Pioneered in the 1930s, Mohs micrographic surgery is a specialized approach to the resection of cutaneous malignancies. Its two guiding principles are complete margin analysis and maximal tissue conservation. Whereas most skin cancers do not require Mohs, many head and neck cancers are well-suited for this technique. Given the migration toward outpatient and office-based surgery in the current healthcare climate, oncological surgeons should be familiar with Mohs surgery, which offers higher cure rates and greater patient satisfaction than conventional excision and at considerably less cost than facility-based excision with frozen section margin control. This article reviews the Mohs technique; its indications, with emphasis on recent consensus guidelines; and its relative merits compared with other therapeutic options for high-risk skin cancers.