If you’ve been diagnosed with skin cancer, you may hear about two popular treatment options: Mohs micrographic surgery and radiation therapy. Both are effective treatments, but they work in different ways. Deciding which option is right for you may feel overwhelming, especially when you’re balancing medical information with personal concerns like recovery time, appearance and overall health.
To help you make an informed decision, this article explains:
- What is Mohs surgery?
- What is radiation therapy for skin cancer?
- Mohs versus radiation: How to decide
- The pros and cons of Mohs surgery and radiation therapy
If you or a loved one is concerned about possible signs or symptoms of cancer and would like an initial appointment or a second opinion, call us 24/7 at 877-460-4673.
What is Mohs surgery?
Mohs surgery is a precise type of surgery used to treat skin cancer, including common types like basal cell carcinoma and squamous cell carcinoma. It’s performed by a specially trained surgeon who removes the tumor one section at a time and immediately examines each section under a microscope. If cancer cells are still seen, another section is taken, and this process continues until no cancer cells are visible.
“This thorough, step-by-step approach helps ensure the cancer is completely removed while preserving as much healthy skin as possible, which can improve healing and appearance,” says Gaurav Singh, M.D., M.P.H., F.A.A.D., F.A.C.M.S., a dermatologist and Mohs micrographic surgeon at City of Hope® Cancer Center Chicago.
He explains that during the procedure, a board-certified fellowship-trained Mohs surgeon also serves as the pathologist, which allows for the highest possible cure rates that approach 99%.
“Patients almost always have reconstruction afterwards,” adds Dr. Singh, who has performed more than 10,000 Mohs surgeries. “This is typically done the same day by the Mohs surgeon, but in some instances, reconstruction is coordinated with a plastic surgeon.”
With Mohs surgery, patients undergo complete cure, as confirmed under the microscope with histology, of their skin cancer along with reconstruction on the same day in one visit.
What is radiation for skin cancer?
When it comes to treating skin cancer—especially basal cell or squamous cell carcinoma—radiation therapy is also an option in some situations, including:
- When skin cancer surgery isn’t the best option
- When a tumor is difficult to remove
- Before or after surgery to lower the risk of cancer returning
Instead of cutting the tumor out, radiation is aimed precisely at cancer cells from a machine outside the body (external beam radiation therapy), or in some cases through a small device placed on top of or into the tumor. This focused delivery helps kill cancer cells or stop them from growing while limiting radiation exposure to nearby healthy skin and tissue.
The actual treatment is usually painless and takes only a few minutes per session, though it’s often given many times over several weeks for maximum effectiveness.
Radiation therapy versus superficial radiation therapy
Superficial radiation therapy (SRT) is a non-surgical treatment for early skin cancers that uses low-energy X-rays to target cancer cells near the surface of the skin. The radiation doesn’t go deep, so it limits exposure to nearby healthy tissue. Treatments are painless and usually given over several sessions. Often, 15-30 sessions are required.
SRT differs from standard radiation therapy, which uses high-energy beams that reach deeper tissues and is frequently used for larger or more advanced skin cancers.
It’s important to know that SRT has lower cure rates than treatments like Mohs micrographic surgery. A Journal of the American Academy of Dermatology (JAAD) study found that skin cancers treated with SRT were more likely to come back compared with those treated with Mohs surgery.
Because of this, doctors carefully consider the cancer’s size, depth and location—along with the patient’s overall health and preferences—when discussing available treatment options.
Mohs versus radiation: How to decide
When deciding which treatment to recommend, Dr. Singh says medical oncologists, radiation oncologists and cutaneous (skin) oncologists discuss which therapy—or combination of therapies—will work best for specific patients.
“Sometimes that means Mohs surgery, sometimes radiation, or a combination of treatments,” says Dr. Singh. “We talk with the patient about options, explaining the benefits and risks while keeping their personal goals in mind.”
Drawing on Dr. Singh’s expertise, here’s an overview of the key pros and cons of Mohs surgery and radiation therapy for skin cancer.
The pros and cons of Mohs surgery and radiation therapy
Mohs surgery pros
Very high cure rate: Mohs surgery has a cure rate of up to 99% for new skin cancers, making it the most effective treatment for most skin cancers.
Tissue-sparing: Because the surgeon checks the cancer cells in real time, as little healthy skin as possible is removed.
Done in one visit: Most of the time, Mohs may be completed in a single office session with local anesthesia.
Mohs surgery cons
Surgery is required: Though generally well tolerated, it still involves cutting and may require stitches or reconstruction, especially for larger tumors.
Healing time: You’ll need time to heal and follow your doctor’s follow-up care instructions.
Radiation Therapy Pros
Non-surgical option: This may be appealing for people who aren’t good candidates for surgery or would prefer not to have it.
No incisions: Since there’s no cutting, there’s no surgical wound to heal.
Radiation Therapy Cons
Lower cure rate: Studies generally show higher long-term recurrence rates after radiation therapy than after Mohs surgery. Recent research has found that nonmelanoma skin cancers treated with superficial radiation therapy had higher local recurrence rates than those treated with Mohs surgery.
Requires multiple visits: Radiation is usually given over many sessions across several weeks, rather than in a single visit.
Skin changes: Radiation may lead to redness, dryness, irritation and long-term changes in skin texture or color.
Choosing the right treatment for you depends on several factors, including:
- Type and size of your skin cancer
- Location of the tumor (for example, on the face versus the body)
- Your overall health and personal preferences
- How quickly you wish to complete treatment
For many people, Mohs surgery is recommended as the first choice because of its high cure rate and tissue-sparing approach, especially for cancers on the face or in sensitive areas.
Radiation therapy may be a good option when surgery isn’t possible, or if you and your doctor agree it’s the right fit for your situation.
Dr. Singh emphasizes collaboration in decision-making. “Talking openly with your care team is essential to understanding which option best supports your goals and health needs,” he says.
If you or a loved one is concerned about possible signs or symptoms of cancer and would like an initial appointment or a second opinion, call us 24/7 at 877-460-4673.