Mohs micrographic surgery is performed by thousands of dermatologists across the country. However, only a very small group of dermatologists are accepted into a 1- to 2-year long fellowship accredited by the American College of Mohs Surgery (ACMS). During this time, ACMS members dedicate their training purely to Mohs micrographic surgery and facial-plastic reconstruction. To graduate, they must complete a minimum of 500 cases, often for skin cancers in difficult anatomic locations, and are exposed to rare tumors of the skin. In addition, only ACMS fellowships provide Mohs surgeons with formal training in performing complex wound reconstruction. Fellowship-trained Mohs surgeons are thus able to ensure the highest cure rate and most cost-effective skin cancer treatment available. To be accredited by the ACMS, a fellowship training program must undergo a peer-reviewed process by the Accreditation Council for graduate Medical Education (ACGME). Board-certification in Mohs surgery (aka “Micrographic Surgery and Dermatologic Oncology” (MSDO)) is a relatively new certification. In late 2018, the American Board of Medical Specialties initiated the board certification process, which started by allowing any dermatologist to take the exam between the years 2021 to 2025. Starting in 2026, only dermatologists who have completed a rigorous ACGME-accredited fellowship may sit for the MSDO board certification. In short, fellowship training is 1-2 years of dedicated hands-on training after dermatology residency, under the guidance of experts who ensure their graduates achieve the highest cure rates and most elegant cosmetic outcomes. Board-certification is achieved only by taking an exam, and does not currently require graduation from an accredited Mohs surgery training program. The most qualified Mohs surgeons in the country are those who are both fellowship-trained AND board-certified.