Is it necessary to remove basal cell via Mohs? What are alternatives?

Posted by cdeldeo @cdeldeo, Dec 16, 2023

Was dx with basal cell on tip of nose. Derm wants to do Mohs surgery with nose reconstruction which will alter my nose. I am 78 and do not want to do this. Any suggestions?

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jakefix82 | @jakefix82 | Jun 5 9:03pm

I have a consultation with my Mohs surgeon next week, June 11th. She is skilled at cosmetic re-construction, so I’m leaning in that direction. Radiation can be really tough on skin and addresses just the skin’s surface. My dear Mohs surgeon who fixed my nose fifteen years ago - when I lived 300 miles from where I do now - called me yesterday (I’d left a message with him, but he was out of the office last week. Wondered if they had my records, but no such luck). He offered to re-do my nose again if I wanted to travel. He is also skilled at doing cosmetic re-construction, so no need for plastic surgeon to be involved. I read where Mohs surgery can be done again if a basal cell carcinoma arises in same area. He also leaned toward Mohs surgery again and was very honest, spent a good deal of time on the phone, for which he wasn’t paid. Good provider! Very rare to have basal cell return in same area after fifteen years. Thanks for checking!

itchyrich | @itchyrich | Jun 6 6:54pm

In reply to @jakefix82 "I had Mohs done for basal cell carcinoma on lower side of nose at age 60..." + (show)

@jakefix82

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.

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I've had multiple BCCs removed since 1992 with most of them being done in the Derm's office and I never heard about Mohs until 7-8 years ago. Had the first one done on my ear with no effort to hide it and nobody ever says "what's that on your ear" so it must look ok. The next one was on my lower right eye lid and was a lot trickier. The eye lid was mostly missing and I was driven a few miles to a reconstructive surgeon who told me my eye would be sewn shut for 6 weeks. I was not prepared for that. That was a grueling 2 or 3 hours in a very uncomfortable chair, during covid with a mask, Looked like I had been mugged. Despite all the grief, it turned out great and nobody can tell it happened. Several months ago I had a larger BCC on my shin removed via Mohs. I then learned that lower leg surgeries take much longer to heal, especially if you have diabetes like I do. Of course, it got infected and 3 antibiotics later it finally started to heal. So, ten weeks later it's almost done. In the meantime, I had 4 more biopsies and 2 were positive on my chest so soon I'll be healing all over again. I had radioactive seeds for my prostate cancer 21 years ago and I don't consider radiation an option. I'll be 84 in August.

lkay5719 | @lkay5719 | Jun 14 12:57pm

I had Mohs on front of lower leg by a Mohs Surgeon. I then had the hole closed by a plastic surgeon (22 stitches). Looks Great!
I would recommend having a plastic surgeon close/repair any Mohs procedure. Don't let anyone say you don't need one!!!

elderly1 | @elderly1 | Jun 15 8:58am

I'm even older and had a dermatologist with Mohs experience do extensive surgery on my nose, and today not even a visible scar! Same experience with many other places on face. Don't know of options?

cdeldeo | @cdeldeo | Jun 15 1:04pm

Am 78
.was in your position one yr ago..finally had Mohs surgery as basal cell can grow..I have a scar on my nose now..thankful for makeup.

mermaid7272 | @mermaid7272 | Jun 16 8:16am

In reply to @cdeldeo "Am 78 .was in your position one yr ago..finally had Mohs surgery as basal cell can..." + (show)

Have 2 scars on nose from Mohs, but they aren't too bad. They could be covered with a concealing makeup. But new one near lip is bad, painful and very ugly. It's bumpy, red and large.
What makeup do you use? Brand? Availability?

@lkay5719 ---- I'm just about ready to check out with a plastic surgeon, do they take insurance for repair of Mohs?

cdeldeo | @cdeldeo | Jun 16 9:20am

In reply to @mermaid7272 "Have 2 scars on nose from Mohs, but they aren't too bad. They could be covered..." + (show)

Dermablend

jakefix82 | @jakefix82 | Jun 16 1:05pm

“Jakefix” here. Thanks for all the responses! I had Mohs fifteen years ago on side of nose, near nostril. Great job, used ear cartilage to re-construct. Doctors agree the new BCC in same spot is a new growth unrelated to the one removed 15 years ago (considered cured).

My original Mohs surgeon agreed to do the surgery for the new one, but I’ve since moved and the logistics of traveling 200 miles, a motel, etc, were overwhelming.

So I had Mohs last week again - 6/12 - on nose by a different surgeon. She didn’t close the wound…allowing the wound bed to heal a couple weeks and will then do a skin graft with skin likely from behind my ear. I read grafts “take” better after waiting for wound bed to heal. My surgeon is Mayo Clinic trained and does re-construction, though uses a separate plastic surgeon when necessary.

My concern right now - 4 days after Mohs surgery - is I only have half a smile. There’s a droop of my lip on side where BCC was on nose…I look similar to someone with Bell’s Palsy. My front teeth aren’t visible where the lips don’t move upward as they should when smiling. This didn’t happen 15 years ago.

Has this happened to anyone? Is my face just numb or is there nerve damage? I go back tomorrow for wound check and fresh bandage. I was 60 yrs old fifteen years ago, am now 75. I am worried about this.

itchyrich | @itchyrich | Jun 18 8:47pm

In reply to @jakefix82 "“Jakefix” here. Thanks for all the responses! I had Mohs fifteen years ago on side of..." + (show)

Hope you got good news at your appointment. I didn't know the answers to your questions but I am interested in the outcome. I've had a couple of Mohs surgeries with the most relevant being on my right lower eyelid. The surgeon removed most of the eyelid even though the BCC looked very small to me. I was sent to a second surgeon for reconstructive surgery and was told right off the bat that my eye would be sewn shut for six weeks. It was then that I realized I should have asked more questions earlier in the game. After a couple uncomfortable hours in a hard chair, he took skin from my upper eyelid and it was done. I looked like I had been severely beaten about the face. It bled and wept for a couple days sending my wife into a panic. Eventually, it all worked out and it seems to look just fine. Now, I have small bump on my upper nose, close to my other eye that I am concerned about. I haven't seen anybody about it yet as I really don't want to go through that again. I had a Mohs surgery on my shin that, after an infection, and three different antibiotics, is finally about healed after 10 weeks. I'll be 84 in August and have to wonder if it's worth it. Don't think I trust the people who did my shin to work close to an eye. The eyelid was done about 60 miles away.

mermaid7272 | @mermaid7272 | Jun 19 8:27am

Anyone here have had alternative methods for removing basals or squamous cancers, beside the dreaded Mohs? Radiology? Skin creams?
I had Moh's on my lip, and don't want that repeated! And after reading poor @itchyrich's experience, I'm hoping that my next experience will be a little more gentle. They never seem to end, but the facial ones are the worst.
Also, is plastic surgery paid for by insurance after a Moh's surgery?

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