Updated for 2026.
When it comes to treating skin cancer, Mohs surgery is considered the gold standard for many non-melanoma types, such as basal cell carcinoma (BCC) and squamous cell carcinoma (SCC). Its precision allows Mohs surgeons like Dr. Dharia to remove cancerous cells layer by layer while preserving as much healthy tissue as possible. But when it comes to melanoma, Mohs surgery is not typically the first choice. Here’s why.
Melanoma Can Spread More Quickly
Unlike BCC and SCC, which tend to spread very slowly, melanoma has the ability to spread, or metastasize, rapidly to other parts of the body, including lymph nodes and internal organs. Because of this, it is critical to remove melanoma with clear margins right away rather than slowly examining it layer by layer in real time. Thus, traditional surgical excision is preferred when treating melanoma because it allows the surgeon to take a wider margin of tissue around the tumor, reducing the risk that even a small cluster of cancerous cells is left behind and able to spread.
Melanoma Has a Greater Recurrence Rate
Melanoma is also more likely to come back compared to non-melanoma skin cancers, which is another reason why wide local excision is preferred for treating melanoma rather than Mohs surgery. Wide local excision ensures that both the visible tumor and a generous amount of surrounding tissue are removed, decreasing the risk that even a small number of cancerous cells could be left behind and cause a recurrence of melanoma after treatment.
Melanoma Cells Can Be More Difficult to Detect
During Mohs surgery, each layer that is removed is quickly frozen and examined under a microscope while the patient waits. This “frozen section” process is highly effective for spotting basal cell carcinoma and squamous cell carcinoma, as those cancer cells have distinct shapes and growth patterns that are easier to identify in frozen tissue.
Melanoma, however, can be much more difficult to detect in this way. Its cells can blend in with surrounding normal cells, and subtle changes are harder to distinguish in frozen sections. For that reason, melanoma is usually treated with excision, where the removed tissue is carefully analyzed using permanent sections that provide a clearer, more reliable view of the cells.
When Is Mohs the Right Choice?
While Mohs surgery is not the go-to treatment for melanoma, it remains the gold standard for many other types of skin cancer, including basal cell carcinoma and squamous cell carcinoma. These are the most common forms of skin cancer, and Mohs surgery’s layer-by-layer approach makes it very well-suited for treating them.
Mohs is especially helpful when the cancer is located in an area like the face, ears, nose, lips, eyelids and hands, where preserving as much healthy tissue as possible is a priority. Because Mohs removes only what is cancerous and confirms clear margins in real time, it allows Dr. Dharia to treat the cancer completely while leaving the surrounding healthy tissue intact.
Mohs is also preferred for skin cancers that are large, have irregular borders, have recurred after previous treatment or are located in areas with a higher risk of recurrence. In these cases, the precision of Mohs surgery offers both the highest cure rate of any skin cancer treatment and the best possible cosmetic outcome.
Are There Exceptions?
In rare cases, a modified version of Mohs surgery, sometimes called “slow Mohs” may be used for certain types of early or in-situ melanomas. This method uses permanent sections processed in a lab rather than immediate frozen sections, allowing for more accurate detection. However, this is not the norm, and wide excision remains the gold standard for most melanoma cases.
What Does Melanoma Treatment Look Like?
If Mohs isn’t ideal for melanoma, what does the best treatment for melanoma entail?
The first step is almost always wide local excision, or the surgical removal of the tumor along with a margin of surrounding healthy tissue. The size of that margin depends on the thickness of the melanoma. Thinner melanomas require smaller margins, while thicker or more advanced melanomas require wider ones.
For melanomas beyond the very earliest stage, wide excision is often accompanied by a sentinel lymph node biopsy. This procedure involves identifying and removing the first lymph nodes that drain the area around the tumor, then examining them for signs that cancer has spread. The results help to determine the stage of the melanoma and guide what treatment comes next.
Depending on the stage, additional treatment may include immunotherapy, targeted therapy or radiation. Early-stage melanomas that are caught before they’ve spread are often treated with excision alone and carry an excellent prognosis.
Throughout the process, close coordination between your dermatologist, surgeon and, if needed, an oncologist is essential. At Pacifica, Dr. Dharia works closely with Dr. Kolder to ensure that both the treatment and any necessary reconstruction are handled with the same level of precision and care.
Take Charge of Your Skin Health
The best protection against melanoma is early detection. Regular skin checks and prompt evaluation of suspicious moles can make all the difference. If you’ve been diagnosed with skin cancer or notice a spot that concerns you, schedule an appointment with our experienced dermatologist and Mohs surgeon, Dr. Dharia.
To make an appointment, call our Camarillo office at 805-491-9535 or contact us online.
Author: Dr. Daniel G. Kolder
Dr. Daniel G. Kolder is board certified by the American Board of Plastic Surgery. As a highly trained plastic surgeon serving Ventura County, he is best-known for his warm, easy manner, compassionate care, and beautiful, natural results.