The Florida Society of Plastic Surgeons

Mohs Surgery and Reconstruction
in Florida

Mohs Micrographic surgery is a specialized surgical technique used to remove many skin cancers while preserving as much healthy tissue as possible. The procedure is typically performed by dermatologists who are fellowship trained in Mohs Surgery. It involves removing thin layers of skin, examining them under a microscope, and repeating the process until no cancer cells are found in the remaining tissue. This is usually done in a single day. Literature shows that performing Mohs surgery on skin cancers results in a smaller excision and a lower risk of recurrence. Plastic Surgeons often coordinate with dermatologists to close the Mohs defects created with the excision.

Michael A. Harrington, MD, MPH

What is Mohs Micrographic Surgery and Reconstruction?

Frederic Edward Mohs developed Mohs Micrographic surgery in 1936 while he was a medical student at the University of Wisconsin. The theory behind the technique is for 100% microscopic tissue margin examination. It can be described as a “Pie”– scooping out the inside of the “pie” and leaving the crust behind. The crust is then removed separately and examined. This examined the true edges of the skin cancer.

Reconstruction of the Mohs excision is dependent on the location of the skin cancer. Many Plastic Surgeons assist Mohs Surgeons with the repair when the skin cancer involves the head and neck. But other areas that are complicated or if the skin cancer removal leaves a wound which is large or has exposed important structures like bone, nerve, or tendon, the dermatologist or the patient may elect to involve a Plastic Surgeon. The goal of any reconstruction is to restore the anatomy and appearance as best as possible while limiting scarring.

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Benefits of Mohs Surgery and Reconstruction

Mohs Surgical excision of most nonmelanoma skin cancers remains a gold standard. Skin cancer removal prevents lesions from growing bigger or growing into deeper layers of your skin, muscle, or bone. Early removal also reduces the chances of spread to organs of the body. Removing cancerous lesions this way often eliminates the need for radiation, chemotherapy, or immunotherapy. Knowing you have completely removed your cancerous lesion can not only restore your good health but will also help alleviate any anxiety you may have after receiving a cancer diagnosis.

Mohs Surgery allows for 100% examination of the tissue edges to make sure the skin cancer has been completely removed. Research shows a lower chance that lesions removed with Mohs surgery come back (recur) less often than other surgical methods. Mohs also conserves normal tissue– less tissue needs to be removed to completely remove the skin cancer. This usually leads to better cosmetic and functional results as well.

Mohs Reconstruction with a Plastic Surgeon is beneficial to optimize your reconstructive outcome and minimize scarring and contour deformity. Talk with your dermatologist if he or she believe you might need a Plastic Surgeon for your reconstruction, or simply if you would prefer a Plastic Surgeon perform your reconstruction!

Who is an Ideal Candidate

While there are other options for nonmelanoma skin cancer treatment, Mohs surgical excision remains the gold standard of care. Your physician will likely recommend Mohs nonmelanoma skin cancer removal if he or she believes it has not yet spread beyond the skin. Reconstruction of these areas works best if you don’t smoke or use nicotine products. Be honest with your dermatologist and Plastic Surgeon about your nicotine history so they can help you get the best result.

The Procedure Process

Initial Consultation

Your Mohs surgeon will evaluate the pathology report and the location of the skin cancer. Based on the size and location, he or she may consult a Plastic Surgeon for assistance with closure of the defect. The Plastic Surgeon will explain the details of the planned operation including the reconstructive options for wound closure. The risks, benefits, and alternatives of the procedure will also be discussed.

Day of Surgery

Many practices perform the Mohs excision and reconstruction on the same day, but others may break up the procedures into a two-day span. This is dependent on a number of factors. Mohs excision is performed under local anesthesia by the dermatologist. The reconstruction by the Plastic Surgeon may be performed under local anesthesia, twilight anesthesia, or general anesthesia.

Immediate Aftercare

You’ll be monitored in a recovery area and return home with dressings based on the closure of the surgical wound.

Follow-Up Visits

Your Board Certified FSPS surgeon will guide your healing process and carefully monitor your progress with scheduled follow-ups. Post-operative care is an important part of recovery to get your best result.

Recovery and Aftercare

Initial downtime ranges from 1–2 weeks, with light activity encouraged as you heal. Most patients return to normal routines within 4–6 weeks. Following your surgeon’s instructions is key to optimal healing.

Results: What to Expect

Depending on the closure of the wound, the incisions will start to look “normal” around 3-6 months postop. The desired outcome is a scar that is difficult to see and minimal contour deformity of the surrounding anatomy.

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Risks and Considerations

As with any surgery, skin cancer excision carries some risks, including bleeding, infection, scarring, or recurrence of the skin cancer. Choosing a board-certified FSPS member surgeon ensures that you’re in expert hands, with safety protocols and personalized care to minimize complications.

Why Choose an FSPS Member Plastic Surgeon?

Choosing a Florida Society of Plastic Surgeons member means you’re in the care of a highly trained expert.

Certification by the American Board of Plastic Surgery
Extensive experience and surgical precision
Hospital privileges as a Board-Certified Plastic Surgeon
Commitment to the highest safety and ethical standards
Convenient locations across Florida—Boca Raton, Miami, Tampa, Jacksonville, Orlando, and more

Frequently Asked Questions About Skin Cancer Excision

Plastic Surgeons do not perform Mohs Surgery, but many Plastic Surgeons work closely with Mohs Surgeons by reconstructing the Mohs Defect following the excision. If you would like your Plastic Surgeon to perform the entire operation, he or she would likely use a pathologist in the operating room to determine if the skin cancer has been completely removed.

The main difference is the technique involved in cutting and preparing the skin cancer to be examined under a microscope. Mohs Micrographic Surgery boasts a 100% margin examination while other techniques fall just short of this standard.

Plastic Surgeons are trained in several surgical techniques to close defects of any size. A “flap” is a technique of using incisions based on geometric shapes to close defects using local tissue. A skin “graft” is a technique in which skin is taken from somewhere else on the body and transplanted to the wound. Both techniques have pros and cons. You will need to consult with your Plastic Surgeon for specific closure needs based on the size and location of your skin cancer.

No, melanoma cells cannot accurately be visualized with Mohs Surgery technique. Melanomas need to be excised with wide margins and examined carefully to ensure a lower risk of spread and recurrence.

This depends on the size and location of the skin cancer as the reconstruction will determine the recovery.

Yes, you will have a scar. However, a Plastic Surgeon hides scars in natural creases and close wounds to decrease the chances of any contour deformities.

Serving Florida Communities Statewide

FSPS surgeons proudly serve patients across Florida, including Boca Raton, Delray Beach, Miami, Tampa, Orlando, Jacksonville, Sarasota, Gainesville and beyond.

What Should I Do Next?

Schedule a consultation with an FSPS member and discover how Mohs Surgery can help you feel more confident in your skin.

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Mohs Surgery and Reconstruction in Florida