I had Mohs done for basal cell carcinoma on lower side of nose at age 60 - was 15 years ago. Excellent surgeon, beautiful cosmetic appearance (used cartilage from my ear to re-construct.). Dr was previously head of Mohs at Bethesda, MD, Naval Hospital before retiring (at a fairly young age of 50ish?) and going into private practice - he had great experience! Now I’m 75 and one of the rare birds with a presumable recurrence after 15 years - just diagnosed with bcc in same spot.

This time I’m re-thinking options. I’m assuming there’s scar tissue from the procedure done 15 years ago and wondering if that’ll negatively impact the Mohs outcome, cosmetically speaking, if I choose Mohs again. Radiation (SRT) has a five year cure rate of over 95%, almost as good as Mohs. The chances of the bcc recurring again would put me at 80 or likely older, if something else doesn’t “do me in” before then.

Radiation can’t be used when bcc recurs in same spot if it was used the first go-round; I read where side effects aren’t tolerable with a do-over of radiation for recurrence. That’s why they discourage younger folks from radiation, as there’s a slim chance basal or squamous cell could recur later, as mine has. I’m at an older age now - didn’t use radiation 15 years ago. Surgery is riskier at my age now, as my body doesn’t fight off infection, if that should occur. So, I’m leaning toward SRT, as I can safely opt for radiation this second time. If I choose radiation, it’ll be a a practice that specializes in it. Everything I’ve read said doctors have a lot of biased opinions - SRT doctors say go with SRT, Mohs surgeons say Mohs is better. But age factors in - not sure there’s a strong enough reason for elective surgery at 75, when radiation is a good option, too.

I’m on traditional Medicare and called to learn Medicare will pay for a second opinion if referring Dr says it’s a medical necessity. So I’m going to talk to my Mohs surgeon, my dermatologist, and get a consultation with a radiation oncologist, too. Wondering if I need lymph node tests since this looks like a recurrence.

I also called the American Cancer Society - they have a 24 hr call line. They couldn't give me a definitive answer as to which might be preferable in my case - radiation or surgery - so they’re taking my dilemma to their nurse oncologist who will be getting in touch with me in the next couple days. Their nurse will give be information, but won’t give a definitive decision, of course. It’ll be up to me.