Mohs Micrographic Surgery for Skin Cancer in Birmingham
Advanced skin cancer removal with same day margin checking
Mohs micrographic surgery is a highly precise treatment for selected skin cancers, designed to remove the cancer completely while preserving as much healthy skin as possible. At Midland Skin, our specialist team of Consultant Dermatologists perform Mohs surgery under local anaesthetic with same-day microscopic margin checking and wound repair.
What is Mohs Surgery?
Mohs micrographic surgery is a highly precise treatment used to remove certain types of skin cancer while preserving as much healthy skin as possible.
It is most often used for skin cancers in areas where it is important to achieve the highest possible cure rate and keep tissue loss to a minimum, such as the nose, eyelids, lips, ears, scalp and other parts of the face.
Quick Facts about Mohs Surgery
Comfort
Local anaesthetic
Recovery
1-2 weeks
Duration
Allow most of the day
Laboratory
On site frozen section lab
Doctor
This is an example
Dumbbells
This is an example
What makes Mohs surgery different to other forms of excision?
During Mohs surgery, the visible skin cancer is removed along with a small margin of surrounding tissue. That tissue is then examined under the microscope straight away, layer by layer, to check whether any cancer cells remain at the edges. If cancer is still present, a further thin layer is removed only from the precise area where it remains. This process is repeated until the cancer has been fully cleared.
Because each layer is mapped and examined in detail, Mohs surgery allows your surgeon to confirm that the skin cancer has been completely during the procedure, removed while sparing as much normal skin as possible.
By eliminating guess work as to whether the tumour is fully removed, Mohs is one of the most effective treatments for selected basal cell carcinomas and squamous cell carcinomas.
Key Points about Mohs Micrographic Surgery
- Highly precise treatment for selected basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)
- Same day microscopic margin checking during surgery using an onsite frozen section laboratory
- Removes cancer stage by stage until fully cleared
- Provides confidence that the tumour is completely removed prior to closure of the wound
- Preserves as much healthy skin as possible, resulting in smaller wounds and therefore smaller scars.
- Highest cure rates among treatments for selected BCC
Watch More on Mohs
Who is Mohs surgery suitable for?
Mohs micrographic surgery is most commonly used for selected basal cell carcinoma (BCC) and squamous cell carcinoma (SCC).
These skin cancers tend to grow locally over time, like a weed with roots (see below). If the roots are not completely removed, they can continue to extend into the surrounding skin and nearby structures. Curing these skin cancers relies on removing these roots fully.
Mohs surgery may also be recommended when:
- the edges of the skin cancer are not clearly defined
- the skin cancer is in a high-risk site
- the skin cancer has come back after previous treatment
- the highest possible cure rate is an important consideration
- tissue preservation is important for both appearance and function
Not every skin cancer requires Mohs surgery.
The most appropriate treatment depends on the type of skin cancer, its size and position, whether it has been treated before, and how far it may extend beneath the surface.
Richard Green
How effective is Mohs micrographic surgery?
Mohs micrographic surgery offers very high cure rates for basal cell carcinoma, with published 5-year cure rates of around 99% for primary BCC and 94.4% for recurrent BCC.
This is the highest cure rate among all treatments available for treating the common skin cancers.
Prices for Mohs Surgery
Consultation Show pricing
Book NowInitial dermatology consultation
Mohs surgery Show pricing
Mohs surgery for skin cancer
How does skin cancer grow?
Understanding how skin cancer grows helps explain why Mohs micrographic surgery can be so effective. Many skin cancers begin in the upper layer of the skin and can grow both across the surface and deeper below it. They may also develop small extensions beyond the visible edge of the tumour, a little like the roots of a weed.
This means that the part of the skin cancer seen on the surface may not always reflect its full extent beneath the skin. If these extensions are not completely removed, the skin cancer can return.
Mohs surgery helps address eliminating roots that can not be seen by the naked eye by examining the removed tissue under the microscope during the procedure.
The tissue is frozen, and made into slides immediately after it is removed in our on site frozen section laboratory.
Each stage is carefully mapped so that any remaining cancer cells can be identified and removed with precision, while preserving as much healthy skin as possible
hello world
This s just a test.
Another test.
Hello world.
What happens on the day of Mohs surgery?
Mohs micrographic surgery is performed as an outpatient procedure under local anaesthetic. Because the tissue is examined during the procedure, you should expect to be with us for most of the day.
What happens when I arrive?
When you arrive, you will meet the Mohs surgeon and the team looking after you. The procedure will be discussed with you again, including what to expect on the day, and you will have the opportunity to ask any final questions before treatment begins.
The area to be treated is then examined carefully, and the skin cancer is marked on the skin together with a small safety margin.
Will the procedure hurt?
The skin is numbed using local anaesthetic injections which may sting for a few minutes. This means that you will not feel any pain during the procedure, even though you will still feel other sensations like touch. The local anaesthetic is topped up every time you have a further stage or when you have your reconstruction. You will be awake during the whole procedure.
How is Mohs surgery carried out?
After the skin has been numbed, the area that was marked out is removed. This tissue is then processed at the on site frozen section laboratory, and examined microscopically to check whether any cancer cells remain at the edges. This takes about 90-100 minutes.
A dressing is applied on the wound. You will be asked to wait in the waiting area while your tissue is being processed where light refreshments, tea, coffee and water are served.
If any residual cancer is identified, a further thin layer is removed only from the precise area where it remains. The tissue is then checked again, and this process is repeated until the cancer has been fully removed. This means that you may be in and out of theatre a few times in the day.
This staged approach allows complete cancer clearance to be confirmed while preserving as much healthy skin as possible. The steps involved are shown in the diagram below:
How many stages of Mohs surgery will I need?
In our experience, in around 50% of cases, the skin cancer is removed in 1 stage. In 90% of cases, the skin cancer is removed in 2 stages. 10% of cases required three or more stages. This is broadly consistent with published studies.
The exact number of stages, and the final wound that results, depends on how far the skin cancer extends beyond what is visible on the surface.
Repair and recovery
How is the wound managed after Mohs surgery?
Once the skin cancer has been completely removed, the wound is carefully assessed and the best way to manage it is decided in discussion with you.
Depending on the size, depth and position of the wound, this may involve direct closure with stitches, a skin flap, a skin graft, or allowing the area to heal naturally where appropriate.
In most cases, repair is carried out immediately on the same day. In others, it may be better to delay repair for a short period if this is considered the most appropriate approach.
In selected cases, reconstruction may be planned in advance with a specialist reconstructive colleague when this is considered the most appropriate option.
Because the final size of the wound can only be confirmed once the cancer has been fully cleared, it is not always possible to decide in advance exactly how the area will be repaired.
What dressings and aftercare will I need?
At the end of the procedure, a dressing is applied and you will be given written aftercare advice. A wound check appointment may also be arranged where needed.
It is important to keep the area clean, dry and protected, and to follow the aftercare instructions carefully. This helps support healing and reduces the risk of bleeding, infection or problems with the wound.
When do stitches come out?
You will be informed if you have any stitches which need removing. The timing of stitch removal depends on the area treated and the type of repair performed. In most cases, stitches are removed 6 to 14 days after surgery.
You will be advised about the expected timing of stitch removal and any follow-up appointments after your procedure.
How long does healing take?
Healing time varies depending on the size of the wound and how it is repaired.
As a general guide:
- small wounds may settle in around 7 to 10 days
- moderate excisions, with or without flap or skin graft repair, may take around 14 to 21 days
- wounds left to heal naturally may take around 4 to 8 weeks
Everyone heals at a slightly different rate, and the final scar will continue to mature over time.
Will there be a scar?
Yes. Any form of skin cancer surgery will leave a scar.
The aim of Mohs surgery is to remove the cancer completely while preserving as much healthy skin as possible. This helps keep the wound and resulting scar as small as possible, while still achieving complete cancer clearance.
The final appearance of the scar will depend on the size and position of the skin cancer, the number of stages needed, and the type of repair required. In most cases, the scar will continue to improve over the weeks and months after surgery.
What practical recovery advice should I follow?
You should plan to take things easy after your procedure. Avoid strenuous exercise, swimming and heavy lifting for at least 14 days, or for as long as advised by your surgeon.
Arrange for someone to drive you and to accompany you home. Local anaesthetic around the eye can occasionally cause temporary blurred vision or swelling afterwards.
It can also be helpful to keep the rest of the day free and to bring something to help pass the waiting time during the procedure, such as headphones, music or a podcast.
Book in with us
Ready to get started? Book a consultation with our team at Midland Skin. Friendly, expert advice tailored to you.
John Osborn
References used for this article
- Telfer NR, Colver GB, Morton CA. Guidelines for the management of basal cell carcinoma. Br J Dermatol. 2008;159(1):35–48. doi:10.1111/j.1365-2133.2008.08666.x.
- Tomás-Velázquez A, et al. Risk factors and rate of recurrence after Mohs surgery in basal cell and squamous cell carcinomas: a nationwide prospective cohort (REGESMOHS, Spanish Registry of Mohs Surgery). Acta Derm Venereol. 2021 Nov 24;101(11):adv00602. doi: 10.2340/actadv.v101.544.
About the Author
This page has been written and/or medically reviewed by Dr Sajjad Rajpar, Consultant Dermatologist and Medical Director of Midland Skin, Birmingham.
Dr Rajpar is on the GMC Specialist Register in Dermatology and has over 20 years’ experience in clinical dermatology. He provides clinical oversight to ensure the information on this page is accurate, balanced and consistent with current dermatology practice.
Dr Sajjad Rajpar
Date last updated: 14th Apr 2026
Book in with us
Expert, consultant led care in dermatology, skin surgery, eyelid surgery, lasers and aesthetics.
Disclaimer
The content on this website is provided for general information only. It is not, and must not be treated as, medical advice, a diagnosis, or a recommendation for any particular treatment. We make reasonable efforts to keep information accurate and up to date, but medicine and technology change, and content may not reflect the most current evidence, guidance, product information, or individual practice. You should not rely on this website to make decisions about your health or treatment. Always seek personalised advice from an appropriately qualified healthcare professional. Any examples, images, testimonials, and outcome descriptions are illustrative only. Results vary between individuals and no outcome can be guaranteed.
