Background: Lentigo Maligna (LM), a subtype of melanoma in situ occurring on chronically sun-damaged facial skin, presents unique therapeutic challenges due to its subclinical extension and the need for tissue preservation. Wide Local Excision (WLE) remains the conventional treatment; however, margin control is often difficult. Mohs Micrographic Surgery (MMS), particularly when performed using the spaghetti technique, has emerged as an alternative approach allowing staged peripheral margin assessment while preserving healthy tissue. The economic implications of this technique remain poorly defined. Objective: To evaluate current evidence on the costs and cost-effectiveness of MMS using the spaghetti technique for facial lentigo maligna. Methods: A scoping review of PubMed, EMBASE, Scopus, and Cochrane databases was conducted. Studies reporting clinical outcomes, costs, or resource utilization associated with MMS (including the spaghetti technique) for LM were included. Data were synthesized qualitatively with emphasis on economic implications. Results: Evidence is limited and primarily consists of retrospective studies and case series. MMS with the spaghetti technique demonstrates high rates of complete margin control and low recurrence. Although associated with higher upfront procedural costs compared to WLE, potential economic advantages include reduced need for re-excision, fewer recurrences, and more conservative reconstructions. Formal cost-effectiveness analyses are lacking. Limitations: The available literature is limited by small sample sizes, lack of standardized economic reporting, and absence of long-term cost-effectiveness models. Conclusion: MMS using the spaghetti technique appears to offer clinically effective and potentially cost-efficient management for facial lentigo maligna. However, robust economic evaluations are needed to confirm its value and guide clinical decision-making.