Mohs Surgery in Houston: What to Expect, Recovery, and Cure Rates

This article is educational and does not replace an evaluation by a board-certified dermatologist. If you have a concerning skin change, please book a visit.

Most people hear the words "Mohs surgery" for the first time right after a biopsy comes back as basal cell or squamous cell carcinoma, usually on the face, ears, scalp, or hands. It is a reasonable moment to feel anxious. Mohs micrographic surgery is a precise, office-based way to remove these cancers one thin layer at a time, checking every edge under the microscope while you wait, so that as little healthy skin as possible is removed. This guide explains how a Mohs day actually goes, what the published cure rates mean, when Mohs is and is not the right choice, and what recovery looks like. If you have a spot that has not been checked yet, start with a skin exam.

What Mohs micrographic surgery is

Where the technique came from

The procedure is named for Frederic E. Mohs, MD, who treated his first patient with the technique at Wisconsin General Hospital in Madison in 1936. His early method fixed tissue chemically; a shift to fresh frozen tissue in the decades that followed made it possible to remove the cancer and repair the wound on the same day (American College of Mohs Surgery). The defining feature has not changed: color-coded mapping of every piece of removed tissue and complete microscopic examination of its edges.

How Mohs differs from a standard excision

In a standard excision, the surgeon removes the visible tumor with a fixed margin of normal-looking skin, closes the wound, and sends the specimen to a lab. The pathologist examines representative slices, and results come back days later. In Mohs surgery, the surgeon processes and reads the tissue on site, examining the entire peripheral and deep margin. The American Academy of Dermatology describes the unique benefit simply: during Mohs, the surgeon can see where the cancer stops (AAD). That has two consequences. Cancer roots that extend beyond what the eye can see are followed and removed, and healthy skin is spared, which matters most on the nose, eyelids, lips, and ears.

How a Mohs surgery day actually goes

Plan to spend much of the day with us. The AAD and our own Mohs surgery page describe the same sequence:

1. Examination and numbing. The surgeon examines and marks the site, then injects local anesthetic. You stay awake; only the treatment area is numb.
2. The first stage. The visible tumor is removed along with a thin layer of surrounding skin. The wound is bandaged and you wait in a comfortable area.
3. Mapping and microscope review. The tissue is divided, color-coded to a map of your wound, frozen, cut into thin sections, stained, and examined under the microscope. This usually takes the most time.
4. Additional stages if needed. If cancer cells remain at any edge, the map shows exactly where, and only that area is removed in the next stage. The cycle repeats until the margins are clear.
5. Repair. Once the margins are clear, the wound is repaired, most often the same day.

Most patients need one or two stages. Because each stage requires processing time, expect to be at the office at least two to four hours, and longer if more stages are needed. Bring a book, a snack, and a sweater.

Mohs surgery cure rates, and what the numbers mean

The most frequently quoted Mohs numbers come from a series of pooled reviews by Rowe, Carroll, and Day, which compiled every published study with long-term follow-up for each treatment method. The figures below are 5-year outcomes, the standard way to measure recurrence for these cancers:

• Primary (previously untreated) basal cell carcinoma. The 5-year recurrence rate after Mohs was 1.0%, meaning about 99% did not recur, compared with 10.1% after surgical excision, 7.7% after curettage and electrodesiccation, 8.7% after radiation, and 7.5% after cryosurgery (Rowe et al., 1989).
• Recurrent basal cell carcinoma. For cancers that had already come back after an earlier treatment, the 5-year recurrence rate after Mohs was 5.6%, or roughly 94% control, compared with 19.9% for non-Mohs methods combined (Rowe et al., 1989).
• Squamous cell carcinoma. Local recurrence after Mohs was 3.1% for primary squamous cell carcinoma of the skin and lip versus 10.9% for other methods, and 10% versus 23.3% for squamous cell carcinomas that had recurred (Rowe et al., 1992).

The Skin Cancer Foundation summarizes the same picture as a cure rate of up to 99% for a skin cancer that has not been treated before and up to 94% for one that has recurred. These are pooled averages from older literature, not a guarantee for any single tumor. Size, location, subtype, and your immune status all change individual risk, which is why follow-up skin exams continue after surgery.

Mohs is also used for some early melanomas, specifically melanoma in situ of the lentigo maligna type on the head and neck. The AAD notes these cases are often treated with a modified "slow Mohs," in which tissue takes longer to process and patients usually return the next day for results (AAD).

When Mohs is the right choice

The Appropriate Use Criteria

Mohs is not the right operation for every skin cancer. In 2012 the American Academy of Dermatology, the American College of Mohs Surgery, and two other dermatologic surgery societies published Appropriate Use Criteria rating 270 clinical scenarios. The panel rated 200 scenarios (74%) appropriate for Mohs, 24 uncertain, and 46 inappropriate (Connolly et al., 2012). Tumor type, size, location, aggressive features, prior treatment, and a patient's immune status all shift the rating.

Where and what Mohs is used for

Mohs is generally favored when a basal or squamous cell carcinoma:

• Sits in an area with little tissue to spare or high functional or cosmetic importance, including the eyelids, nose, ears, lips, scalp, hands, feet, and genitals (AAD; ACMS).
• Has come back after previous treatment.
• Has an aggressive growth pattern on biopsy, poorly defined borders, or is large.
• Occurs in someone who is immunosuppressed, such as an organ transplant recipient, or in skin previously treated with radiation.

When another treatment fits better

A small, low-risk, well-defined basal cell carcinoma on the trunk or limbs is often well served by a standard excision or by curettage and electrodesiccation, a scraping-and-cautery technique performed in the office. Rowe's 1989 review also concluded that curettage and electrodesiccation should not be used for recurrent basal cell carcinoma. Radiation is reserved mainly for patients who are not surgical candidates, and some very superficial cancers can be treated with prescription creams. Our skin cancer treatment page outlines these options.

What to expect during recovery

The first 48 hours

Keep the pressure bandage on and dry as instructed, rest, and keep the area elevated if it is on the head. Swelling and bruising are common, especially around the eyes after surgery on the forehead or nose. Most patients manage discomfort with acetaminophen; ask before taking aspirin or ibuprofen, which can increase bleeding. Skip alcohol and strenuous activity.

Weeks one and two

After the first day or two, most wound care comes down to gentle daily cleansing and keeping the wound covered with petrolatum and a bandage so it stays moist rather than scabbing. Our post on petroleum jelly and recovery after Mohs explains why. Sutures, if used, are typically removed or checked about one to two weeks after surgery. Your surgeon will set limits on lifting, bending, and exercise, which commonly last one to two weeks.

When to call

Call the office for bleeding that does not stop after 20 minutes of firm pressure, rapidly increasing swelling, spreading redness or warmth, pus, fever, or pain that worsens after the first few days instead of improving.

Scarring, reconstruction, and cosmetic outcomes

After the cancer is cleared, there are several ways to repair the wound: letting it heal on its own, closing it side to side with stitches, moving nearby skin as a flap, or placing a skin graft. The best option depends on the size and location of the wound. The AAD notes that some wounds heal nicely without stitches, and that patients with a very large wound are sometimes referred to another surgeon for repair.

Scars are usually pink and firm at first and continue to flatten and fade for up to a year. Daily sun protection on the scar helps prevent it from darkening. If a scar remains raised or red after it matures, silicone gel, steroid injections, or laser treatment can improve it.

Cost, insurance, and Medicare coverage

Mohs surgery for skin cancer is treatment of a diagnosed cancer, not a cosmetic procedure, so it is generally covered by Medicare and commercial insurance when medically necessary. Under Medicare Part B, patients typically pay 20% of the Medicare-approved amount after the annual Part B deductible for covered doctor services (Medicare.gov). What you owe depends on your plan, deductible, the number of stages, and the type of repair, since reconstruction is billed separately from the Mohs stages. Our office can help verify benefits before your surgery date.

Questions to ask before Mohs surgery

Whoever performs your surgery, it is reasonable to ask:

• Why is Mohs recommended for this tumor, rather than excision or another option?
• What training do you have in Mohs surgery and in the repair it may require?
• How long should I plan to be here, and will the repair happen the same day?
• What kind of scar should I expect, and what will wound care involve?
• How often will I need skin exams afterward?

For context, the American College of Mohs Surgery requires its physician members to complete a dedicated Mohs fellowship of at least one year after residency (ACMS). Many excellent dermatologic surgeons also perform Mohs, and your dermatologist can walk you through their own training.

What Bayou City Dermatology patients can expect

We perform Mohs surgery in the office, with tissue processed and examined while you wait and the wound repaired in the same visit in almost all cases. Follow-up visits are scheduled over the months after surgery, and we continue full-body skin exams afterward because anyone who has had one skin cancer has a higher chance of developing another. Daily sunscreen suited to Houston's climate and treatment of precancers such as actinic keratosis are part of that long-term plan.

Frequently asked questions

Is Mohs surgery painful?

The injection of local anesthetic stings briefly, and after that most patients feel pressure rather than pain during surgery. Soreness afterward is usually mild to moderate and managed with acetaminophen.

Will I need general anesthesia?

No. Mohs is performed under local anesthesia, and most patients remain awake and alert, which is why the AAD notes it can be performed safely in a medical office. Hospital admission is only needed for unusually extensive surgery.

How long does a Mohs procedure take?

Plan for at least two to four hours. Each stage requires time to process and read the tissue, so a cancer that needs several stages or a complex repair can take longer.

Can I drive myself home?

Many patients can, but we recommend arranging a ride, especially if your surgery is near the eye, where swelling or a bandage can block your vision, or if you received any sedating medication.

When can I return to work and exercise?

Many people return to desk work within a day or two. Strenuous exercise, heavy lifting, and bending are usually paused for about one to two weeks, depending on the location and type of repair. Your surgeon will give you specific limits.

Will my skin cancer come back after Mohs?

Recurrence after Mohs is uncommon. In the pooled data, about 1% of primary basal cell carcinomas recurred within five years. New, separate skin cancers are more common than recurrences, which is why regular skin exams continue for life.

Book a skin cancer evaluation

If you have a biopsy-confirmed skin cancer, or a spot that is new, changing, bleeding, or not healing, book a skin cancer evaluation at Bayou City Dermatology. Between visits, our monthly skin self-exam guide for Texas residents shows you what to watch for, and an annual full-body skin exam remains the foundation.

References

1. American Academy of Dermatology. Mohs surgery. Accessed September 2026. aad.org
2. American College of Mohs Surgery. For patients. Accessed September 2026. mohscollege.org
3. American College of Mohs Surgery. History of Mohs surgery. Accessed September 2026. mohscollege.org
4. Connolly SM, et al. AAD/ACMS/ASDSA/ASMS 2012 appropriate use criteria for Mohs micrographic surgery. J Am Acad Dermatol. 2012;67(4):531-550. pubmed.ncbi.nlm.nih.gov
5. Rowe DE, Carroll RJ, Day CL Jr. Long-term recurrence rates in previously untreated (primary) basal cell carcinoma: implications for patient follow-up. J Dermatol Surg Oncol. 1989;15(3):315-328. pubmed.ncbi.nlm.nih.gov
6. Rowe DE, Carroll RJ, Day CL Jr. Mohs surgery is the treatment of choice for recurrent (previously treated) basal cell carcinoma. J Dermatol Surg Oncol. 1989;15(4):424-431. pubmed.ncbi.nlm.nih.gov
7. Rowe DE, Carroll RJ, Day CL Jr. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. J Am Acad Dermatol. 1992;26(6):976-990. pubmed.ncbi.nlm.nih.gov
8. Skin Cancer Foundation. Mohs surgery. Accessed September 2026. skincancer.org
9. Medicare.gov. Doctor and other health care provider services. Accessed September 2026. medicare.gov