Mohs Surgery vs. Superficial Radiation Therapy: What Patients Need to Know

Posted on: October 8th, 2025 by Our Team

When it comes to treating skin cancer, patients today are faced with a variety of options. Two treatments often discussed are Mohs micrographic surgery and superficial radiation therapy (SRT, sometimes called IG-SRT when paired with imaging). While both approaches aim to eliminate skin cancer, the effectiveness, safety, and long-term outcomes are not the same. At Peak Skin Center in Fuquay-Varina, we believe it is important for our patients to understand these differences so they can make informed decisions about their care.

Mohs Surgery: The Gold Standard

Mohs micrographic surgery has long been considered the gold standard for treating the most common types of skin cancer, including basal cell carcinoma and squamous cell carcinoma. The procedure is highly specialized: A board-certified, fellowship trained Mohs surgeon like Dr. Thomas Knackstedt removes tissue one stage at a time and examines it under a microscope in real time until no cancer cells remain. This process ensures that 100% of the surgical margin is evaluated, confirming complete cancer removal before the wound is repaired. Mohs surgery preserves as much healthy skin as possible.

This approach leads to a cure rate of 98% for most cancers and often the best long-term cosmetic results, particularly for delicate or cosmetically sensitive areas such as the face, ears, and scalp. Importantly, reconstruction of the wound typically occurs the same day, meaning patients leave with both the cancer removed and the repair completed. 

Radiation Therapy: A Less Established and Less Effective Alternative

Superficial radiation therapy (SRT) delivers targeted radiation to destroy cancer cells. While it may seem appealing because it avoids surgery, radiation has important limitations.

• No margin confirmation: Unlike Mohs surgery, radiation does not provide histologic proof that the cancer is completely gone. This means there is no confirmation of cure at the time of treatment. To overcome this, the method either requires an unnecessarily large treatment field or risks a recurrence from skin cancer that remains hidden at the edges of the radiation treatment field.
• Lower cure rate: Studies show that up to 1 in 20 cancers treated with SRT will recur, a significantly higher rate than Mohs surgery. Studies on SRT with more promising cure rates tend to have significant limitations in their study design and many patients were lost to follow-up (this means it is unsure if they had a cancer recurrence or not but the patients were simply assumed not to have had a recurrence).
• Treatment burden: SRT typically requires 15–20 treatment sessions spread over several weeks, compared to Mohs surgery which is completed in a single day .
• Side effects: Patients may experience skin irritation, blistering, peeling, pigment changes, and hair loss. While SRT is not scarring in the surgical sense, it can cause permanent skin color and texture changes that are often far more noticeable than a well-executed surgical scar.
• Not guideline recommended: National cancer guidelines do not recommend radiation therapy as a first- or even second-line treatment for most non-melanoma skin cancers.
• Weaker evidence base: Importantly, the studies supporting SRT often lack the rigor, sample size, and long-term follow-up compared to the extensive body of literature supporting Mohs surgery and other established treatments. This makes the true long-term safety and effectiveness of SRT less certain.

While radiation may have a role in specific, uncommon situations—such as in patients who are not surgical candidates—it is generally not the preferred treatment option.

Long-Term Considerations

One of the most important aspects of treatment selection is the long-term outlook. With Mohs surgery, once the cancer is removed, it is removed with certainty. In contrast, SRT leaves patients with uncertainty, as there is no pathology-based confirmation of cure. Furthermore, many types of radiation can paradoxically increase the risk of developing additional skin cancers over time.

From a cosmetic perspective, Mohs surgery typically provides a more predictable outcome, especially when performed by a fellowship-trained Mohs surgeon with expertise in reconstruction. By contrast, radiation frequently results in scarring-like skin changes — such as blotchy pigment, thinning, or a leathery texture — that can be more visible than the fine-line scars produced by expert surgical repair. For patients concerned with both cancer control and appearance, Mohs surgery remains the superior option.

Comprehensive Skin Cancer Care at Peak Skin Center

At Peak Skin Center in Fuquay-Varina, we are committed to helping patients make decisions that are guided by science, compassion, and long-term outcomes. Under the leadership of board-certified dermatologist and board-certified, fellowship trained Mohs surgeon Dr. Thomas Knackstedt, a nationally recognized expert in skin cancer management, we provide comprehensive skin cancer management. Our approach is rooted in our mission: to provide exceptional care by making a difference in the skin and lives of the people we touch every day. That means the team at Peak Skin Center guides patients through diagnosis, treatment, and recovery with clarity, integrity, and genuine concern for their well-being.

For most patients with non-melanoma skin cancers, Mohs surgery remains the most effective, reliable, and cosmetically sound option. Radiation may sound appealing on the surface, but it does not match Mohs in cure rate, safety, or the strength of evidence supporting its use. Our responsibility to the patients of Fuquay Varina, Holly Springs, Apex, Cary and beyond is to ensure every patient receives the highest standard of care for their unique situation — and for the vast majority, Mohs surgery is that standard.