Mohs Surgery vs. Wide-Local Excision: Uses, Benefits, Side Effects, and More

Surgery is a common treatment for skin cancer. The kind of surgery that is performed will depend on the type of skin cancer you have, where it’s located, the stage of the cancer (how much cancer is present and the extent of spread), and your overall health. Mohs surgery and wide-local excision are two of types of surgery for skin cancer.

This article will discuss Mohs surgery and wide-local excision, the differences between them, and what to expect.

What to Know About Mohs Surgery

Mohs surgery, also known as Mohs microscopic surgery, is a minimally invasive surgery that is known as the most effective surgery for the two most common skin cancers: basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs).

How Does It Work?

In Mohs surgery, once you are given a local anesthetic (to numb the area where the surgery will be performed), the surgeon removes all visible areas of skin cancer. Then the surgeon removes a layer of surrounding skin.

You are bandaged, and the surgeon looks at the layers of skin removed to check for cancer cells. If any are found, the surgeon will unbandage you and remove another layer of skin. That layer is then checked for cancer cells, as well. This is repeated until cancer cells are not seen anymore.

Mohs Surgery Delivery

Mohs surgery is an outpatient treatment (done without a hospital stay). The surgery may be performed in an operating room or a surgical site in a dermatology center. A laboratory is available at the same site.

Dermatologists (physicians specializing in skin conditions) can perform Mohs surgery. In addition, surgical dermatology specialists called Mohs surgeons can both perform the surgery and examine the tissue removed for cancer. This allows them to fine-tune their techniques. Mohs surgeons may be available at cancer centers, dermatology clinics, or hospitals.

The length of your surgery will depend on how many times the surgeon needs to remove additional tissue to check for cancer cells.

Side Effects

Every medical procedure has a risk of side effects, and Mohs surgery is no different. Pain should be minimal. If you do have pain or discomfort, over-the-counter (OTC) pain relievers are typically enough.

Other side effects can include:

• Swelling and/or bruising
• Allergic reaction to adhesive tape
• Minor bleeding
• Infection (rare, but can be treated with antibiotics)

Prices and Where to Get It

The price of Mohs surgery can vary depending on where you live and whether your insurance provider approves it. If it isn't approved, your insurer may suggest a different treatment option, or you would have to pay out of pocket for Mohs surgery, which can be several thousand dollars.

If you have insurance, speak with a company representative to get a sense of what your plan covers, how much it covers, and what your estimated payment might be.

What to Know About Wide-Local Excision

Wide-local excision is often used with BCCs and SCCs, and also for early-stage melanomas that aren’t deep and haven’t spread. It requires the removal of extra tissue, so it may not be as easily performed on some parts of the body, like the head or scalp.

How Does It Work?

Wide-local excision involves cutting out the skin cancer along with a small margin of healthy, noncancerous tissue. This is typically done in a football shape.

The area is numbed with a local anesthetic. After the incision has been made and the skin and surrounding tissue are removed, the wound is stitched shut. The sample is sent to a pathologist (a physician specializing in laboratory medicine), who will examine in in a lab.

This procedure usually is for certain skin cancers on lower-risk areas of the body that have not spread to deeper levels of tissue or distant sites. Sometimes, this procedure is enough to cure the skin cancer. Other times, more treatment may be necessary.

Wide-Local Excision Delivery

This is usually an outpatient procedure performed by a dermatologic surgeon at a clinic, surgery center, or a hospital surgical suite.

Side Effects

Any surgical procedure carries risks of side effects, including wide-local excision. Side effects may include:

• Infection
• Scarring
• Bleeding
• Anesthetic reactions (allergic)
• Problems with healing process
• Some pain or discomfort (typically relieved by OTC pain relievers)

Prices and Where to Get It

Wide-local excision costs can vary widely depending on the surgical setting, where you live, and whether you have insurance.

For early-stage melanomas, one 2022 study found that when done in an outpatient setting, the average billing to insurance was $6,605; the average billing to insurance for an operating room setting was $23,694.

If you have insurance, you should speak to a company representative to get a sense of what your plan will cover, how much is covered, and what your estimated payment might be.

Which Treatment Is Best for You?

The treatment you choose for your skin cancer can depend on many factors: the type of skin cancer you have, the stage of the cancer, and where it is located. Your treatment team will discuss your surgical options for your type and stage of cancer, and where on the body it is located. 

Can Mohs Surgery and Wide-Local Excision Be Used Together?

These two procedures are not used together for the same skin cancer lesion during the same procedure. They are two distinct procedures that use different approaches to surgical treatment.

Coping With Side Effects

While the side effects of Mohs surgery or wide-local excision surgery are minimal, you may experience some emotional or physical side effects. You may have some pain or discomfort, or you may be self-conscious about scarring.

Talk with your surgeon and treatment team about what can be done about the scarring and different ways you can help reduce the appearance of any scarring or marks that you may have.

If you are having trouble adjusting to life after cancer surgery and have concerns about cancer survivorship, you don’t have to face life after cancer by yourself. There are online support groups for people living with cancer, as well as in-person support groups.

Many cancer centers offer cancer support groups. Your treatment team may know of any local community centers or clinics that host support groups.

Summary

Mohs surgery and wide-local excision are two surgeries that are used to treat skin cancer. Depending on the kind of cancer you have, where it’s located, the stage of your cancer, and your prognosis, this might guide the treatment that is recommended.

Talk with your healthcare provider about your treatment options, which one is more suited to your situation, and any next steps that might take place.

A Word From Verywell

Each person’s treatment may look different, depending on nuances of the cancer, individual health, and personal preference. If you have any hesitation or questions about your treatment team’s recommendations, it’s OK to get a second opinion. Another set of eyes and clinical opinions can be very helpful.