Mohs Surgery in Houston, TX

What Mohs Surgery Is and How It Works

The technique was developed by Dr. Frederic Mohs and has been refined over many years. It builds on standard skin cancer surgery, which removes the visible cancer along with a margin of normal-looking skin around it. Mohs surgery takes a more precise approach: the surgeon removes very thin pieces of tissue and examines them under the microscope while you wait, rather than estimating how much skin to take.

How the procedure works

• Numbing: the area is numbed with a local anesthetic so you are comfortable throughout.
• Removal: your surgeon removes the visible cancer along with a very thin layer of surrounding tissue.
• Microscopic check: the tissue is processed and its edges are examined under the microscope on the same day to look for any remaining cancer cells.
• Repeat only where needed: if cancer cells remain, your surgeon removes another small piece of skin from just that spot and checks it again, continuing until the margins are clear.
• Repair: once the cancer is fully removed, the wound is repaired, with stitches or a skin graft when needed, using reconstructive techniques chosen to help it heal well.

The surgical steps themselves are short. Most of the visit is spent waiting while the tissue is prepared and examined, so the whole process usually takes a few hours.

Skin Cancers Treated With Mohs Surgery

Mohs surgery is used to remove the most common types of skin cancer, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and certain melanomas. Its precision makes it a strong choice for cancers in difficult areas, such as the face, where keeping scarring to a minimum matters.

Mohs surgery is not the right treatment for every skin cancer. Depending on the type and location of the cancer, other options such as traditional excision or radiation therapy may be considered, and your dermatologist will help you decide which approach fits your situation.

• Basal cell carcinoma
• Squamous cell carcinoma
• Melanoma

Benefits of Mohs Surgery

Minimal scarring

Because only small amounts of tissue are removed, and only where cancer is found, as much healthy skin as possible is preserved. That generally means a smaller wound and a smaller scar than a wider excision would leave.

A natural-looking result

Sparing healthy tissue also gives your surgeon more to work with when repairing the area. This is a large part of why Mohs surgery is favored for the face and other places where appearance is a priority.

A high cure rate

Because every edge of the removed tissue is checked under the microscope, your surgeon can confirm that the cancer cells are gone before the wound is closed. This careful verification gives Mohs surgery an over 98% cure rate for most skin cancers and lowers the chance that you will need further treatment or surgery for the same cancer.

Preparing for Your Surgery

Treat the morning of your surgery like any normal day. Eat a good breakfast and take all of your prescribed medications exactly as you normally would, including blood thinners such as aspirin and blood pressure medications. Our preparation document also asks you to avoid alcohol, over-the-counter pain relievers and fish oil in the week before surgery, so please read it ahead of time and let us know every medication and supplement you take.

If you expect to feel nervous, please tell us ahead of time. We can prescribe a mild sedative for you to take in the office.

What to bring

• Your insurance card and a method of payment.
• A book or magazine, or a family member or friend to keep you company while the lab work is done.
• Comfortable clothing you can relax in during the procedure.

What to expect on the day

Plan on spending a few hours with us. The surgery itself is quick, but the laboratory analysis of each layer can take an hour or two, and more than one layer may be needed. Since the length of a Mohs visit varies, it is wise to keep the rest of your day clear. As with any surgery, there are some risks, such as bleeding and infection, and your surgeon will go over them with you.

You can review our written instructions before and after your visit:

• Preparation before skin surgery (PDF)
• Post-operative instructions (PDF)

Recovery After Mohs Surgery

Some swelling and mild pain are normal after surgery. We recommend taking your pain medication before the numbing wears off so you stay ahead of any discomfort. The scar may look red, swollen and tender at first, and it will gradually fade over time.

Before you leave, we will walk you through your wound care instructions in detail and give you a printed copy to take home. Your surgeon will call you the evening after surgery to check on you, and you will have a follow-up visit in the office to make sure everything is healing as it should.

Most people can return to work within a few days, depending on the kind of work they do. We will explain any restrictions that apply to you and can provide a doctor's letter for your employer.

Insurance and Cost

Skin cancer treatment is generally covered by insurance, but deductibles and coinsurance vary from plan to plan. The cost of your procedure also depends on the type of procedure needed and on any additional steps, such as a skin graft, that may be needed.

Before your surgery, our team checks your benefits with your insurance company and gives you an estimate of how they apply and what you may owe out of pocket. We only proceed with surgery once you have had a chance to review it. Please keep in mind that the estimate is not a guarantee, since deductibles are not always updated right away and insurance details can change, so it is a good idea to confirm your coverage directly with your carrier.

Payment options are available. If you have questions about a quote or about scheduling, you can email our scheduling coordinator at [email protected].

• Payment plans

Frequently Asked Questions

What is Mohs surgery?

It is a skin cancer surgery in which the surgeon removes the cancer in thin layers and examines each one under the microscope during your visit, repeating the process until no cancer cells remain. It is considered the gold standard for most skin cancers.

What should I bring to my appointment?

Bring your insurance card and a method of payment. Because the visit can last a few hours, you may also want a book or magazine, or a friend or family member to keep you company.

What do I need to know before my surgery?

Eat breakfast and take your prescribed medications as usual, including blood thinners, and tell us about every medication and supplement you take. Avoid alcohol, over-the-counter pain relievers and fish oil for the week before. If you think you may be nervous, let us know and we can prescribe a mild sedative to take in the office. Our preparation document above has more detail.

What can I expect during my procedure?

The area is numbed with a local anesthetic, and the surgeon removes a thin layer of tissue for examination. You will wait comfortably while it is checked, and more tissue is removed only if cancer cells remain. Once the margins are clear, the wound is repaired.

What can I expect after my procedure?

Expect some swelling and mild pain. Take your pain medication before the numbing wears off. Your surgeon will call you that evening to see how you are doing, and our post-operative instructions explain what to watch for.

Will I be able to return to work?

Most people return within a few days, depending on their job. We will explain any restrictions and can give you a doctor's letter.

How do I take care of my surgery site?

We will go over your wound care instructions in detail before you leave and give you a printed copy. If questions come up while you heal, contact our office.

Will my insurance cover this?

Skin cancer treatment is generally covered, though deductibles and coinsurance differ by plan. Our team checks your benefits and gives you an estimate before surgery, and we proceed only after you have reviewed it. For the most current details on your policy, check with your insurance carrier.

Who handles my skin checks after surgery?

If another dermatologist referred you, we keep them informed and help coordinate your follow-up skin checks with them. If you need a dermatologist for regular skin checks, our general dermatology team can see you.

Our Mohs Surgeons

Team Dermatology's Mohs surgeons include Dr. Tarek Fakhouri, a fellowship-trained Mohs surgeon, and Dr. Laraib Safeer, who is board certified in Mohs micrographic surgery.

• Tarek M. Fakhouri, MD
• Dr. Laraib Safeer

Related reading

• Mohs surgery before & after photos
• What is Mohs surgery? (glossary)
• Melanoma (glossary)
• Skin cancer
• Superficial Radiation Therapy (SRT)

If you have been diagnosed with skin cancer or have a spot you are concerned about, we are here to help. Request an appointment with Team Dermatology to talk with our team about whether Mohs surgery is right for you.