Abstract Mohs surgeons' fallibility is an important topic to explore. There are no studies on the role of cognitive biases in heuristic decision-making within Mohs micrographic surgery (MMS) as a contributing factor in mistakes or errors of clinical judgement. We reviewed established cognitive biases applied to heuristics during the pre-operative, intraoperative and reconstruction stages of MMS, and recommend conscious cognitive bias mitigating strategies for Mohs surgeons. Clinical errors/incidents may be reframed as opportunities to learn and develop, rather than evidence of competency or status. These experiences offer the opportunity to sharpen skills within metacognition and allow for more cognizant Mohs surgeons. We highly recommend all Mohs surgeons develop in-depth knowledge and maintain awareness of cognitive biases throughout clinical practice, to enhance clinical performance.