Table of Contents
Double Board-Certified Dermatologist and Mohs Surgeon
REJUVA Dermatology, Vein & Cosmetic Center
“Doctor, am I too old for this?”
It is one of the most common questions we hear when a patient in their 80s or 90s learns they need Mohs surgery for skin cancer. The short answer is no—advanced age alone is generally not a reason to avoid Mohs surgery.
Mohs micrographic surgery is an effective treatment for many high-risk basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), particularly in areas such as the face, ears, scalp and hands. Research involving patients in their 80s and beyond has found low complication rates, and because Mohs is typically performed with local anesthesia, it is often well tolerated by older adults.[1,2,6–10]
Here on Florida’s Gulf Coast, cumulative sun exposure means skin cancer is something we see frequently in older patients. Understanding what Mohs involves—and when it may or may not be the right choice—can make the decision much easier for patients and their families.
Key Takeaways
- Age alone does not determine whether someone is a good candidate for Mohs surgery.
- Mohs is typically performed using local anesthesia rather than general anesthesia, which can be particularly helpful for older patients.
- Large studies have found low complication rates, including among patients over age 80 and 85.[6–9]
- Mohs examines the surgical margins during the procedure, allowing the surgeon to remove additional tissue only where cancer remains.
- The best treatment depends on more than age. Overall health, tumor characteristics, medications, functional status and the patient’s goals should all be considered.[2,11,13]
What Is Mohs Surgery?
Mohs micrographic surgery is a specialized technique used primarily for certain basal cell carcinomas and squamous cell carcinomas. More than 876,000 skin cancers are treated with Mohs surgery each year in the United States.[1,2]
What makes Mohs different is the way the tissue margins are examined during your visit.
What happens during Mohs surgery?
1. Numbing the area.
The treatment area is numbed with a local anesthetic. You remain awake during the procedure, and general anesthesia is usually unnecessary.
2. Removing the visible tumor.
The surgeon removes the visible skin cancer along with a thin margin of surrounding tissue.
3. Mapping and examining the tissue.
The removed tissue is carefully mapped, frozen, processed and examined under the microscope.
4. Removing additional tissue only where necessary.
If cancer cells remain at an edge, another thin layer is removed specifically from that location. The process continues until the margins are clear.
5. Repairing the wound.
Depending on its size and location, the wound may heal naturally, be closed with stitches, or be reconstructed using a flap or skin graft.
Because it is impossible to know beforehand how many stages will be required, patients should generally plan to spend several hours at the office on the day of surgery.[3]
Why Is Mohs Surgery Used for High-Risk Skin Cancers?
One of the major advantages of Mohs surgery is comprehensive microscopic examination of the surgical margin while preserving as much healthy tissue as possible.
A standard excision samples only a small percentage of the surgical margin for microscopic examination, whereas the Mohs technique evaluates essentially the entire peripheral and deep margin.[4]
This can be particularly important on the nose, eyelids, lips, ears and hands, where preserving healthy tissue can affect both appearance and function.
Long-term research also demonstrates low recurrence rates.
In a randomized trial with 10 years of follow-up, first-time facial basal cell carcinomas recurred in 4.4% of patients following Mohs surgery compared with 12.2% following standard excision. For previously recurrent BCC, recurrence was 3.9% following Mohs compared with 13.5% following standard excision.[5]
Reported local recurrence following Mohs is approximately 3.8% for high-risk BCC and 2.8% for SCC.[1]
Is Mohs Surgery Safe for Seniors?
Yes. Available evidence indicates that Mohs surgery can be performed safely in appropriately selected older adults, and chronological age by itself is not a reason to rule out the procedure.[2]
Several studies are particularly reassuring.
Complication rates are low overall
In a large prospective study involving 20,821 Mohs procedures at 23 centers, adverse events occurred in 0.72% of cases. Serious events occurred in only 0.02%, with no deaths or permanent disabilities reported.[6]
Patients over 80 have outcomes comparable to younger patients
A study comparing Mohs patients younger and older than 80 found complication rates of 7% in both groups, with no significant difference in first-year recurrence. This was despite older patients tending to have larger and deeper tumors.[7]
Studies of patients 85 and older are also reassuring
Among 1,683 Mohs procedures in patients age 85 and older, the complication rate was 1.78%. Factors associated with complications included blood-thinner use, tumors on the arms or legs, procedures requiring more than two Mohs stages and flap reconstruction—not age itself.[8]
Research examining larger and more complex Mohs repairs has likewise not demonstrated a meaningful increase in complications simply because a patient is 65 or older.[9]
Why Can Mohs Be Well Tolerated by Older Adults?
An important reason is that most Mohs surgery is performed using local anesthesia rather than sedation or general anesthesia.[10]
Patients remain awake, generally go home the same day and avoid many of the additional considerations associated with general anesthesia.
For an older patient with other medical conditions, this can be an important consideration when discussing treatment options.
What Is Recovery Like After Mohs Surgery?
Recovery varies according to the tumor location, wound size, type of reconstruction and the patient’s overall health.
Pain following Mohs surgery is generally mild. Studies report average pain around 2 out of 10, usually decreasing substantially within the first day. Acetaminophen is often sufficient, and prescription pain medication is rarely required.[2]
During the first several days, some swelling, bruising and redness are normal.
Wound care commonly continues for approximately 7–14 days using plain petroleum jelly. We generally avoid routine antibiotic ointments on clean surgical wounds because these products can cause allergic contact dermatitis.
Stitches, when used, are typically removed approximately 5–14 days after surgery, depending on the location and repair.
Healing time varies according to the size and location of the tumor, type of reconstruction, medications, smoking status and overall health.
What About Blood Thinners?
Do not stop a prescribed blood thinner on your own before Mohs surgery.
Current evidence generally supports continuing medically necessary anticoagulant and antiplatelet therapy because the increased surgical bleeding risk is often manageable, whereas discontinuing these medications can expose certain patients to potentially serious thrombotic complications.[8,12]
Medication decisions should be individualized. When appropriate, your Mohs surgeon can coordinate with your cardiologist, primary care physician or prescribing clinician.
Is Mohs Always the Best Choice for an Older Patient?
No.
Chronological age alone does not determine whether Mohs surgery is appropriate. Overall health, functional status, medications, tumor characteristics, expected benefits of treatment and the patient’s individual preferences and goals should all be considered.[13]
Even among patients older than 85 who were referred for Mohs surgery, approximately 9% were ultimately considered better suited to another management approach.[11]
For a very frail patient with a slow-growing, low-risk tumor, alternatives such as standard excision, curettage, radiation therapy, topical treatment or, in selected circumstances, careful observation may be reasonable.[2,14]
On the other hand, older patients can present with larger or more aggressive tumors. In those situations, timely treatment may be important for controlling the cancer and preserving function and appearance.[11]
The decision should be individualized rather than based on a patient’s birthday.
Mohs Surgery and Nonsurgical Skin Cancer Treatment at REJUVA
At REJUVA Dermatology, Vein & Cosmetic Center, Mohs surgery is performed in our office under local anesthesia.
We also offer electronic brachytherapy (EBT) as a nonsurgical radiation treatment for appropriately selected skin cancers. Having access to both surgical and nonsurgical approaches allows us to discuss treatment based on the individual cancer, its location and characteristics, the patient’s overall health, and the patient’s preferences and goals.
For some skin cancers, Mohs surgery remains the preferred treatment. For appropriately selected patients and tumors, EBT may provide a nonsurgical alternative.
Our goal is not simply to recommend one treatment for every patient, but to help each patient understand the available options and make an informed decision.
Frequently Asked Questions
Is 80 too old for Mohs surgery?
No. Age alone is not a contraindication to Mohs surgery. Research comparing patients above and below age 80 found similar complication rates, despite older patients having larger and deeper tumors in that study.[7] Overall health and the characteristics of the skin cancer are generally more important considerations than chronological age alone.
Can a 90-year-old have Mohs surgery?
Yes. Mohs surgery can be appropriate even for patients in their 90s. Research involving patients age 85 and older has demonstrated low complication rates.[8] The decision should still be individualized based on the tumor, the patient’s overall health, functional status, medications and treatment goals.
Does Mohs surgery require general anesthesia?
Usually not. Most Mohs surgery is performed using local anesthesia, meaning the treatment area is numbed while the patient remains awake.[10] This is one reason Mohs can be well tolerated by many older adults.
Should seniors stop blood thinners before Mohs surgery?
Not without speaking with their physicians. Evidence generally supports continuing medically necessary blood-thinning medications for many Mohs procedures because stopping them can create a risk of blood clots or other cardiovascular complications.[8,12] The decision should be individualized with the prescribing clinician when necessary.
Is Mohs the only option for skin cancer in seniors?
No. Treatment depends on the type, size, location and risk characteristics of the skin cancer as well as the patient’s overall health and preferences. Depending on the individual case, alternatives can include standard excision, curettage, radiation-based treatment, topical therapy or observation.[2,14]
When Should You See a Dermatologist?
If you or a loved one has been diagnosed with skin cancer—or has a spot that is new, changing, bleeding or not healing—a dermatologic evaluation can help determine the diagnosis and appropriate treatment options.
For older adults in particular, treatment decisions should consider not simply age, but the characteristics of the cancer, overall health and what matters most to the patient.
Patients in Sarasota, Venice and Southwest Florida who would like to discuss Mohs surgery or nonsurgical skin cancer treatment can schedule a consultation with REJUVA Dermatology, Vein & Cosmetic Center.
Call 941-529-0070 or visit us at 395 Commercial Ct, Suite C, Venice, FL 34292.
This article is for educational purposes and is not a substitute for individualized medical advice. Please discuss your specific situation with your physician.
References
1. Wehner MR. Keratinocyte Carcinoma: A Review. JAMA. 2026;335(1):70-81. doi:10.1001/jama.2025.18749
2. Maciejewska M, et al. Mohs Micrographic Surgery: A Narrative Review of Current Practices, Emerging Trends, and Case-Based Insights. Adv Ther. 2025;42(11):5397-5426. doi:10.1007/s12325-025-03354-w
3. Etzkorn JR, Alam M. What Is Mohs Surgery? JAMA Dermatol. 2020;156(6):716. doi:10.1001/jamadermatol.2020.0039
4. Thomson J, et al. Interventions for Basal Cell Carcinoma of the Skin. Cochrane Database Syst Rev. 2020;11:CD003412. doi:10.1002/14651858.CD003412.pub3
5. Work Group, Kim JYS, et al. Guidelines of Care for the Management of Basal Cell Carcinoma. J Am Acad Dermatol. 2018;78(3):540-559. doi:10.1016/j.jaad.2017.10.006
6. Alam M, et al. Adverse Events Associated With Mohs Micrographic Surgery: Multicenter Prospective Cohort Study of 20,821 Cases at 23 Centers. JAMA Dermatol. 2013;149(12):1378-1385. doi:10.1001/jamadermatol.2013.6255
7. Camarero-Mulas C, et al. Mohs Micrographic Surgery in the Elderly: Patients Younger and Older Than 80 Years Old in REGESMOHS. J Eur Acad Dermatol Venereol. 2018;32(1):108-112. doi:10.1111/jdv.14586
8. Nemer KM, Ko JJ, Hurst EA. Complications After Mohs Micrographic Surgery in Patients Aged 85 and Older. Dermatol Surg. 2021;47(2):189-193. doi:10.1097/DSS.0000000000002452
9. Pham VX, et al. Evaluating Postoperative Outcomes of Mohs Surgery in the Elderly: A Retrospective Review of Large Repairs. J Drugs Dermatol. 2025;24(5):537-538. doi:10.36849/JDD.8489
10. Cook JL, Perone JB. A Prospective Evaluation of the Incidence of Complications Associated With Mohs Micrographic Surgery. Arch Dermatol. 2003;139(2):143-152. doi:10.1001/archderm.139.2.143
11. Maisel-Campbell A, et al. Nonmelanoma Skin Cancer in Patients Older Than Age 85 Years Presenting for Mohs Surgery. JAMA Dermatol. 2022;158(7):770-778. doi:10.1001/jamadermatol.2022.1733
12. Ruiz-Salas V, et al. Complications Associated With Mohs Micrographic Surgery: Data From the Nationwide Prospective Cohort REGESMOHS. Dermatology. 2022;238(2):320-328. doi:10.1159/000517010
13. National Comprehensive Cancer Network. Older Adult Oncology. Updated September 4, 2026.
14. Ong J, Feig JL, Grant-Kels JM. Beyond Appropriate Use Criteria: Ethical Considerations When Forgoing Mohs Micrographic Surgery. Clin Dermatol. 2026. doi:10.1016/j.clindermatol.2026.07.027
