Blog #Mohs analysis

When patients come to me holding a pathology report, the word “cancer” has already triggered fear. At that stage, most of them don’t really read what’s written - they just see the word and stop.

So let’s talk about the two most common types of tumors I operate on: BCC and SCC.

Yes - both are skin cancers.

No - they are not the same.

First: BCC — Basal Cell Carcinoma

This is by far the most common tumor. About 8 out of 10 cases I see are BCC.It is a slow‑growing tumor. It almost never spreads to other organs.

But - it does invade deeply.

A small BCC on the nose can, over years, reach the cartilage.

On the eyelid - it can extend into the eye socket and even into nerves.In some cases, this tumor can infiltrate surrounding tissue with almost no external sign other than a slight change in skin color or texture.

Classic sign:  A shiny pink sore that keeps returning, bleeds, doesn’t heal, and slowly grows.

Sometimes it can be brown or black in parts, and it often appears in places where the patient assumes it came from trauma (glasses, scratches, etc.).

Second: SCC — Squamous Cell Carcinoma

This tumor is less common and behaves differently.

SCC can spread - to lymph nodes, and in rare cases to distant organs.Not always, not with high probability, but this is a major difference from BCC.

In some cases, this tumor is dangerous and even life‑threatening.

There are several subtypes - some more aggressive, some less, some deep, some superficial.

Classic sign:  A rough, scaly lesion - sometimes ulcerated, sometimes fleshy and nodular - usually on sun‑exposed areas: face, ears, lips, hands.

Why Mohs Surgery Is the Preferred Treatment for Both?

Because in Mohs surgery, unlike standard excision, we examine all tumor margins immediately under the microscope.

We don’t take “wide margins” as a safety measure - we take exactly what is needed, confirm that everything is clear, and then close.

Result:  Maximum cure rates with minimal damage to healthy tissue.

Bottom Line

For BCC - it’s important to treat, maybe slightly less urgent, but we do not wait.

For SCC - we definitely do not wait. Treatment should be done promptly and thoroughly.

If you received a report with one of these names - contact us.

We’ll explain exactly what’s going on and what the next step is.

When I performed my first mole surgery in the early 2000s, I arrived at the operating room with a protocol, equipment, theoretical knowledge acquired during my training in San Diego, and clinical experience acquired during my extensive plastic surgery residency. What I didn't know yet was what only surgery after surgery teaches.

Ten thousand surgeries later, I can say that much of what I know today is not found in any textbook.

What the data doesn't tell:
A 99% cure rate in Mohs surgery for BCC tumors — that's a real number. But behind every percentage are people. A 72-year-old man who came in with a "small pimple on his nose" that turned out to be a tumor that had penetrated the cartilage. A 58-year-old woman who postponed surgery for a year and a half "because it didn't seem important." A 17-year-old boy whose tumor was discovered during a routine checkup.
Every case taught me something.

What surprises patients the most:
Most of them think that Mohs surgery is “major surgery.” They come with anxiety, with someone accompanying them, with questions about general anesthesia.
In reality: Most surgeries are performed under local anesthesia only, in the clinic's operating room. You arrive in the morning, return home at noon. The scar, in most cases, is almost invisible after six months.

What still worries me
Patients who arrive too late.
Not too late in the dramatic sense — but too late in the sense of "I knew something was wrong a year ago, but I thought..., I waited until..." Every month of waiting with BCC or SCC on the face is another millimeter of growth, another tissue that will have to be removed, another risk of complications and aesthetic damage that will be difficult to repair.

If you have a lesion that doesn't heal, a wound that recurs, a spot that changes — come. Even if it turns out to be completely benign in the end. A visit that rules out a tumor is better than a visit that proves you've been nurturing a large and dangerous tumor.

What hasn't changed:
Every surgery, from the first one until now, begins at that moment: when I explain to the patient about the surgery and what's going to happen and I see the anxiety go down their face. That hasn't changed. That won't change.

For questions or to schedule an appointment: WhatsApp/SMS to 050-5633002 or email to 5633033@gmail.com

Too often, my patients come to me not as their first stop, but as their final station after months of exhausting uncertainty. This is the story of a young patient who recently came to me - and it illustrates exactly why Mohs surgery is not just a medical procedure, but peace of mind. 

The First Stop: Months of Waiting It all began with a small lesion on her facial skin. From there, a “snowball” of medical bureaucracy started rolling: two months waiting for an overbooked dermatologist, a quick referral for a biopsy with a plastic surgeon, and then another nerve‑wracking month waiting for the pathology results. The news: positive. A tumor. Surgery required. 

The Second Stop: The Hospital She was referred to a leading hospital’s plastic surgery department. Again - waiting for appointments, pre‑operative tests, and finally, the long‑awaited surgery. Nearly five months after the initial discovery, the lesion was excised. The cosmetic result was good, and she finally breathed a sigh of relief. She thought the story was behind her. 

The Third Stop: The Disappointment at Follow‑Up At her follow‑up visit, the devastating news arrived: 

“The margins are not clear. The tumor is still active.” 

Exhausted and anxious, the young patient was referred to me for complete excision using Mohs surgery. 

Why Mohs Surgery Is Your “Insurance Policy” 

With Mohs, we don’t guess. Unlike standard surgery - where the pathology report arrives days later - here everything happens in real time: 100% Margin Examination I examine the tissue under the microscope while the patient is still in the clinic. 

Complete Certainty We finish the surgery only when I can confirm with 100% certainty that the margins are clear. 

Optimal Cosmetic Outcome We remove only diseased tissue and preserve as much healthy skin as possible - crucial in the facial area. 

This patient is now past it. She left the clinic not only healthy, but with the absolute certainty that this time - it is truly over.

Avi Meller 1953–2025Mohs surgery is considered today the gold‑standard technique for removing malignant skin tumors in the facial area — and not by chance. It enables complete and precise removal of cancer while preserving as much healthy tissue as possible. The story of sports broadcaster Avi Meller, who faced a recurrence of a tumor that was not fully removed and ultimately became an aggressive, life‑threatening disease, illustrates how critical the choice of the right treatment method can be — for one’s health and even for one’s life.

Mohs Surgery: Why Is It So Important, Especially on the Face?

Skin cancer is the most common cancer in the world — and particularly in Israel. Israel is a sun‑drenched country with inviting beaches and a population that includes many fair‑skinned immigrants with lifestyle habits that lead to high exposure to UV radiation. It is important to emphasize that darker‑skinned individuals are also at risk, especially because many mistakenly believe they are “protected” and cannot develop skin cancer.Many malignant lesions appear in exposed areas, especially the face: nose, eyelids, ears, lips, temples, and the hairline. These are areas where:

• The skin is thin and delicate, allowing tumors to penetrate quickly.
• There is very little room for error — every millimeter of tissue matters functionally and aesthetically.
• The risk of recurrence is higher if all cancer cells are not removed.

This is where Mohs surgery comes in — a unique surgical technique in which the tumor is removed in thin layers, and each layer is examined under a microscope in real time. Only if cancer cells are found does the surgeon continue removing additional tissue. This ensures complete tumor removal with minimal damage to healthy tissue.

What Makes Mohs Surgery the Most Precise Method?

Mohs surgery combines surgery and pathology at the same moment. Unlike standard excision, where the tumor is removed “approximately” with wide margins:

• 100% of the margins — both peripheral and deep — are examined.
• The surgeon identifies exactly where cancer cells remain and removes tissue only from that area.
• Healthy skin is maximally preserved, resulting in smaller scars and easier recovery.
• Cure rates reach 97–99% for certain tumors.

On the face, where every millimeter matters, this is not just an aesthetic issue — it is a matter of medical success and improved chances of full recovery.

Avi Meller’s Case: What Happens When a Tumor Is Not Fully Removed?

It was recently reported that sports broadcaster Avi Meller faced a recurrence of facial skin cancer after the original tumor was not completely removed. The disease returned with distant metastases and required difficult chemotherapy and radiation treatments.Cancer cells left behind can continue growing beneath the surface — sometimes months or years after surgery.When a tumor recurs:

• It tends to be more aggressive.
• It may invade deeper tissues, nerves, or blood vessels.
• A simple surgery is often no longer enough.
• Additional treatments such as radiation or chemotherapy may be required — longer, harsher, and accompanied by significant side effects.

Meller’s story is a painful reminder that skin cancer is not “small” or “simple.” Inaccurate treatment can lead to a far more complex medical journey.

Why Is Mohs Surgery Especially Important on the Face?

1. Maximum precision in a sensitive area  The face contains delicate structures — nerves, muscles, cartilage, tear ducts, eyelids, and more. Unnecessary damage can cause functional problems, not just cosmetic ones.2. Preserving a natural appearance  Mohs surgery allows optimal reconstruction with smaller scars and precise placement of incisions.3. Preventing recurrence  Complete removal the first time significantly reduces the risk of the cancer returning.4. Handling complex tumors  Recurrent tumors, tumors with unclear borders, or tumors in difficult locations are particularly suited for Mohs surgery.

Who Should Consider Mohs Surgery?

Not every skin cancer requires Mohs, but it is preferred in cases such as:

• Facial basal cell carcinoma (BCC)
• Squamous cell carcinoma (SCC)
• Recurrent tumors
• Tumors with unclear borders
• Tumors in areas where tissue preservation is crucial
• Younger patients seeking optimal cosmetic results

What Happens If Mohs Surgery Is Not Chosen?

In standard excision, the tumor is removed with relatively wide margins. The problem:

• Not all margins are examined, so cancer cells may remain.
• If the tumor returns, it may be larger, deeper, and more dangerous.
• A more extensive surgery may be needed, sometimes with additional treatments.
• Cosmetic results may be inferior.

In other words: saving time or cost initially may lead to a far more complex treatment later.

A Message to the Public: Do Not Compromise on Treatment Quality

Avi Meller’s story is not just personal — it is an important lesson for anyone facing a suspicious facial lesion. Skin cancer is common, but when treated correctly, it is usually fully curable.Choosing Mohs surgery can be the difference between:A short, focused treatment  andA long, painful, complicated medical journeyEspecially on the face, where even a small mistake can become a big problem.

In Summary

Mohs surgery is not “just another surgery.” It is the most precise method for removing malignant skin tumors from the face, offering a rare combination of:

• Microscopic accuracy
• Very high cure rates
• Preservation of appearance and function
• Prevention of recurrence

Avi Meller’s story reminds us how important it is to choose the right treatment the first time. When it comes to skin cancer, there is no room for compromise.