types While standard excision is often used for melanoma, Mohs surgery may be used in specific cases, such as for certain early-stage melanomas on the face. It is also used for some less common skin tumors.

Location Matters: High-Risk Anatomical Zones

Doctors often refer to an "anatomical map" to classify risk.

Area H (High-Risk): Face, Scalp, Neck This "mask area" of the face, along with the scalp, neck, ears, hands, feet, and genitals, is considered high-risk. Preserving tissue in these areas is critical for function and appearance, making Mohs the preferred treatment.

Area M (Medium-Risk): Cheeks, Forehead, Trunk, and Extremities This includes the cheeks, forehead, and neck, as well as the shins. While not as high-risk as Area H, Mohs may still be recommended, especially for larger or more aggressive tumors.

Special Considerations for Hands, Feet, and Genitals These areas are critical for daily function. Mohs surgery helps preserve nerves, tendons, and other vital structures, making it the gold standard for cancers in these locations.

Tumor Characteristics That Influence Candidacy

Size and Depth Considerations Larger tumors are often candidates for Mohs surgery. Cancers that have grown deep into the skin layers also benefit from the precise, layer-by-layer removal technique.

Recurrent vs. Primary Tumors If a skin cancer has come back after being treated with another method, Mohs surgery is often the best choice for removal. Scar tissue from previous treatments can hide cancerous roots, which the microscopic examination of Mohs can find.

Aggressive Histological Features Sometimes a biopsy report will describe a tumor's cells as having an "aggressive" or "infiltrative" growth pattern. This means the cancer may have roots that extend far beyond what is visible on the surface, making it an ideal case for Mohs.

Timeline Critical: Understanding Your Treatment Urgency

After a diagnosis, it's natural to wonder how quickly you need to act. The urgency of Mohs surgery depends on the specifics of your cancer.

Urgency Classification System

Your doctor will classify the urgency based on risk factors.

• Immediate Priority: Cancers that are growing very quickly, showing aggressive features, or located in critical areas may require surgery within days or a couple of weeks.
• Standard Timeline: For less aggressive, newly diagnosed BCC or SCC, surgery is often scheduled within a few weeks to a month. This allows for proper planning without significant risk of tumor progression.

Factors That Accelerate Treatment Needs

Certain signs indicate a need for more urgent treatment. These include rapidly growing tumors, recurrent cancers, or those with aggressive subtypes noted on the biopsy. Cancers located near vital structures like the eyes also warrant more immediate action to prevent damage.

Safe Waiting Periods by Cancer Type

For a non-aggressive BCC, a delay of a few weeks is generally safe. However, for an incompletely removed SCC, surgeons typically recommend Mohs surgery within 2 to 6 weeks to ensure the initial wound heals while promptly removing any remaining cancer. Always consult your surgeon, as they will provide the best recommendation for your specific situation.

When Immediate Action Is Required

If you notice a lesion changing or growing rapidly, contact your dermatologist immediately. Aggressive cancers require swift action to achieve the best outcome and limit the extent of the surgery.

Alternative Treatments When Mohs Isn't Right

Mohs surgery is not always necessary or appropriate. For low-risk cancers or patients with certain health conditions, other effective treatments are available.

Standard Excision Options

This involves surgically removing the visible tumor along with a surrounding margin of healthy skin. It is a common and effective treatment for many low-risk skin cancers.

Radiation Therapy Considerations

Radiation uses high-energy X-rays to destroy cancer cells. It can be an option for patients who cannot undergo surgery or for large tumors that would be difficult to remove surgically.

Topical and Non-Surgical Treatments

Several non-surgical options exist for superficial or low-risk skin cancers.

• Electrodesiccation and Curettage (ED&C): The tumor is scraped away and the area is treated with an electric needle to destroy remaining cancer cells.
• Cryosurgery: Liquid nitrogen is used to freeze and destroy the cancerous tissue.
• Topical Creams: Creams like Imiquimod can stimulate the immune system to fight very superficial skin cancers.
• Photodynamic Therapy (PDT): A special light-activated drug is applied to the skin to kill cancer cells.

How to Discuss Alternatives with Your Doctor

If you are concerned about surgery, ask your doctor to explain all your options. Discuss the cure rates, potential side effects, recovery time, and cosmetic outcomes for each alternative to make a choice that is right for you.

Preparing for Your Mohs Consultation

A successful consultation starts with good preparation. This is your opportunity to get clear answers and feel confident in your treatment plan.

Essential Questions to Ask Your Surgeon

Being prepared with questions ensures all your concerns are addressed.

• Why am I a good candidate for Mohs surgery?
• What is the expected cure rate for my specific type of cancer?
• What are the potential risks and complications?
• What can I expect during recovery, and what will the scar look like?
• Are there any alternative treatments I should consider?

Medical History and Documentation to Bring

Your surgeon will need a complete picture of your health.

• Bring a copy of your biopsy report and any other relevant medical records.
• Have a list of all medications and supplements you take, especially blood thinners.
• Inform the doctor of any allergies or other medical conditions.

Insurance Verification and Cost Considerations

Understanding the financial aspect is an important part of planning.

• Confirm that the Mohs surgeon is in your insurance network.
• Ask the office about the estimated cost and what your out-of-pocket expenses might be. Mohs surgery is typically covered by insurance when medically necessary, but coverage can vary.
• Inquire about financial assistance programs if needed.

Setting Realistic Expectations

Mohs surgery can be a long day, sometimes lasting several hours, as you wait for the lab results between each stage. Plan to clear your schedule and arrange for someone to drive you home. Understand that while Mohs offers the best cosmetic outcome possible, there will be a scar.

Frequently Asked Questions About Candidacy

Can my age or health prevent me from having Mohs surgery? While advanced age or severe health problems can be a factor, Mohs surgery is often well-tolerated because it uses local anesthesia. Patients with conditions that impair wound healing or who cannot safely lie down for the procedure may not be candidates. Your surgeon will determine if it's safe for you.

What if I have multiple skin cancers? Can they all be treated with Mohs? Yes, it is common for patients to have multiple skin cancers. Depending on the location and number, your surgeon may treat them on the same day or schedule separate appointments.

Should I get a second opinion on my Mohs surgery candidacy? Getting a second opinion is always a reasonable choice, especially if you have a complex case or feel uncertain. A consultation with another fellowship-trained Mohs surgeon can provide reassurance and confirm the recommended treatment plan.

How do I know if my insurance will cover Mohs surgery? Most insurance plans, including Medicare, cover Mohs surgery when it is deemed medically necessary. Your surgeon's office will typically seek pre-authorization from your insurance company. It is always wise to call your insurer directly to confirm your coverage details.

Next Steps: Moving from Assessment to Action

With a better understanding of your potential candidacy, you are ready to take the next steps toward treatment.

How to Find a Qualified Mohs Surgeon

The most important step is to choose a surgeon who is fellowship-trained in Mohs surgery. This means they have completed an intensive, post-residency training program focused exclusively on the Mohs technique and complex reconstructions, ensuring the highest level of expertise. You can ask for recommendations from your dermatologist or check patient reviews online.

Scheduling Your Consultation

Once you have chosen a surgeon, schedule a consultation to confirm your candidacy and create a treatment plan. Be prepared to discuss your medical history and ask any remaining questions you may have.

Preparing for Treatment Success

Follow all pre-operative instructions from your surgeon, such as avoiding certain medications, alcohol, and smoking, which can interfere with healing. A successful outcome is a partnership between an expert surgeon and a well-prepared patient.