Behind the Results: Understanding Mohs Surgery Success with Dr. Steven Krueger

Mohs surgery is a highly specialized surgical technique used primarily for the treatment of skin cancer. Named after Dr. Frederic Mohs, who first developed the procedure in the 1930s, Mohs surgery is renowned for its high cure rates and ability to spare healthy tissue. In this blog, Dr. Steven Krueger, a Board-Certified Dermatologist and Mohs Micrographic Surgeon, takes us through the basics.

“A fully qualified Mohs surgeon is someone who has completed residency training and board certification in general dermatology, followed by fellowship training and board certification in Mohs micrographic surgery and dermatologic oncology,” Dr. Krueger notes. “What makes Mohs surgery unique compared to other forms of skin cancer removal is the way that we evaluate the edges of the tissue we remove – we assess 100% of the surgical margin in real time, allowing for exceptionally high cure rates while also preserving as much of the healthy skin around the cancer as possible.”

A patient is typically referred to a Mohs surgeon after an initial biopsy confirms the presence of skin cancer. Under local anesthesia, the cancerous lesion is excised, and the tissue is promptly sent to an in-house lab. Here, the tissue is meticulously examined by the Mohs surgeon, with a keen focus on identifying any remaining cancer cells at the margins. If cancerous cells persist, the surgeon precisely maps their location and returns to remove additional tissue from the affected area. This process repeats until clear margins are achieved.

Once the cancer is completely removed, the attention shifts to wound reconstruction—a skill honed through specialized fellowship training.

“Surgical wounds may be closed in a simple line with stitches, left to heal without suturing, or we may require the use of more advanced reconstruction techniques, such as flaps or grafts, to cover the wound. When choosing a reconstructive option, maintaining function is our top priority. For example, after surgery we want patients to still be able to fully close their eyes, breathe through their nose, or insert hearing aids into their ear. The next order of business is restoring normal anatomy, such as recreating the outer rim of the ear or the tip of the nose. Finally, we focus on cosmetic fine-tuning to hide scar lines as much as possible.”

This sounds foolproof, right? Dr. Krueger explains why a patient might be hesitant to see a Mohs surgeon.

“Many patients are nervous about undergoing surgery and having a scar (often on their face). While there are nonsurgical treatments for skin cancer, such as creams or radiation therapy, they often do not achieve the same high cure rates as Mohs surgery. I reassure patients that while the affected area can look worse before it looks better while they are healing from surgery, most patients end up pleasantly surprised with the final appearance of their scar. Mohs surgeons have several tools to improve the appearance of scars. I often use injections, lasers, and dermabrasion on my patients to blend scars in with the surrounding normal skin and achieve an optimal aesthetic result.”

Despite the comprehensive nature of Mohs surgery, the entire procedure typically takes only 2-4 hours, offering patients a swift and efficient treatment experience. Following this office-based surgery, patients return home for healing and attend follow-up appointments as needed. Depending on the area and size of treatment, the healing times will vary.

“Most types of skin cancer qualify for Mohs surgery, but the most common that we see are basal cell and squamous cell carcinoma. There are guidelines for which kinds of cancer and which body locations qualify for the procedure. We tend to perform Mohs surgery for cancers on the head and neck, but it is also used for other sensitive areas like the hands, fingers, feet, toes, genitals, and nipples. In some cases, alternative treatment options may be suggested.” According to the Skin Cancer Foundation, 1 in 5 Americans will develop skin cancer by the age of 70. It is important to visit your dermatologist on an annual basis as part of a complete early detection strategy.

Dr. Steven Krueger is currently accepting new patients at our offices in East Greenwich, RI, North Attleboro, MA, and Westport, MA. To book an appointment with Dr. Krueger, please call our office at (401) 715-2215.