Jill Biden’s Mohs Surgery: What Is It and When Is It Needed?

Jill Biden has returned to the White House after being treated for basal cell carcinoma yesterday. Basal cell carcinoma is the most common—and an easily-treated—form of skin cancer.

The First Lady had three skin lesions removed through a same-day procedure called Mohs surgery. Because the procedure allows surgeons to remove only the necessary tissue and leave healthy tissue alone, it’s the gold standard for treating several skin cancers, including basal cell carcinoma, squamous cell carcinoma, and early-stage melanoma. Plus, it’s up to 99% effective.

“All cancerous tissue was successfully removed, and the margins were clear of any residual skin cancer cells,” Kevin O’Connor, DO, Physician to the President, said in a statement. 

Though it happens all in one day, the Mohs surgery process can be a lengthy one. Here’s what happens and when it’s recommended.

What Happens During Mohs Surgery?

Mohs surgery is a multi-stage process that begins with a minor incision to remove the top layer of a suspicious skin growth. It only requires local anesthesia, so patients are awake for the procedure. The sample is immediately sent to a lab, where the surgeon divides, freezes, and examines the tissue under a microscope.

During this first stage, the surgeon determines how much of a growth is cancerous and if a patient needs additional layers of skin removed. The removal and examination process is repeated until no more cancer cells remain.

“The genius of this procedure is that margin status—whether or not the tumor edges are clear of cancer—is determined in real time, and negative margins can be achieved while the patient is present,” Clare Bertucio, MD, an Alaska-based radiation oncologist, told Verywell via email. “Other types of resection require review from a pathologist post-procedure, and may require that a patient return for further surgery if the margins are not clear of all cancer cells.”

In Jill Biden’s case, the surgeon determined a growth above her right eye was cancerous. During skin checks in tandem with the procedure, a lesion on her chest was also identified, removed, and deemed cancerous, while a lesion on her left eyelid was removed for examination.

Who Is a Candidate for Mohs Surgery?

Mohs surgery is most appropriate for visible skin cancers in areas with delicate or thin skin, like the face, fingers, toes, and genitals.

“In general, it leaves a smaller, more cosmetically acceptable outcome,” said Bertucio, who also serves as CEO to skincare company Medicine Mama’s Apothecary.

A cancer diagnosis is necessary before proceeding with Mohs surgery. Typically, Bertucio said that means getting an abnormal lesion biopsied as soon as it’s identified.

“If a lesion is cancerous, it is generally not recommended to just monitor it,” she said. “Further action should be taken in most cases.”

Jill Biden first became aware of the growth above her right eye during a routine skin check late last year, according to a January 4 White House memo. Physicians then scheduled her procedure for the coming weeks.

Who Is a Candidate for Skin Checks?

While early detection is key to positive skin cancer outcomes, the skin checks to make it happen aren’t always accessible. That’s because they’re still not considered “routine”—so insurance may not cover their cost like it would for a primary care visit.

“Unfortunately, there is not enough evidence to know whether or not screening adolescents and adults without [skin cancer] symptoms reduces complications or death,” Katrina Donahue, MD, MPH, a member of the U.S. Preventive Services Task Force (USPSTF), said in an October statement regarding the agency’s lack of skin cancer screening recommendations.

Still, experts say it’s important for those with certain risk factors to seek a skin cancer screening, including:

• A suspicious mole or growth 
• A history of skin cancer
• Fair hair or skin color
• Light-colored eyes 
• Frequent exposure to natural or artificial sunlight (like tanning beds)

“Anyone who has a family history of or personal history of skin cancers should have routine skin checks,” Bertucio said. “Additionally, anyone with a substantial history of sun exposure—even years prior, including childhood—should have routine skin checks. Skin damage that can lead to skin cancer is cumulative and can occur years prior to the appearance of a skin cancer.”

Basal cell carcinoma, specifically, is more common in those with weakened immune systems and adults over 50.