Mohs micrographic surgery is the most precise and effective treatment available for most skin cancers on the face, head, neck, and other cosmetically sensitive areas. At Fayetteville Dermatology, Dr. James Prezzano — a board-certified Mohs surgeon — performs the entire procedure on-site, from removal to microscopic analysis to reconstruction, in a single visit. Patients across Central New York choose Mohs when they need the highest cure rate possible while preserving as much healthy skin as possible.
What Is Mohs Surgery?
Mohs surgery (sometimes called Mohs micrographic surgery, MMS, or simply "Mohs") is a specialized technique for removing skin cancer one thin layer at a time. After each layer is removed, your surgeon examines 100% of its margins under a microscope before deciding whether more tissue needs to be taken. This is fundamentally different from a standard excision, where the tissue is sent off-site to a lab and only sampled — meaning small pockets of cancer cells can be missed.
The result: Mohs offers the highest documented cure rate of any skin cancer treatment — approximately 99% for previously untreated basal cell and squamous cell carcinomas, according to the American College of Mohs Surgery. It also removes the smallest amount of healthy tissue possible, which matters greatly when the cancer is on the nose, eyelid, ear, lip, or hands.
When Mohs Surgery Is the Right Choice
Mohs is most often recommended when:
- The skin cancer is on the face, head, neck, hands, feet, or genitals (areas where every millimeter of healthy tissue matters)
- The cancer is large, recurrent, or has unclear borders
- The cancer is aggressive or growing quickly
- Standard excision has been attempted and the cancer returned
- The patient is immunosuppressed (transplant recipients, certain medications)
- The cancer is in an area where scarring would be highly visible
For small, low-risk basal cell carcinomas on the trunk or limbs, a standard excision or curettage is often appropriate and less expensive. Dr. Prezzano will discuss the right option for your specific case at your consultation.
What to Expect on the Day of Your Mohs Procedure
Mohs is performed under local anesthesia in our Fayetteville office. Most patients are awake and comfortable throughout. Plan to be at the office for 1.5-4 hours — most patients are done in about 2 hours. Most of this time is waiting for tissue analysis, which is why we recommend bringing a book, tablet, or someone to keep you company. The actual surgical time is typically around 10 minutes per layer.
Here's the typical sequence:
- Prep & local anesthesia. The area is cleaned and numbed.
- First layer removed. Dr. Prezzano excises a thin layer of tissue including the visible cancer.
- Microscopic analysis. The tissue is processed and examined on-site. You wait comfortably in the office during this step.
- Repeat if needed. If cancer cells remain, only the affected area is removed. This is repeated until margins are clear.
- Reconstruction. Once the cancer is fully removed, Dr. Prezzano closes the wound — often with a custom flap or graft designed to preserve appearance and function.
You'll go home the same day. Most patients return to work within 2-7 days depending on the location and complexity of the closure.
Why Patients Choose Dr. Prezzano for Mohs in Central New York
Dr. James Prezzano is board-certified in both Dermatology and Micrographic Dermatologic Surgery. He completed his dermatology residency and fellowship at the University of Rochester Medical Center and has been performing Mohs surgery and complex reconstructions throughout his career.
He has co-authored peer-reviewed research on squamous cell carcinoma grading among Mohs surgeons, contributing to how the field standardizes diagnosis. He is a Fellow of the American Academy of Dermatology (FAAD) and a member of the American College of Mohs Surgery.
What this means for you: the same surgeon who removes the cancer is the one analyzing the tissue and reconstructing the wound. There's no handoff, no shipping tissue to a separate lab, and no waiting weeks for results.
Recovery and Aftercare
You'll leave the office with a pressure bandage and detailed written aftercare instructions (we also provide post-procedure care guides for reference at home). Typical recovery looks like:
- Days 1-2: Keep the bandage dry and in place. Some swelling and minor bleeding is normal.
- Days 2-14: Follow daily wound care (gentle cleansing, petrolatum, fresh dressing).
- 1-2 weeks: Sutures removed (or self-dissolve, depending on type used).
- 6-12 weeks: Most Mohs scars fade significantly during this period, with the scar continuing to improve over the first 6 months. If the scar remains obvious, there are quick in office procedures to improve the appearance.
If you ever notice increased pain, warmth, pus-like drainage, fever, or bleeding that doesn't stop with 20 minutes of firm pressure — call our office immediately at (315) 637-9116.
Frequently Asked Questions
For primary (previously untreated) basal cell and squamous cell carcinomas, Mohs offers an approximately 99% cure rate — the highest of any skin cancer treatment. For recurrent cancers, the rate is approximately 94%, still significantly higher than other techniques.
Most insurance plans do not require a referral to see a dermatologist in New York State, but a few HMO plans do. Check with your insurance — or call us at (315) 637-9116 and we'll help you confirm.
Yes — Mohs is covered by Medicare and most private insurance plans when performed for an appropriate skin cancer diagnosis. We accept Aetna, Blue Cross Blue Shield, Cigna, United Healthcare, and most major plans. Contact our office to confirm your specific coverage before your appointment.
Some scarring is unavoidable any time skin is cut. However, because Mohs removes the smallest amount of tissue possible to remove the cancer and Dr. Prezzano performs the reconstruction himself, scars are typically smaller and less noticeable than those from standard excision. Most fade significantly over 6-12 months.
Plan for 1.5-4 hours at our office. Most of this is waiting for tissue analysis between layers. The actual surgical time per layer is typically 10 minutes. Same-day reconstruction adds another 20-30 minutes depending on complexity. Most patients are in the office for about 2 hours.
No. Mohs is performed under local anesthesia, so you'll feel a brief pinch when the numbing medication is injected, then nothing during the procedure itself. Most patients experience only mild discomfort afterward, usually managed with Tylenol or ibuprofen.
Schedule Your Mohs Consultation
If you've been diagnosed with a skin cancer — or your primary care provider or another dermatologist has recommended Mohs surgery — we typically have appointments available within the same week.
We accept most major insurance plans including Aetna, BCBS, Cigna, United Healthcare, and Medicare.
Phone
Call us during our open hours for more information or guidance on the next steps
If you'd prefer please send us an email provided below and we'll get back to you the same day
What Our Patients Say
Our commitment to our patients is unwavering
Ready To Schedule?
Current wait time is less than one week