Comparing Numbing Techniques in Mohs Micrographic Surgery

Inclusion Criteria: * Age ≥18 years. * Scheduled to undergo MMS. * Lesions on the face or scalp, defined as the region superior to the mandibular margin anteriorly, superior to the external occipital protuberance posteriorly, and superior to the mastoid processes laterally. * Tumor diameter plus anticipated stage 1 MMS margin ≥2 cm in diameter OR any tumor on the ear, lip, nose, or eyelid. * Ability to complete patient reported outcome measures in English. Exclusion Criteria: * Known allergy or contraindication to lidocaine or epinephrine. * Chronic opioid use or pre existing pain disorders that may interfere with pain reporting. * Presence of scar tissue at the anatomic site of local infiltration or nerve block that may alter anesthetic penetration. * Concurrent multi site Mohs procedure. * Signs of skin and soft tissue infection at the anatomic site of local infiltration or nerve block. * Inability to understand or complete pain and satisfaction assessments. * Pregnant or breastfeeding. * Use of sedatives or anxiolytics prior to the procedure.