Mohs Surgery VS Wide Excision What are the differences?


Normal skin to be cut out1-2 mm margin4-6mm margin
Margin examination technique100% margin peripheral and deep
en face margin examination
*Circle of excised tissue with peripheral 100% “pie tin” specimen removed.
1-2% margin of vertical section evaluated
-Bread loaf sampling (random pieces of bread are examined)
Intraoperative microscopic examinationYes,
Mostly 30-45 minutes pathologic report.
*Mohs surgeon cut and read pathologic slides themselves, allow for precise mapping the tumor. 
*Our Mohs surgeon is also a Dermatopathologist. 
May be 
Generally  pathological report come 7-10 days after operation. 
*Some surgeons send the remove tissue for frozen section, 30-45 minutes waiting time, but pathologic slides were read by other pathologist not the surgeon.  
IndicationHigh risk area
Moderate risk
* Size> 1cm
Low-risk area
* Size>2 cm
Recurrence tumor
High risk area-if Mohs surgery is not available.
Moderate risk area
*Size<1 cm
Low risk area
*Size< 2cm
Operating timeAt least 4hr
*Depend on number of stages to clear the tumor.Most of the cases are complete within one day
At least 1 hr
*Depend on tumor size, location and wound closure technique.
Type of anesthesiaMostly local anesthesiaMostly local anesthesia
Recurrence rateLowest 
SCC: 3% 
BCC: 0.8-17.4% 
SCC: 8% 
CostMore expensiveCheaper
National Comprehensive Cancer Network Clinical Practice Guideline in Oncology 2024 (NCCN guideline)

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