Mohs Surgery vs. Radiation Therapy: What Patients Should Know
By Ada West Dermatology · Mohs Surgery Center
At Ada West Dermatology, our Mohs surgeons treat a high number of skin cancers each year, including many complex cases that are referred to us from clinics across southwestern Idaho and neighboring areas. While we are not a formal regional referral center, we often function like one simply because of the volume and variety of tumors sent our way.
This experience gives us a clear understanding of how different treatments perform — and it’s very common for patients to ask: “Are there other options besides Mohs surgery?”
Radiation therapy and other modalities do exist, and it’s important to understand how they compare.
Below, Dr. Winchester explains the differences in a clear, patient-friendly way.
What Mohs Surgery Is — and Why It’s So Effective
Mohs surgery is a specialized surgical technique that removes skin cancer layer by layer, examining 100% of the margin under the microscope during the procedure.
Dr. Winchester explains:
“We look at the entire margin under the microscope to make sure it is clear. This allows us to remove the least amount of skin while achieving complete removal.”
Although Mohs involves cutting and suturing, he notes:
“What’s done to your skin is actually about as minimally invasive as you could conjure.”
Mohs continues to show the highest effectiveness for:
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Basal cell carcinoma
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Squamous cell carcinoma
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Many cases of melanoma (with growing evidence supporting improved outcomes)
Radiation Therapy: A Valid Option, But With Important Considerations
Radiation therapy is a well-proven treatment used widely in oncology. It does not require surgical excision or sutures, and modern outpatient radiation devices are being explored as potential additions to dermatologic care.
However, Dr. Winchester emphasizes several key differences:
1. Radiation does not provide margin control
“You don’t check the histologic margins. They treat it with a certain amount of radiation… It does not have as good of a cure rate as Mohs surgery.”
Margin control is essential for high-risk tumors and cancers located on cosmetically or functionally important areas — especially the face.
2. Cure rates are typically not as strong as Mohs
While radiation is effective for many cancers, Mohs surgery remains the most reliable option for complete tumor clearance in the areas we treat most often.
3. Radiation can permanently change the skin
Dr. Winchester explains:
“When radiation is done to the skin, it does a significant amount of damage. Radiated areas become firm, or sclerotic, and they can be a real challenge when we have to remove a recurrence or a new skin cancer nearby.”
Radiated skin:
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Cannot be radiated again
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Becomes less flexible
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Heals less predictably
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Can complicate reconstruction if a tumor returns
This is one of the reasons Ada West dermatologists prefer Mohs surgery for facial and high-risk cancers.
When Radiation Is an Appropriate Treatment
Despite its limitations, radiation remains an important option when used in the right context.
Radiation may be considered when:
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A patient cannot undergo surgery
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The cancer is located in a site where surgery would be difficult or risky
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A patient strongly prefers a non-surgical option
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Certain anatomic situations make radiation practical and safe
We collaborate closely with radiation oncologists in the Treasure Valley to ensure that patients receive the approach most appropriate for their diagnosis and overall health.
Other Treatment Modalities Dr. Winchester Mentions
Dermatology includes several additional tools that may be appropriate depending on tumor type and location:
Topical therapies
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Some topical chemotherapy agents can treat precancerous lesions.
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Dr. Winchester cautions that topical ivermectin—while safe as an antiparasitic—is not a valid treatment for invasive skin cancer.
“It might make your skin cancer look less red, but do not trust that as a treatment option.”
Electrodesiccation and curettage
A time-proven option for certain low-risk cancers — typically not used on the face or high-risk tumors — and used selectively based on tumor behavior.
Watch Dr. Winchester Explain Mohs vs. Radiation Therapy
Bottom Line: Individualized Care Matters
Every skin cancer is unique. Subtype, location, patient health, and recurrence risk all influence the best treatment option.
Dr. Winchester’s summary captures it best:
“There are promising new treatments, but we must take into account how effective they are and whether they are truly less invasive than Mohs surgery.”
Mohs surgery remains the gold standard for achieving the highest cure rates with the least tissue removed, while radiation therapy retains an important — but selective — role in skin cancer management.
If you have questions about your diagnosis or treatment options, our dermatologists and Mohs surgeons are here to guide you.