<p>Squamous cell carcinoma in situ (SCCIS) is a common precursor to invasive squamous cell carcinoma. While Mohs micrographic surgery (MMS) is frequently used in the treatment of this condition, emerging evidence highlights the effectiveness of non-surgical methods, underscoring the need to understand current practice patterns. Our objective was to identify current preferences amongst members of the American College of Mohs Surgery (ACMS) when treating SCCIS to reassess the need for targeted studies and updated guidelines. An online survey was distributed to ACMS members in July 2024, with responses collected through February 2025. Demographics and first-line treatment preferences were analyzed using descriptive statistics and chi-square testing (<i>p</i> &lt; 0.05). 100 Mohs surgeons completed the required portion of the survey, with 72 completing supplemental items. MMS was consistently the preferred first-line treatment across most anatomic sites and lesion characteristics, except for lesions in area L, for which malignant destruction and excision were most often preferred, and actinic keratosis with focal SCCIS in areas M and H, for which topical 5-fluorouracil was preferred. Treatment of SCCIS varies substantially by lesion and patient characteristics. While MMS remains the predominant approach, findings highlight opportunities to refine guidelines and better integrate non-surgical modalities for select low-risk cases.</p>