Mohs Surgery in Coral Gables: What to Know Before Choosing Your Surgeon

Skin cancer on the face, ears, or scalp is not a diagnosis to rush through. The surgeon you choose for Mohs micrographic surgery directly affects both your cure rate and your cosmetic result. In South Florida — where dermatology practices and surgical centers are abundant — that choice deserves real scrutiny.

Why surgeon credentials matter in Mohs surgery

Unlike many subspecialties, Mohs surgery combines two distinct skills in one physician: surgical excision and intraoperative pathology. The surgeon removes tissue, processes it in the on-site laboratory, and reviews 100% of the margins under the microscope — all during the same appointment. This dual role is precisely why cure rates reach up to 99%.

But not every physician performing Mohs surgery has the same training. Some completed a recognized fellowship in Mohs Micrographic Surgery and received double board certification from the American College of Mohs Surgery (ACMS); others have completed limited training courses. The difference in tissue processing skill, margin interpretation, and wound closure technique is meaningful.

What "double board-certified" means

A double board-certified Mohs surgeon holds two separate credentials:

1. Board certification from the American Board of Dermatology (ABD) — confirming mastery of medical and surgical dermatology
2. Fellowship training and certification in Mohs Micrographic Surgery — typically a 1–2 year ACMS-accredited fellowship focused specifically on the surgical, pathological, and reconstructive aspects of Mohs

The second certification is not automatic. It requires a dedicated training program, case volume requirements, and examination. When you're choosing a surgeon, this is the credential to ask about.

5 questions to ask before your Mohs procedure

1. Are you double board-certified in both Dermatology and Mohs Micrographic Surgery?

This is the single most important question. Fellowship-trained and ACMS-certified surgeons have the highest level of training in both the surgical removal and the microscopic analysis of tumor margins.

2. Do you process the tissue yourself, or does it go to an outside lab?

In true Mohs surgery, the surgeon processes and reads the slides on-site, the same day. If tissue is sent to an outside pathology lab, you are not receiving Mohs surgery — you are receiving a standard excision with delayed pathology.

3. Do you perform the reconstruction yourself?

Closure of the Mohs defect — whether by primary repair, local flap, or graft — is part of the procedure and should be done by the same surgeon on the same day. Separate closure appointments or referrals to another surgeon are less ideal.

4. How many Mohs cases do you perform per year?

Volume correlates with consistency. An experienced Mohs surgeon performing hundreds of cases annually has refined technique, efficient processing, and sophisticated closure options.

5. Do you speak my language?

This is practical, not trivial. Post-operative instructions, surgical planning, and informed consent are best delivered in the patient's preferred language. At Miami Skin Center, Dr. Puyana conducts consultations and post-op care in both English and Spanish.

Mohs surgery in Coral Gables: what to know locally

Miami Skin Center, located at 299 Alhambra Circle in Coral Gables, is led by Dr. Puyana — who is double board-certified in both Dermatology and Mohs Micrographic Surgery. She completed her Mohs fellowship training in an ACMS-accredited program and performs the full procedure — excision, tissue processing, margin analysis, and reconstruction — on-site, the same day.

Coral Gables and South Miami patients have access to this level of care without traveling to a large academic medical center. If you've been referred for Mohs surgery for a basal cell carcinoma, squamous cell carcinoma, or other appropriate indication, a consultation at a double board-certified, single-surgeon practice ensures you're getting the highest standard of care.

Bottom line

Mohs surgery is the most effective skin cancer treatment available for tumors on critical areas. The procedure's success depends heavily on the surgeon's training in both the surgical and pathological components. Double board certification in Dermatology and Mohs Micrographic Surgery is the credential that ensures both — and it's the first thing to ask about when choosing your surgeon.