Your Complete Guide to Mohs Surgery at Clearview Dermatology
Key Points:
- Mohs surgery offers up to 99% cure rates for primary skin cancers and preserves the maximum amount of healthy surrounding tissue.
- Dr. Joe Overman at Clearview Dermatology is a fellowship-trained Mohs surgeon who has performed over 8,000 Mohs surgeries.
- Mohs surgery is performed in a single outpatient visit, with the surgeon acting as both the operating physician and pathologist for real-time margin analysis.
- Clearview Dermatology serves patients at three locations: Arvada, Evergreen, and Littleton, Colorado.
A skin cancer diagnosis can feel overwhelming. At Clearview Dermatology, our goal is to make sure you understand every step of your treatment so you feel informed, prepared, and confident in your care. This guide walks you through everything you need to know about Mohs Micrographic Surgery, covering what it is and why it is recommended, to what happens on the day of your procedure and how to care for your skin afterward.
Clearview Dermatology's skin cancer team is led by Dr. Joe Overman, a double Board-Certified Dermatologist and Fellowship-Trained Mohs Surgeon. After completing four years of dermatology residency, Dr. Overman completed a rigorous fellowship at Oregon Health Science University in Portland, one of the top Mohs fellowship programs in the United States. His fellowship combined Mohs micrographic surgery, reconstructive and facial plastic surgery, cosmetic dermatology, laser surgery, and oculoplastic surgery, giving him comprehensive surgical expertise that goes well beyond Mohs alone. Dr. Overman has performed over 8,000 Mohs surgeries and brings that depth of experience to every patient at our Arvada, Evergreen, and Littleton offices.
What Is Mohs Surgery?
Mohs Micrographic Surgery is the most advanced and effective treatment available today for many types of skin cancer. Originally developed by Dr. Frederic E. Mohs in the 1930s and continuously refined over the past 90 years, it is a highly specialized technique that allows the surgeon to remove skin cancer layer by layer while examining each layer under a microscope in real time.
This precise approach means that cancerous tissue is tracked and removed completely, including any microscopic "roots" or "branches" that extend beyond what is visible to the naked eye, while leaving as much healthy surrounding tissue intact as possible. The result is the highest cure rate of any skin cancer treatment available, combined with better cosmetic outcomes.
Why Mohs Surgery Has the Highest Cure Rate
The key difference between Mohs surgery and standard surgical excision lies in how the tissue margins are examined. With standard excision, a pathologist examines a small, random sample of the removed tissue, typically less than 1% of the total margin. This means tumor cells can remain undetected, sometimes requiring a second surgery.
With Mohs surgery, 100% of the tissue margin is examined before the wound is closed. If cancer cells are found at any edge, Dr. Overman removes only the additional tissue in that precise location and repeats the process until every margin is completely clear. This approach results in:
- Up to 99% cure rate for new (primary) skin cancers
- Up to 95% cure rate for recurrent cancers
- Maximum preservation of healthy tissue, particularly important on the face and other visible or sensitive areas
- Complete cancer removal confirmed the same day, in a single office visit
What Types of Skin Cancer Does Mohs Treat?
Mohs Micrographic Surgery is used to treat:
- Basal Cell Carcinoma (BCC), the most common form of skin cancer
- Squamous Cell Carcinoma (SCC), the second most common form
- Melanoma In-Situ, Superficial Spreading Melanoma and superficially invasive melanomas
- Other rare or aggressive skin tumor types
When Is Mohs Surgery Recommended?
Mohs surgery is typically recommended when:
- The cancer is located on or near cosmetically sensitive or functionally important areas, including the face, nose, lips, eyelids, ears, scalp, fingers, toes, or genitals
- The tumor is large or has poorly defined margins
- There is a high risk of recurrence
- The cancer has already recurred after previous treatment
- The tumor is located near or within scar tissue
- The cancer is aggressive or fast-growing
- The patient is immunosuppressed
Mohs Surgery vs. Surgical Excision
Not every skin cancer requires Mohs surgery. Some cancers, particularly those on the trunk, such as the chest or back, can be treated effectively with wide local excision, a traditional surgical approach. Understanding the difference helps you have an informed conversation with Dr. Overman about which option is right for your diagnosis.
Wide Local Excision
Standard surgical excision involves numbing the area with local anesthesia, removing the lesion along with a set margin of normal tissue around it, then closing the wound with sutures. The removed tissue is sent to a dermatopathologist, who examines it to confirm the cancer has been completely removed. Results are typically available within one week of surgery.
Wide local excision is a well-established, effective treatment for many skin cancers, particularly those in locations where tissue preservation is less of a concern and where the cancer has well-defined edges.
How Mohs Surgery Differs
The critical distinction with Mohs surgery is real-time, on-site pathology. Rather than sending tissue to an outside lab and waiting days for results, Dr. Overman processes and reads the slides himself in the on-site Mohs laboratory during your appointment. This allows for same-day confirmation that all cancer has been removed before the wound is ever closed.
Because Dr. Overman is fellowship-trained in surgery, pathology, and reconstruction, the entire process of removal, analysis, and repair is performed by one specialist in a single visit. This eliminates the need for a second surgery to address positive margins and significantly reduces the risk of recurrence.
At a Glance: Mohs vs. Surgical Excision
| Feature | Mohs Surgery | Surgical Excision |
|---|---|---|
| Margin analysis | 100% of margins examined in real time | Random sample (<1%) sent to outside lab |
| Results timing | Same day, confirmed before wound closure | Typically 5–7 business days |
| Cure rate | Up to 99% (primary), 95% (recurrent) | Lower; re-excision sometimes needed |
| Tissue preservation | Maximum: only cancerous tissue removed | Fixed margin of healthy tissue also removed |
| Best for | Face, scalp, ears, nose, lips, eyelids, hands, feet; aggressive or recurrent cancers | Trunk, less cosmetically sensitive areas; well-defined, lower-risk tumors |
| Visits required | One visit: surgery and repair in same appointment | One for surgery; results arrive later; possible second surgery if margins positive |
Mohs Surgery for Melanoma
While Mohs surgery has long been the gold standard for basal cell and squamous cell carcinomas, it is also an effective treatment for certain types of melanoma. Dr. Overman is one of the few Mohs surgeons in Colorado with extensive training and experience treating melanomas using Mohs surgery, making Clearview Dermatology a trusted resource for patients throughout the Denver metro area and the foothills communities.
Which Melanomas Can Be Treated with Mohs?
Mohs micrographic surgery is used to treat melanoma in-situ, superficial spreading melanoma and superficially invasive melanomas. These are early-stage melanomas confined to or near the surface of the skin. The precise, layer-by-layer removal approach of Mohs surgery is particularly well-suited to ensuring complete removal of these lesions.
Why Mohs for Melanoma?
Numerous clinical studies have shown that Mohs surgery decreases the risk of melanoma recurrence and increases overall survival compared to standard excision. Because 100% of the tissue margins are examined before wound closure, Mohs surgery confirms complete removal, eliminating the uncertainty and the potential need for multiple surgeries that can come with standard approaches.
Dr. Overman always works in conjunction with medical and surgical oncologists when appropriate to ensure that patients receive the most comprehensive, coordinated treatment plan for their specific case.
If you have been recently diagnosed with melanoma, ask your dermatologist whether Mohs surgery is right for your case, or contact Clearview Dermatology directly to schedule a consultation with Dr. Overman.
Preparing for Your Mohs Surgery
For most patients, a brief discussion of the surgery and treatment plan on the morning of the procedure is all that is needed. However, for more complex cases, or for patients who prefer to meet Dr. Overman in advance, a separate pre-operative consultation can be scheduled.
Before Your Procedure
- Continue taking any prescribed medications unless Dr. Overman specifically instructs you otherwise
- Eat a normal meal before your appointment. Do not come on an empty stomach
- Wear comfortable, loose-fitting clothing appropriate to the area being treated
- Avoid self-tanning products or significant sun exposure in the treatment area in the days leading up to your procedure
What to Bring
Mohs surgery is a thorough, meticulous process. Most procedures take approximately 3 to 5 hours from start to finish, and complex cases can take longer.
The majority of this time is spent in the Mohs laboratory between surgical stages. Plan accordingly:
- Books, magazines, a laptop, or other work to keep you occupied during waiting periods
- A snack (Clearview Dermatology is happy to provide one if you forget)
- A companion if you would like someone with you, though it is not required
Clearview Dermatology provides complimentary Wi-Fi, and our offices are designed with patient comfort in mind, featuring calming decor, music, snacks, and refreshments available throughout your visit.
What Happens During Mohs Surgery
Mohs surgery is performed on an outpatient basis at Clearview Dermatology's state-of-the-art offices under local anesthesia. You will be awake throughout the procedure, and most patients experience little to no discomfort once the area has been numbed.
The Mohs Process, Step by Step
Step 1: Numbing the Area
Local anesthesia is injected around the tumor site to completely numb the treatment area. This is the most uncomfortable moment of the procedure for most patients, and it passes quickly.
Step 2: Removing the First Layer
Dr. Overman removes a thin layer of visible cancerous tissue along with a small margin of surrounding skin. The wound is temporarily bandaged while the tissue is processed in the laboratory.
Step 3: Laboratory Analysis
The removed tissue is taken to Clearview Dermatology's on-site Mohs laboratory, where it is prepared with colored dyes, frozen, cut into thin sections, and mounted on slides. Dr. Overman reads each slide under the microscope and maps any remaining cancer cells with precision. This is where most of the waiting time during the procedure occurs.
Step 4: Additional Stages If Needed
If cancer cells are detected at any margin, Dr. Overman returns to the surgical site and removes an additional thin layer only in the precise location where cancer remains. This process of removal, bandaging, and laboratory analysis continues until all margins are completely clear of cancer cells. Because only affected areas are re-excised, healthy tissue is preserved as much as possible.
Step 5: Wound Repair
Once the cancer is confirmed completely removed, Dr. Overman addresses wound closure. The approach depends on the size, depth, and location of the surgical site. Options include:
- Healing by secondary intention, allowing the wound to heal naturally on its own, appropriate for certain locations and wound sizes
- Linear closure, which involves suturing the wound closed in a straight line
- Flap repair, a local rearrangement of nearby tissue to fill the wound, drawing from reconstructive plastic surgery technique
- Skin graft, which involves transferring tissue from another part of the body to cover the wound
Dr. Overman's fellowship training in both Mohs surgery and reconstructive and facial plastic surgery allows him to choose the repair technique that best restores cosmetic appearance and function for each individual patient.
Step 6: Bandaging and Aftercare
After repair, the area is bandaged and you receive detailed written aftercare instructions. Sutures are typically removed 7 to 14 days later at a scheduled follow-up appointment.
Recovery and Postoperative Care
Following your aftercare instructions carefully is one of the most important things you can do to support healing and achieve the best possible outcome. The following is a general overview. Your specific written instructions will be tailored to your procedure and repair type.
Immediately After Surgery
- You will leave with a bandage over the surgical site. Keep it clean and dry as instructed
- Some minor bleeding is normal and expected
- Swelling, bruising, tenderness, and tightness around the site are common in the first several days
- Avoid strenuous physical activity and heavy lifting, particularly in the first 48 hours, as increased exertion can raise the risk of bleeding
Wound Care
Your team will provide specific wound care instructions based on your repair type. In general:
- Keep the wound clean and moist. Proper moisture supports faster, better healing
- Gently clean the site as directed, typically once or twice daily
- Apply any recommended ointment to prevent drying
- Do not pick at, scratch, or disturb the healing wound
Activity and Follow-Up
- Avoid direct sun exposure on the healing skin. Use sunscreen and protective clothing once the wound is healed
- Attend all scheduled follow-up appointments, including suture removal at 7 to 14 days
- Contact Clearview Dermatology promptly if you notice signs of infection: increasing redness, warmth, significant swelling, discharge, or fever
Healing Timeline
The surgical site typically heals significantly in the first few weeks, but the final appearance of the scar continues to improve over the following months. Complete healing, including full scar maturation, can take up to 12 months depending on the size and location of the surgery and your body's individual healing response.
It is normal to feel self-conscious about the appearance of your surgical site during the healing process. The majority of patients are pleasantly surprised by how much improvement occurs over time, and many report that the result is far less noticeable than they expected.
Scar Treatment Options
Even with the most meticulous surgery, some degree of scarring is unavoidable. Clearview Dermatology offers a range of scar treatment options for patients who wish to further improve the appearance of their surgical site after healing is complete:
- Scar massage: once fully healed, gentle massage helps break down dense scar tissue and improves flexibility
- Medical-grade silicone gel or sheets, which flatten and soften scars over time with consistent use
- Excel V+ vascular laser to target redness and help scars blend with surrounding skin
- Steroid injections to reduce raised or thickened (hypertrophic or keloid) scars
- Surgical scar revision for cases where a more involved approach is beneficial
Your Clearview Dermatology provider will discuss scar management options at your follow-up appointments. For more detail, visit our dedicated blog post on scar treatment after Mohs surgery at https://www.clearviewdermatology.com/blog/scar-treatment-after-mohs-surgery.
Frequently Asked Questions
Who is a candidate for Mohs surgery?
Mohs surgery is typically recommended for skin cancers on the face, scalp, ears, nose, lips, eyelids, hands, feet, or other sensitive areas, and for cancers that are large, aggressive, poorly defined, or have recurred after previous treatment. Dr. Overman will review your diagnosis and discuss whether Mohs or surgical excision is the right approach.
Do I need a consultation before my surgery date?
For most patients, a discussion with Dr. Overman on the morning of surgery is all that is needed. If your case is more complex or you prefer to meet Dr. Overman in advance, a separate pre-operative consultation is available upon request.
How long will the procedure take?
Plan for approximately 3 to 5 hours. Complex cases can take longer. Most of this time is spent in the laboratory between surgical stages. We encourage patients to bring reading material, a laptop, or other ways to pass the time comfortably. Clearview Dermatology provides complimentary Wi-Fi, snacks, and refreshments.
Will I be awake? Is it painful?
Yes, you will be awake throughout. Local anesthesia is used to completely numb the treatment area, so most patients experience little to no discomfort after the initial injection. Dr. Overman and his team prioritize patient comfort at every stage.
Will I need reconstructive surgery?
In many cases, some form of wound repair is needed after the cancer is removed, ranging from simple suture closure to a flap or skin graft. Some wounds can also be allowed to heal naturally. Dr. Overman's fellowship training in reconstructive and facial plastic surgery means he handles the repair himself as part of the same appointment, with no separate plastic surgery referral required for the majority of patients.
What side effects can I expect?
Common side effects include swelling, bruising, tenderness, and some tightness at the surgical site. Minor bleeding can occur and is normal. As with any surgical procedure, there are small risks of infection and scarring, which the team will discuss with you. Complete healing, including scar maturation, can take up to 12 months.
What is the recovery time?
Recovery varies depending on the size and location of the skin cancer. You may experience some swelling or bruising in the days following your procedure. Sutures are typically removed at a follow-up appointment 7 to 14 days after surgery. Complete healing, including scar maturation, can take up to 12 months.
How much does Mohs surgery cost?
Mohs surgery is generally no more costly than standard excision and less expensive than excision in a hospital or ambulatory surgery center or radiation therapy. Because Mohs minimizes the risk of recurrence, it also reduces the likelihood of needing a larger, more costly surgery down the road. Most insurance plans cover Mohs surgery when it is medically indicated. Contact our office for coverage information specific to your plan.
Can Mohs surgery treat melanoma?
Yes. Dr. Overman is one of the few Mohs surgeons in Colorado with extensive training and experience treating melanoma in-situ, superficial spreading melanoma and superficially invasive melanoma using Mohs surgery. He works in coordination with medical and surgical oncologists when appropriate to ensure each patient receives comprehensive, coordinated care.
Will I need ongoing skin cancer screenings after my surgery?
Your Clearview Dermatology provider will discuss follow-up care and monitoring with you after your procedure. Clearview Dermatology sees patients for both Mohs surgery and ongoing skin care needs.
About Clearview Dermatology
Clearview Dermatology is a full-service dermatology practice serving the Denver metro area and Colorado's foothills communities. Our skin cancer team is led by Dr. Joe Overman, a double Board-Certified Dermatologist and Fellowship-Trained Mohs Surgeon who has performed over 8,000 Mohs surgeries. Dr. Overman's fellowship training encompasses Mohs micrographic surgery, reconstructive and facial plastic surgery, and advanced cosmetic procedures including lasers and scar revision.
Our team is committed to providing world-class skin cancer care, from diagnosis through surgery, reconstruction, and follow-up, with the warmth, attention to detail, and professionalism that our patients consistently describe in their reviews.
Our Locations
Candelas (Arvada)
14789 W. 87th Parkway, Arvada, CO 80005 | 720-797-9184
Bergen Park (Evergreen)
32135 Castle Court, Ste 202, Evergreen, CO 80439 | 720-694-8550
Dakota Ridge (Littleton)
13402 W Coal Mine Ave, Ste 360, Littleton, CO 80127 | 720-909-8154
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Disclaimer: The information provided on this blog is for general informational purposes only and is not intended as, and should not be considered, medical advice. All information, content, and material available on this blog are for general informational purposes only. Readers are advised to consult with a qualified healthcare professional for medical advice, diagnosis, or treatment. The author and the blog disclaim any liability for the decisions you make based on the information provided. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition.
