A hand-held through-skin (HHTS) sensor for determining the location of an underlying aperture in a support structure suited to mount a skin or surface. In an embodiment, the HHTS sensor includes a sensor disposed in a housing and configured to determine a location of an aperture disposed in an adjacent surface through electromagnetic, x-ray, ultrasonic or other means. The HHTS sensor further includes an alignment assembly having an alignment orifice disposed in the housing and configured to be maneuvered in an x-y plane within the housing. The HHTS sensor also includes a processor coupled to the sensor and configured to receive a signal from the sensor indicating the location of the aperture and configured to control first and second actuators to maneuver the alignment orifice within the x-y plane to be co-axially located with the aperture in response to the sensor signal.