If you have just been diagnosed with skin cancer, you probably have a lot of questions. That is completely normal. At Biscayne Dermatology, our team of dermatology providers, led by double board-certified dermatologist and fellowship-trained Mohs surgeon Dr. Devorah Shagalov, diagnoses and treats skin cancer every day. We have gathered the questions our patients ask most often, with clear answers to help you feel prepared and confident.

About Mohs Surgery

What is Mohs surgery?

Mohs micrographic surgery is a precise, in-office procedure for removing skin cancer. The cancer is removed one thin layer at a time, and each layer is checked under a microscope while you wait. The process stops as soon as no cancer cells remain. Learn more on our Mohs Micrographic Surgery page.

What types of skin cancer does Mohs surgery treat?

Mohs surgery is most often used for basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), the two most common skin cancers. It is also used for certain early melanomas, such as melanoma in situ (lentigo maligna), and for a number of rarer skin cancers, including:

• Dermatofibrosarcoma protuberans (DFSP)
• Sebaceous carcinoma
• Atypical fibroxanthoma (AFX)
• Malignant fibrous histiocytoma (MFH), now often called undifferentiated pleomorphic sarcoma
• Microcystic adnexal carcinoma (MAC)
• Mucinous carcinoma
• Other rare skin tumors

Our providers will review your diagnosis and let you know whether Mohs surgery is the right treatment for you.

Why is Mohs surgery called the gold standard for skin cancer?

Mohs surgery checks 100% of the surgical margin, while standard excision checks only a small sample. This is why Mohs surgery has cure rates of up to 99% for basal cell and squamous cell carcinomas. It also removes the least amount of healthy skin, so scars are smaller.

Who is a good candidate for Mohs surgery?

Mohs surgery is often recommended when skin cancer:

• Is on the face, ears, nose, eyelids, lips, scalp, neck, hands, feet or genitals.
• Has come back after a previous treatment.
• Is large, fast-growing or has poorly defined edges.
• Is an aggressive type under the microscope.
• Occurs in someone with a weakened immune system.

Does it matter who performs my Mohs surgery?

Yes. During Mohs surgery, your surgeon is also your pathologist, reading every layer under the microscope. Fellowship-trained Mohs surgeons complete one to two years of additional training focused only on Mohs surgery and reconstruction. Dr. Shagalov is fellowship-trained in both Mohs surgery and cosmetic dermatology.

Before Your Mohs Surgery

How do I prepare for Mohs surgery?

Get a good night’s sleep, eat a normal breakfast, and wear comfortable clothes. Bring a book, tablet or snack, since part of the day is spent waiting for lab results. See our full Preparing for Mohs Surgery guide.

Should I stop my blood thinners before Mohs surgery?

Do not stop any prescribed blood thinner, such as aspirin prescribed by your cardiologist, Eliquis, Xarelto or warfarin, unless your prescribing doctor tells you to. Most patients safely continue their medications. Please tell our team about every medication and supplement you take.

Can I drive myself home after Mohs surgery?

Many patients can. However, we recommend bringing a driver if your surgery is near your eye, since the bandage may block your vision.

The Day of Your Mohs Surgery

Does Mohs surgery hurt?

You will feel a quick pinch when the numbing medicine is given. After that, most patients feel only pressure. You stay awake and comfortable the whole time.

How long does Mohs surgery take?

Please plan to spend the entire day with us and keep the rest of your day free. Each layer takes one to two hours to process and examine under the microscope, some skin cancers need several layers, and your repair takes additional time. Many patients finish sooner, but it is best to come prepared with a book, tablet or snack.

How many layers will I need?

It is impossible to know in advance. Skin cancer can grow roots under the skin that are not visible on the surface. Mohs surgery follows those roots precisely, so you only lose the tissue that needs to be removed.

Will my wound be repaired the same day?

In most cases, yes. Once the cancer is fully removed, Dr. Shagalov reconstructs the wound. Depending on its size and location, she may use a linear closure with sutures, a local flap that repositions nearby skin, or a skin graft. Some wounds heal beautifully on their own, a process called second intention healing. Learn more about Reconstructive Surgery Post Mohs Surgery.

After Your Mohs Surgery

Will I have a scar?

Every surgery leaves a scar, but Mohs surgery keeps it as small as possible. Scars continue to fade and flatten for 3 to 12 months. If needed, our cosmetic dermatology team offers laser resurfacing, microneedling and subcision to further improve the scar.

How painful is recovery?

Most patients have mild soreness for a day or two that is well controlled with acetaminophen (Tylenol). When needed, our providers may recommend alternating Tylenol with ibuprofen (Advil), following the instructions you receive after surgery. Ice packs help reduce swelling. Call us if pain gets worse instead of better.

When can I exercise after Mohs surgery?

Most patients should avoid heavy lifting, bending and strenuous exercise for one to two weeks. Dr. Shagalov will give you instructions based on where your surgery was done. Read our Recovering from Mohs Surgery page for details.

Will I need follow-up visits?

Yes. You may return for stitch removal and a wound check. Just as important, anyone who has had one skin cancer has a higher risk of developing another. We recommend regular full-body skin cancer screenings with our dermatology team.

Cost and Insurance

Is Mohs surgery covered by insurance?

Mohs surgery for skin cancer is a medically necessary procedure. It is covered by Medicare and most insurance plans. Our team will help you verify your benefits before your surgery.

Do I need a referral for Mohs surgery?

Some insurance plans require a referral and some do not. Patients may be referred by another dermatologist or primary care doctor, or diagnosed right here at Biscayne Dermatology. Call us and we will guide you.

Why Choose Biscayne Dermatology for Mohs Surgery in Miami?

Dr. Devorah Shagalov is a double board-certified dermatologist and Mohs surgeon who is dual fellowship-trained in Mohs surgery and cosmetic dermatology. She performs your surgery, reads your slides and repairs your wound herself, all in one visit.

We know that skin cancer surgery can feel intimidating. Dr. Shagalov treats every patient like family and supports you before, during and after surgery. Biscayne Dermatology is located in Midtown Miami on the border of Edgewater and Wynwood, a few blocks from the Design District, Miami Beach and Downtown Miami.