As a dermatologist, I am often asked about the conditions I treat and the treatments I provide. I have compiled answers to the most common questions and organized them by category, so you can quickly find the information you need.
Named for its inventor, Dr. Frederick Mohs, Mohs surgery is a highly effective surgical technique for removing cancerous skin tumors. Developed in the 1940s, the method is widely regarded as the gold standard for the treatment of aggressive and complex skin lesions.
Much like a glacier, many cancerous lesions extend beyond what is visible to the naked eye: a small portion is visible above the surface, while the bulk remains hidden beneath. Mohs surgery is designed to remove the entire cancer, including these hidden extensions.
The unique advantage of Mohs surgery is that 100 percent of the tissue is evaluated during the procedure itself. The cancerous lesion is removed one thin layer at a time, with each layer examined immediately under a microscope until no cancer cells remain. This ensures the complete removal of the cancer while preserving as much healthy skin as possible.
In addition to maximizing tissue preservation, Mohs surgery offers the highest cure rates of any skin cancer treatment. It is particularly well suited for high-risk or recurrent tumors, and well as for lesions located in areas where both function and appearance matter most, such as the face, ears, nose, and hands. Once the tumor has been fully removed, the surgical site is carefully reconstructed to achieve the best aesthetic and functional result.
Mohs surgery is considered the best option for aggressive, recurrent or complex skin cancers. Its advantages are many:
• Highest Cure Rates – By analyzing 100% of the tumor margins under a microscope, Mohs surgery ensures complete cancer removal, with cure rates up to 99%.
• Excellent Cosmetic Outcomes – By preserving as much healthy tissue as possible, Mohs surgery minimizes scarring and promotes better aesthetic results.
• Outpatient Procedure – Conducted under local anesthesia, Mohs surgery avoids the risks of general anesthesia, and allows patients to return home the same day.
• Low Risk of Infection – The minimally invasive approach reduces the likelihood of infection and speeds up recovery.
In some situations, cancerous lesions can be treated with radiation therapy, which targets the tumor and the surrounding tissue . This treatment usually requires multiple sessions in a hospital-based radiation unit.
Other options may include chemotherapy or biologic agents, particularly for patients who are not candidates for surgery.
However, when feasible, surgical treatment is generally preferred. Mohs surgery, in particular, offers the highest cure rates while minimizing side effects and preserving as much healthy tissue as possible.
Mohs surgery is usually recommended for skin cancers in areas where preserving healthy tissue is especially important, such as the face, neck, ears, scalp, hands, pre tibial shins, feet, and genital areas. It is also frequently used for tumors that have recurred after prior treatment, or for large tumors on the limbs, such as the lower legs.
Mohs surgery is a highly specialized field within dermatologic surgery, and not all dermatologists are trained in this technique. It is important to ask about your doctor’s specific qualifications.
After completing my dermatology residency, I trained in an ACGME-accredited Mohs surgery fellowship in the United States. During the fellowship, I performed approximately 1,200 procedures, including over 400 complex reconstructions, and became a Fellow of the American College of Mohs Surgery.
In recent years, I have been involved in establishing Israel’s first ACMS-recognized Mohs fellowship program at Ichilov Hospital, where I now have the privilege of training the next generation of Israeli Mohs surgeons.
Mohs surgery can be performed safely in patients with a pacemaker. Simply make sure to inform the medical team about your pacemaker before the procedure so we can take it into account.
Having an artificial heart valve does not prevent you from safely undergoing Mohs surgery. According to established guidelines, you simply need to take prophylactic antibiotics before the procedure as a precaution.
Please be sure to let the medical team know about your valve replacement as soon as you arrive, so they can prepare as needed.
Mohs surgery can be performed safely even if you have had a joint replacement within the last six months. As an added precaution, current medical guidelines recommend taking prophylactic antibiotics before the procedure. Please let the medical team know about your joint replacement when you arrive, so they can prepare as needed.
No fasting is required. Since the surgery is performed under local anesthesia, you may eat and drink as usual before to the procedure.
You should continue all medications as usual, including blood thinners such as aspirin, Plavix, Clexan, Eliquis or Xarelto. There is no need to stop any prescribed medication prior to your surgery.
In most cases, you do not need to bring a companion to Mohs surgery. However, if you do choose to come with someone, they are welcome to join the discussions both before and after the procedure, and to hear all the post-operative care instructions.
While it is usually possible to drive after the procedure, many patients find it more comfortable and relaxing to have someone else drive them home.
Please note: in cases where a patient is unable to provide informed consent, the legal guardian must be present on the day of surgery .
Since Mohs surgery naturally involves some waiting periods while the removed tissue is being examined, many patients find it helpful to bring something to pass the time. You are welcome to bring a laptop, book, snacks or anything else you enjoy. Free Wi-Fi is available in the waiting area.
In most cases, no imaging is required before Mohs surgery. If imaging is needed, I will discuss this with you explicitly beforehand.
No, Mohs surgery is generally not painful. The only discomfort you may feel is when the local anesthesia is injected, which can cause a brief sting or mild burning sensation. Once the area is numb, you should not feel any pain. If more anesthesia is needed during the procedure, I will carefully top it up while the area remains numb, so you will not feel it.
In Mohs surgery, the surgeon himself examines the tissue under a microscope to ensure the cancerous cells have been removed. Only after confirming that the margins are cancer-free do I proceed with reconstructing the surgical site, aiming for the best possible aesthetic and functional outcome.
The duration of Mohs surgery depends on the size, location, and complexity of the tumor. Because the procedure includes on-site microscopic examination of the tissue margins to ensure complete cancer removal, it naturally takes time.
On average, most surgeries last between 2 to 5 hours. Simpler cases may be shorter, while more complex tumors that require multiple stages or intricate reconstruction can take longer.
While waiting between stages for tissue analysis, you can read, work, or use a laptop, and there is free Wi-Fi available in the clinic.
It is not possible to know in advance how many stages will be necessary . The goal of Mohs surgery is to remove the entire cancer while preserving as much healthy tissue as possible.
The procedure is performed in stages: first, the visible tumor is removed and examined under a microscope. If cancer cells are present at the edges, another thin area is removed from that specific area. The process is repeated till all the margins are clear.
Most patients—between 70-80 percent—require only one stage. Around 20-30 percent require two or more stages, all performed on the same day. Each decision is made in real-time, based on what is seen under the microscope.
Not at all. Requiring more than one stage is a normal part of the Mohs procedure. The goal is to remove every trace of cancer while preserving as much healthy tissue as possible. This requires working in stages.
In the first stage, the visible tumor is removed and checked under a microscope. If any cancer cells are found either beneath or to the sides of the visible tumor, I carefully mark their location on a surgical map, and remove additional tissues in that specific area. This process is repeated until the margins are completely clear.
Remember: The top priorities during Mohs surgery are complete removal of the tumor, preservation of healthy tissue, and achieving the best possible reconstruction—not speed. Taking the time to proceed with care ensures the most precise, effective, and lasting outcome.
The length of Mohs surgery varies from patient to patient. Factors such as the location, type, and depth of the tumor, the number of stages needed to ensure all cancer is removed, and the complexity of the reconstruction all affect how long the procedure takes. Because of this, some patients who arrive after you may finish before you.
I personally perform all reconstructions following tumor removal. During my fellowship, I received comprehensive training in complex surgical reconstructions under the guidance of Prof. Glenn Goldman, a leader in the field of facial reconstruction. This training ensures optimal aesthetic and functional outcomes.
Any time a lesion is removed, some degree of scarring is inevitable. However, Mohs surgery is specifically designed to minimize scarring by preserving as much healthy tissue as possible. In most cases, the resulting scar is subtle and blends naturally with the surrounding skin, often becoming barely noticeable at a normal conversational distance. For a better sense of typical results, I encourage you to view the photo gallery, which shows examples of healing over time.
For patients without special risk factors or a personal or family history of skin cancer, a yearly visit is recommended.
If you have risk factors such as immunosuppression, or a history of skin cancer, visits should be at least twice a year. Your dermatologist will determine a follow-up schedule tailored to your individual risk during the clinic examination.
A definitive diagnosis of skin cancer requires a biopsy. However, dermatologists can evaluate and identify potentially concerning lesions during a clinical exam with a dermatoscope. Pathology testing then confirms whether the lesion is cancerous or not.
Early detection significantly increases the chances of a full recovery. It is therefore recommended to have a complete skin examination by a dermatologist at least once a year, and to perform a self-examination once a month.
Lesions that warrant professional evaluation can be identified with the help of the ABCDE mnemonic:
A – Asymmetry: One half of the mole or lesion looks different from the other.
B – Border: Irregular, blurred, or poorly defined edges.
C – Color: Multiple shades within the same mole (black, blue, brown, red) or very dark pigmentation.
D – Diameter: Lesions larger than 6 mm (about the size of a pencil eraser).
E – Evolution: Any noticeable changes in size, shape, color, texture, or elevation. Studies show that changes in an existing lesion are the most significant warning sign.
Additionally, see a dermatologist if you notice:
A persistent wound that does not heal within 6-8 weeks.
A recurring sore that intermittently bleeds and heals over weeks or months.
If you are unsure about any skin lesion, err to the side of caution and have it examined promptly. Remember: early detection and timely treatment can be life-saving.
Most skin cancers are caused by cumulative exposure to ultraviolet (UV) radiation from the sun. Sun damage accumulates over time, and even moderate sun exposure during childhood, without severe sunburn, can contribute to skin cancer later in life. Individuals with fair skin, or a tendency to freckle or burn easily are at heightened risk.
Additional risk factors include occupational exposure to carcinogenic substances (such as arsenic or coal tar); a personal or family history of skin cancer; and certain genetic syndromes that increase susceptibility.
Sun damage accumulates over many years, so even occasional or mild sun exposure, especially during childhood, can contribute to the development of skin cancer. This is true even if you never experienced severe sunburns. Skin cancer is particularly common in fair-skinned individuals.
Being outdoors is healthy and enjoyable, but it is important to avoid direct exposure to strong sunlight. To protect your skin, plan activities for early morning (before 10 a.m.) or late afternoon (after 5 p.m.), when sunlight is less intense. When spending time in the sun, wear protective clothing such as a broad-brimmed hat, long sleeves, and sun-safe fabrics. Using 30 SPF sunscreen on exposed skin is also recommended.
This, for example, is how my daughter surfs:
Here is a link to a video that explains post-surgery care
It is likely that you will feel a certain degree of discomfort after the procedure. A dull, throbbing or burning pain is completely normal. This feeling usually peaks the night after surgery, with significant relief the day after. The pain should gradually resolve over the course of a few days
It is recommended to take over-the-counter pain relievers before the pain starts, as it is easier to prevent pain than to treat it.
Avoiding strenuous physical activity for the first two days also helps relieve discomfort and supports better healing.
Preventing pain is often easier than treating it. If you have no medical restriction or allergies, you may take 1 gram of paracetamol (Dexamol) every 6 hours. This can be combined with 1 gram of Optalgin every 6 hours. I suggest alternating the medications at 3-hour intervals to prevent pain from mounting.
Ibuprofen (Advil or Nurofen) is also effective for pain and does not increase bleeding risk, but it should be avoided if you have diabetes, kidney problems, or an active stomach ulcer.
Always follow the recommended dosages on the packaging and consult with me if you are unsure about which medications are safe for you.
If your surgery was near or above the eye, some swelling under or around the eye is completely normal. Fluid from the surgical area can naturally settle in the soft tissue below the eye, causing temporary puffiness.
The swelling is not harmful, and will not affect your vision. It typically subsides over the course of a few days, and will resolve on its own.
It is normal for the surgical scar to appear longer than anticipated. This is intentional—extending the incision allows the skin to heal smoothly and evenly. Over time, a longer, flat scar blends in better than a shorter scar that might be raised or uneven. As a general guideline, the scar is usually about three times the diameter of the surgical area, and in some cases—especially on curved surfaces—up to six times.
Generally, the sutures used in Mohs sugary are dissolvable, and will gradually disintegrate on their own.
If non-dissolvable sutures were used, I will let you know after the surgery, and will give you a specific date for removal (usually between 7-21 days). This date will also be noted in your surgical report.
Suture removal is quick and painless. It does not require special expertise, and can be done safely by a nurse at your local HMO (Kupat Holim) branch. I recommend making an appointment in advance via the HMO phone directory or app. Please remember to bring the surgery report with you, as the nurse will need to see it before removing the stitches.
If you prefer, you are also welcome to schedule an appointment with me for suture removal.
Unless you were specifically told otherwise, the sutures used in your Mohs surgery are dissolvable. They disintegrate gradually over the course of several weeks.
If your stitches are still present at 4 weeks, you can rub them with soap under running water. From 10 days post-surgery, there is no need to treat the area delicately, so don’t be afraid to rub until the stitches dissolve or fall off.
If after 6 weeks, the stitches have still not dissolved, please contact me.
Exact instructions will be given to you at the end of your surgery, as the recovery time depends on the scope and complexity of the surgery.
In general:
It is important to note: If your surgery was performed on the lower limbs, a longer rest period is usually required. You will receive specific guidance before you leave.
You can shower from the morning after surgery.
Avoid swimming or bathing in public water such as pools, the sea, or a mikveh until about two weeks after surgery to reduce the risk of infection.
Recovery time varies from person to person. Many patients experience mild throbbing pain the day after surgery. Depending on the size and complexity of the lesion removed, most people are able to return to non-physical work the following day.
There are no limitations on travel immediately after Mohs surgery. However, if you are traveling for vacation, keep in mind that you might need to avoid strenuous physical activity and swimming during the first days of recovery, which could affect your plans.
A follow up process is important to ensure healing is progressing as expected. This is usually scheduled 6 weeks post-surgery.
If you have any concerns, I am available by cellphone. For your convenience, you can also send a photo of the surgical area via WhatsApp (058-6276872) for a virtual check-up. If an in-person visit is needed, I will let you know.
In most cases, no further oncological treatment is needed after Mohs surgery. If additional treatment is required, I will review all options with you personally during the detailed post-surgery discussion.
However, it is important to remember that having skin cancer once increases the chances of developing additional tumors in other areas. For this reason, regular follow-up visits with your dermatologist for a complete skin exam are essential.
Mohs surgery is the most effective treatment for many types of skin cancer. Cure rates are very high—typically 96̶99%, depending on the type and aggressiveness of the tumor. This means that recurrence is very rare (1̶4%), and far less likely than with other treatment methods.
That said, having skin cancer once increases the chance of developing new tumors elsewhere on the skin. For this reason, regular full skin exams with your dermatologist are essential.
For any questions or concerns about your surgery, you can reach me directly at my cellphone number, which is listed at the top of your post-op instruction sheet, and highlighted in yellow.
For administrative matters, such as scheduling appointments or other office-related questions, please call the office at 058-6276872.
During healing, the skin forms new blood vessels around the wound to nourish the tissue. This causes the scar to appear red and slightly swollen. Over the course of several months, as new skin forms, the blood vessels gradually recede and the redness and swelling fade.
Definitely. The healing process of the skin can take months. The redness and swelling will gradually decrease, and small bumps under the skin will smooth out and flatten. Over time, the scar typically becomes subtle and blends naturally with the surrounding skin.
Carefully follow the post-surgery instructions, including gentle cleansing with soap and water and applying any prescribed ointments. There is no need to use the expensive creams marketed as scar treatment. It is enough to apply a simple moisturizing cream or pure petroleum jelly (Vaseline) to soften the scar. Healing is mostly a matter of time and patience.
Protecting the area from sun exposure is also very important, as it helps the scar heal more smoothly.
Over time, the scar will continue to improve and gradually become more subtle.
I work with Maccabi, Meuhedet, and Leumit-Zahav.
I work with some insurance providers. Coverage often depends on the specific policy—some are more comprehensive and allow you to choose your surgeon, while others may have more limitations.
For detailed information about your coverage, please contact the clinic at 058-6276872.
Feel free to contact me, and I will get back to you as soon as possible.
058-627-6872
