Objective: The objective was to observe whether there is a difference in the number of subjects requiring more than one stage of Mohs micrographic surgery for small lesion nonmelanoma skin cancers using the punch scoring method versus freehand approach. Design: Retrospective review. Setting: Outpatient Mohs Clinic. Participants: Thirty patients with small lesion (<5mm) basal cell and squamous cell carcinoma who had Mohs micrographic surgery using either the punch scoring method (15) for scoring the first layer or the freehand method (15). Measurements: Differences between the two groups were evaluated by the number of subjects requiring more than one stage and the reason for any additional stages. Results: There was no observed difference in the number of subjects requiring more than one Mohs stage between the punch scoring group and the freehand group. Conclusion: Dermatologic surgeons can use the punch scoring method or the freehand approach for scoring small lesion Mohs based on provider preference.