The face receives more sun than almost any other part of the body. That is why most basal cell carcinomas and squamous cell carcinomas appear on the face, scalp, ears and neck. It is also why these cancers need special care.

On the face, every millimeter of skin matters. The skin is thin, and it sits close to important structures like the eyelid margin, the edge of the nostril and the border of the lip. Removing too much tissue can affect both appearance and function. Removing too little can leave cancer cells behind. Mohs surgery solves both problems.

Mohs surgery is the gold standard and the treatment of choice for basal cell and squamous cell carcinomas on the face. National guidelines developed by leading dermatology and Mohs surgery organizations single out the face, including the nose, eyelids, ears and lips, as the area where Mohs surgery is most strongly recommended. For most facial skin cancers, it is simply the best option available.

While Mohs surgery is best known for treating basal cell and squamous cell carcinomas, it is also used for certain less common skin cancers on the face. These include some early melanomas, such as melanoma in situ (lentigo maligna), as well as rare tumors like dermatofibrosarcoma protuberans and sebaceous carcinoma. Dr. Shagalov will review your diagnosis and let you know whether Mohs surgery is the best approach for you

Mohs surgery offers several advantages for facial skin cancer:

• 100% of the surgical margin is examined under the microscope, so nothing is left to chance.
• Cure rates of up to 99% or greater for most basal cell and squamous cell carcinomas.
• The smallest possible wound, which means a smaller scar and an easier repair.
• Your cancer is removed, checked and repaired in one visit, in the office, under local anesthesia.
• Your Mohs surgeon also acts as your pathologist, ensuring negative margins prior to reconstruction.

Mohs surgery on the nose

The nose is one of the most common places for skin cancer on the face, and both basal cell and squamous cell carcinomas develop here. Skin cancers on the nose, especially basal cell carcinomas, are often more advanced than they appear, with roots spreading well beyond the visible spot. Because there is very little extra skin on the nose, a tissue-sparing technique is essential. Mohs surgery allows Dr. Shagalov to follow the roots of the cancer precisely to ensure its complete removal while also ensuring a reconstruction that will preserve the natural shape of the nostril, tip and bridge.

Mohs surgery on the eyelids and around the eyes

Skin cancers near the eye require extreme precision. Mohs surgery protects the eyelid margin and tear drainage system, so your eye can continue to open, close and protect itself normally. Dr. Shagalov repairs many eyelid wounds herself. When a more complex reconstruction is best, she partners with trusted, highly skilled oculoplastic surgeons who specialize in the eyelids.

Mohs surgery on the ears

The ears are often missed with sunscreen, making them a frequent site for both basal cell and squamous cell carcinoma. Cancers on the ear can be more advanced than they look, and squamous cell carcinomas here can be more invasive. Because the skin of the ear sits directly over cartilage, precision matters. Mohs surgery removes the cancer completely while preserving as much of the ear’s natural shape as possible.

Mohs surgery on the lips

The lips and the skin around them receive direct sun and can develop both basal cell and squamous cell carcinoma. Squamous cell carcinomas on the lip can be more invasive, so complete removal is especially important. Preserving the line where the lip meets the skin is key to a natural smile, and Mohs surgery helps keep that border intact.

Mohs surgery on the forehead, temples and scalp

The forehead, temples and scalp receive intense, year-round sun, especially in Miami, and thinning hair often leaves the scalp unprotected. Skin cancers in these areas can spread wider beneath the surface than they appear on the skin. Mohs surgery precisely maps and removes these hidden extensions, so no cancer is left behind. At the temple, Dr. Shagalov takes special care to protect the delicate nerve that raises the eyebrow and to preserve your natural brow position and hairline.

Mohs surgery on the cheeks, chin and neck

These areas often have a little more skin to work with, but a natural result still matters. Dr. Shagalov places repairs along your natural skin lines and creases whenever possible so scars blend in.

Mohs surgery is performed in our Midtown Miami office. You are awake the entire time and only the treated area is numbed.

1. The area is cleaned and numbed with a local anesthetic.
2. Removing the first layer. Shagalov removes the visible cancer along with a thin layer of surrounding tissue.
3. Mapping and microscope review. The tissue is mapped, processed in our on-site lab, and examined by Dr. Shagalov under the microscope. This takes about an hour, and you can relax in our waiting area.
4. Additional layers if needed. If cancer cells remain, only that exact area is removed. This repeats until the margins are clear.
5. Once you are cancer-free, Dr. Shagalov repairs the wound, usually the same day.

Most patients go home the same day. Learn more on our Preparing for Mohs Surgery page.

Any surgery leaves a scar, but Mohs surgery keeps it as small as possible. Because Dr. Shagalov is also fellowship-trained in cosmetic dermatology, she plans every repair with your appearance in mind.

Depending on the size and location of the wound, she may use:

• Side-to-side closure hidden in natural skin lines.
• A local flap, which moves nearby skin to cover the area.
• A skin graft, which uses skin from a nearby area.
• Healing on its own, which can give excellent results in certain spots.

Scars continue to improve for 3 to 12 months. If needed, treatments such as laser resurfacing, microneedling or subcision can further soften a scar. Read more on our Reconstructive Surgery Post Mohs Surgery page.

See a dermatologist if you notice any of the following on your face:

• A pimple-like bump that does not go away after a few weeks.
• A shiny, pearly or pink bump, sometimes with tiny blood vessels.
• A sore that bleeds, crusts, heals and then comes back.
• A rough, scaly red patch that does not clear with moisturizer.
• A flat, shiny, scar-like area that you do not remember injuring.
• A new or changing mole or dark spot.

Early skin cancers are smaller and easier to treat, with smaller scars. Schedule a skin cancer screening if anything looks new, changing or unusual.