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BACKGROUND: Bleeding remains a frequent complication during Mohs micrographic surgery, particularly among patients receiving anticoagulant or antiplatelet therapy. The growing use of these medications has prompted increased exploration of adjunctive methods to improve perioperative hemostasis. OBJECTIVE: To systematically review the literature on topically and locally administered hemostatic agents used to reduce bleeding in Mohs micrographic surgery. METHODS: A systematic search of PubMed, Scopus, Cochrane, and EMBASE was conducted through March 2024. Original studies evaluating hemostatic agents applied topically or by local injection during Mohs micrographic surgery were included. RESULTS: Seven studies met inclusion criteria, encompassing 458 patients. Agents evaluated included tranexamic acid, brimonidine gel, hemostatic powders, and microporous polysaccharide materials. These agents were generally well tolerated and associated with reductions in intraoperative and postoperative bleeding. CONCLUSION: Locally administered hemostatic agents offer a promising adjunct to improve bleeding control in Mohs micrographic surgery. Their use may be particularly beneficial in patients at elevated bleeding risk and warrants further investigation in larger, controlled studies.