Mohs Micrographic Surgery in Clovis & Fresno, CA
When it comes to treating skin cancer — particularly on the face, neck, ears, scalp, and hands — precision matters enormously. Mohs micrographic surgery is the gold standard for surgical skin cancer removal, offering the highest cure rates of any treatment method while conserving the maximum amount of healthy tissue. At Dehesa Dermatology, Dr. Luis A. Dehesa is a fellowship-trained, board-certified Mohs surgeon — one of the few in the Clovis-Fresno area — providing this specialized procedure to patients throughout the Central Valley.
What Is Mohs Micrographic Surgery?
Mohs micrographic surgery, developed by Dr. Frederic Mohs in the 1930s and refined over decades into the procedure used today, is a specialized surgical technique for removing skin cancer that achieves the highest possible cure rate while preserving the greatest amount of surrounding healthy tissue. It accomplishes this through a unique process: the surgeon removes the visible tumor plus a thin margin of surrounding tissue, then immediately processes and examines 100% of the surgical margin under a microscope while the patient waits. If cancer cells are detected at any margin, only that precise area is removed in the next stage — and the process repeats until all margins are completely clear.
This real-time, complete margin analysis is what sets Mohs surgery apart from standard surgical excision, which examines only a small representative sample of the margin. By examining every millimeter of the excised tissue’s edges and undersurface, Mohs surgery achieves cure rates of up to 99% for primary basal cell carcinoma — the highest of any treatment available — while minimizing the amount of healthy tissue removed.
When Is Mohs Surgery Recommended?
Mohs surgery is the preferred treatment for skin cancers with specific characteristics that make complete removal with standard excision more challenging or uncertain:
- Location in cosmetically or functionally critical areas: Face, nose, eyelids, ears, lips, scalp, neck, hands, feet, and genitalia — where preserving tissue is essential for both appearance and function.
- Aggressive growth patterns: Morpheaform, sclerosing, infiltrative, or micronodular basal cell carcinomas, and poorly differentiated squamous cell carcinomas that tend to spread along tissue planes.
- Recurrent tumors: Skin cancers that have returned after previous treatment, which often have ill-defined margins and require the complete margin control that Mohs provides.
- Large tumors: Cancers with large surface areas where minimizing tissue removal is important.
- Tumors with indistinct borders: Including lentigo maligna melanoma on the face, where margins are difficult to define visually.
- Immunocompromised patients: Who have higher rates of aggressive, recurrent, or multiple skin cancers and benefit from the most definitive treatment available.
- Tumors in high-risk anatomical zones: Areas known for high rates of recurrence with standard excision, such as the nose, around the eye, and the ear.
The Mohs Surgery Process at Dehesa Dermatology
Your Mohs surgery day at Dehesa Dermatology is an outpatient procedure performed entirely under local anesthesia. Here is what to expect:
- Preparation: The surgical site is cleaned, marked, and numbed with local anesthetic injections. You will be awake and comfortable throughout the procedure.
- Stage 1 — Tumor Removal: Dr. Dehesa removes the visible tumor and a thin margin of surrounding tissue. The wound is temporarily bandaged.
- Tissue Processing and Mapping: The excised tissue is precisely mapped, color-coded, and processed into frozen sections in our on-site laboratory. Dr. Dehesa personally examines 100% of the surgical margins under the microscope.
- Margin Analysis: If cancer cells are found at any margin, only the precise area containing remaining cancer is removed in the next stage. This process repeats until margins are completely clear.
- Wound Repair: Once clear margins are confirmed, Dr. Dehesa repairs the wound using the most appropriate reconstructive technique — which may include primary closure, skin flap, skin graft, or referral to our plastic surgery colleague, Dr. Duncan MacKay, for complex reconstructive cases.
Most Mohs surgery cases are completed in 1 to 3 stages within the same day. The total time required varies depending on the number of stages needed, but patients should plan for a full day at the office.
Skin Cancers Treated with Mohs Surgery
Mohs surgery is most commonly used for basal cell carcinoma and squamous cell carcinoma. It is also used for select cases of melanoma — particularly lentigo maligna melanoma on the face. Learn more about our comprehensive approach to skin cancer care on our skin cancer treatment page and our melanoma page.
Basal cell carcinoma (BCC) is the most common skin cancer in the United States, with over 3 million cases diagnosed annually. It develops from the basal cells of the epidermis and is most commonly found on sun-exposed areas. While BCC rarely spreads to other parts of the body, it can cause significant local destruction and disfigurement if not treated promptly and completely — making Mohs surgery the preferred approach for BCCs in high-risk locations.
Why Choose Dr. Dehesa for Mohs Surgery
Not every dermatologist performs Mohs surgery — it requires specialized fellowship training beyond standard dermatology residency. Dr. Dehesa completed formal training in Mohs micrographic surgery and is one of a small number of fellowship-trained Mohs surgeons serving the Clovis and Fresno communities. Patients from throughout the Central Valley choose Dehesa Dermatology for Mohs surgery because they want the most experienced, most precise care available for their skin cancer — without traveling to a distant academic center.
Frequently Asked Questions About Mohs Surgery
What is the cure rate for Mohs surgery?
Mohs micrographic surgery achieves a cure rate of up to 99% for primary (previously untreated) basal cell carcinoma and approximately 94 to 97% for recurrent cases — significantly higher than standard surgical excision or other treatment modalities. For squamous cell carcinoma, Mohs also achieves excellent cure rates. This unmatched precision makes Mohs the gold standard for skin cancer treatment in anatomically critical or high-risk locations.
How painful is Mohs surgery?
Mohs surgery is performed entirely under local anesthesia, so the procedure itself is not painful. Patients typically feel only the initial injection of anesthetic, which causes brief stinging or burning. During the actual tissue removal and repair, you should feel only pressure or mild tugging — not pain. Post-operative discomfort is usually well managed with over-the-counter pain relievers. Our team provides detailed aftercare instructions and is available to answer any questions during your recovery.
How long does Mohs surgery take?
The duration varies depending on the number of stages required to achieve clear margins. Most procedures are completed in 1 to 3 stages within a single day. Between stages, patients wait comfortably while tissue is being processed and analyzed — which typically takes 45 minutes to an hour per stage. We recommend planning for a full day at our office, though many patients are done within 3 to 4 hours.
Will Mohs surgery leave a significant scar?
Because Mohs surgery removes only what is necessary — taking the smallest possible margin needed to achieve clear cancer-free edges — wounds are typically smaller than they would be with standard wide excision. Our team uses advanced reconstructive techniques to achieve the most cosmetically favorable closure possible. For complex facial or large defects, we work closely with our colleague Dr. Duncan MacKay, our board-certified plastic surgeon, to optimize cosmetic outcomes.
Do I need a referral for Mohs surgery at Dehesa Dermatology?
In most cases, patients come to us for Mohs surgery after a skin biopsy has confirmed a skin cancer diagnosis — either from a biopsy performed here at Dehesa Dermatology or by a referring physician. If you have received a diagnosis of basal cell or squamous cell carcinoma and have been told that Mohs surgery is recommended, call (559) 951-9000 to schedule your surgery consultation. We are happy to coordinate with your referring provider.
What should I do to prepare for Mohs surgery?
Before your procedure, avoid blood-thinning medications and supplements (such as aspirin, ibuprofen, fish oil, and vitamin E) for the period specified by our team. Eat a normal breakfast, wear comfortable clothing, and arrange transportation home as a precaution (though most patients drive themselves). Bring something to read or listen to while waiting between stages, as there may be periods of downtime during tissue processing. Our team will provide a complete pre-operative preparation list at your surgery scheduling appointment.
Does Dehesa Dermatology perform Mohs surgery for patients from Fresno?
Yes. Dr. Dehesa is one of the very few fellowship-trained Mohs surgeons serving the Clovis-Fresno area, and we regularly perform Mohs surgery for patients from Fresno and throughout the Central Valley. Our office at 978 N Temperance Ave in Clovis is accessible from Fresno via Highway 168. For skin cancer care that combines precision, experience, and convenience, call (559) 951-9000 to schedule your consultation.