What is Mohs Surgery

Mohs micrographic surgery is a highly specialized technique used to treat many types of skin cancer, including basal cell carcinoma and squamous cell carcinoma. The procedure combines precise surgical removal with immediate microscopic examination of the tissue, allowing skin cancer cells to be identified and removed layer by layer while preserving as much healthy skin as possible.

Because skin cancer cells can extend beyond what is visible on the surface of the skin, simply removing the visible tumor may not fully eliminate the cancer. Mohs surgery is designed to trace and remove these microscopic extensions with exceptional precision. By examining 100% of the surgical margins in real time, Mohs surgery offers the highest cure rates available for many skin cancers — up to 99% for certain newly treated cancers.

During the procedure, Dr. Ashley Decker removes a thin layer of tissue and carefully maps the area before the tissue is processed and examined under a microscope. If cancer cells remain, their exact location is identified on the surgical map, allowing additional tissue to be removed only where necessary. This process is repeated until the margins are confirmed to be clear of cancer.

Because Mohs surgery removes the smallest amount of healthy tissue necessary while ensuring complete cancer removal, it is considered the gold standard for treating skin cancers in cosmetically and functionally sensitive areas such as the face, ears, eyelids, nose, lips, scalp, hands, and neck.

Advanced and High-Risk Skin Cancer Care

While Mohs surgery is commonly used to treat basal cell carcinoma and squamous cell carcinoma, some skin cancers require a more advanced level of surgical and oncologic expertise.

Dr. Ashley Decker has a particular interest in the treatment of complex and high-risk skin cancers, including recurrent tumors, aggressive tumor subtypes, large or deeply invasive cancers, and select cases of melanoma.

Dr. Decker’s Advanced Skin Cancer Expertise
-Founder of a multidisciplinary high-risk cutaneous oncology clinic
-Former leader of a monthly skin cancer tumor board
-Fellowship-trained through the MD Anderson Cancer Center Network
-Specialized expertise in Mohs surgery for melanoma and other high-risk skin cancers

Prior to joining Southern Marin Dermatology, Dr. Decker worked closely with specialists in medical oncology, radiation oncology, head and neck surgery, pathology, and radiology to develop treatment plans for complex skin cancers.

This multidisciplinary background provides a deeper understanding of tumor behavior, treatment planning, and the management of challenging cases that extend beyond routine skin cancer care.

Reconstruction & Aesthetic Outcomes After Mohs Surgery

Many patients are surprised to learn that reconstruction can often be performed immediately following Mohs surgery, allowing both the cancer removal and repair to be completed on the same day.

Dr. Decker’s expertise extends beyond tumor removal to advanced facial reconstruction, incorporating the same principles of tissue movement, contour restoration, and aesthetic planning that are fundamental to facial plastic and reconstructive surgery. Each repair is tailored to the location, size, and unique characteristics of the surgical site.

This is particularly important for skin cancers involving highly visible areas such as the nose, eyelids, lips, ears, and cheeks, where thoughtful reconstruction helps preserve natural contours and maintain facial harmony. In select cases, additional treatments such as CO2 laser resurfacing or medical-grade skincare may be recommended after healing to further optimize scar appearance.