The incidence of cutaneous malignancies continues to rise and it is likely that the majority of skin cancers referred to otolaryngologists will have characteristics that necessitate a more complex and aggressive approach. Mohs micrographic surgery is a tissue-sparing technique that allows for excision of cancers under complete microscopic control and thus boasts high cure rates. This paper reviews the Mohs technique and discusses the current indications for Mohs surgery in the head and neck.For high-risk basal cell and squamous cell carcinomas, studies continue to report superior cure rates with Mohs surgery compared with non-Mohs modalities such as standard surgical excision. Despite several supporting studies, Mohs surgery for melanoma continues to be controversial in the literature, as histological identification of melanoma with frozen sections remains challenging despite advances. Other means of margin control remain popular among non-Mohs surgeons, including frozen section analysis and, more recently, photodynamic delineation.For cutaneous malignancies of the head and neck, Mohs surgery offers the distinct advantages of complete microscopic margin control coupled with tissue conservation and thus boasts of high cure rates. It is important for otolaryngologists to understand the technique and current indications for Mohs surgery.