Mohs micrographic surgery on the hand is one of the most technically demanding skin cancer procedures. The hand has thin skin, exposed tendons, complex tissue planes, and high functional demands, all of which make tissue-sparing excision and skilled reconstruction essential.
Miss Rakhee Nayar is one of the few UK Mohs surgeons with formal hand surgery training, holding the European Board of Hand Surgery (EBHS) qualification in addition to her dual training in Mohs and plastic surgery. This combination of skill sets means hand skin cancers can be removed with maximum cure rate and reconstructed with the function and appearance of the hand fully in mind.
Why Mohs surgery suits hand skin cancers
- Mohs achieves the highest cure rates for basal cell carcinoma and squamous cell carcinoma at this site.
- Tissue-sparing technique preserves skin, tendons, nerves and vessels.
- Margins are confirmed clear during the same procedure, with reconstruction performed once cancer is fully removed.
- Single-day procedure under local anaesthetic in most cases.
Reconstruction options for the hand
Reconstruction is tailored to defect size, location, and the patient’s functional needs. Techniques include primary closure, full-thickness skin grafts, local flaps, regional flaps, and where required, more complex reconstructive procedures.
Why the back of the hand is a high-risk site
The back of the hand is in the sun for a lifetime, and squamous cell carcinoma is the most common skin cancer here. The skin is thin and the tendons that straighten the fingers sit just beneath it, so removing a cancer with a wide conventional margin can be difficult without exposing them. Mohs takes only the tissue that is actually involved, which is the point of using it at this site.
What happens on the day?
The hand is numbed with local anaesthetic and you stay awake throughout. Each layer removed is examined under the microscope while you wait, and the repair is done in the same visit once the margins are clear. A bulky dressing, and occasionally a light splint, protects the repair for the first few days.
How long before I can use my hand?
Light use usually returns within days. Keeping the hand raised in the first couple of days reduces swelling, and the wound needs to stay dry until it has sealed. Desk work tends to resume quickly. Heavier manual work, lifting and gripping wait until the repair has healed, and how long that takes depends on the size of the defect and the type of repair, so it is discussed honestly at consultation rather than promised in advance. Driving is sensible again once you can grip the wheel comfortably and react normally, which for smaller repairs is often within a few days.
Will movement be affected?
The aim of the repair is full movement and grip. This is where hand surgery training earns its keep: the repair is planned around tendon glide and joint movement, not just skin cover. Stiffness in the early weeks is common and almost always temporary, and formal hand therapy is rarely needed after skin cancer surgery.
Book a consultation
If you are weighing up treatment for a skin cancer on the hand, a consultation covers the diagnosis, the operation and what it means for using your hand. Consultations are usually available within days, not weeks. Bring your referral letter or biopsy result if you have one.