Mohs surgery in Valencia

In a conventional excision , the tumour is removed with a predetermined margin of healthy skin and sent for analysis. Representative sections of the specimen are examined and, if a margin is involved, a second operation may be needed. In Mohs surgery, the tissue is oriented and mapped, and almost the entire margin is examined. If tumour remains, another layer is removed only from the area where it persists, repeating the process until clear margins are confirmed. This is not «margin-free» surgery: it begins with a narrow margin, which is extended only where the microscope indicates.

Its main indications are high-risk basal cell carcinoma and squamous cell carcinoma: recurrent tumours, poorly defined tumours, more aggressive subtypes or those in locations where tissue preservation is especially important — nose, eyelids, lips, ears or temples. The decision combines size, subtype, border definition, whether the tumour is primary or recurrent, and the actual need to preserve tissue. For melanoma , it is not the usual technique and is reserved for selected cases.

The main advantage is thorough microscopic margin control before reconstruction, reducing the likelihood of leaving tumour extensions invisible to the naked eye. The second is selective preservation of healthy tissue: further removal targets only areas containing tumour, which is crucial on the eyelids, nose or lips.

The limitations need precise explanation. «Maximum tissue preservation» does not mean the wound will be small, because the final defect may be larger than the visible tumour if there were microscopic extensions. The very high cure rates sometimes advertised depend on tumour type and follow-up; they are not a universal figure. The technique does not treat metastases or disseminated disease, does not replace sentinel lymph node assessment when indicated for melanoma, and cannot promise freedom from recurrence or a particular scar appearance.

As with any surgery, there may be pain, bleeding, bruising, infection, wound opening or changes in scarring and pigmentation, and, depending on the area, numbness or other discomfort.

All surgery leaves a scar: Mohs preserves tissue but does not eliminate scarring or allow its appearance to be predicted. Swelling and bruising are more noticeable in the first few days, particularly around the eyes and nose, and the scar matures over months. Do not stop anticoagulants or antiplatelet medication yourself: this decision is assessed individually.

During your consultation, we explain in detail how the procedure works, how reconstruction is planned and the care your case requires.

At the preoperative consultation, we review the biopsyreport, the exact lesion location and your medical history — including anticoagulant medication — examine the tumour and confirm that Mohs is indicated, explaining the alternatives and recurrence risk. If the lesion is no longer clearly visible after biopsy, an earlier photograph helps us locate the treatment area accurately.

Mohs surgery is part of our surgical dermatology and skin cancer care in Valencia, available in Spanish, English and Italian. You can meet the medical team before your visit.