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

I have Medicare Part A and B and it paid for Mohs and plastic surgeon.

Just turned 75, had second Mohs in same area, lower left side of nose last week, 6/12/24. First was 15 years ago, drs now think it was cured and this one is new. Decided against radiation - too many treatments, infections can be a complication (same for Mohs), and afraid it would make my skin more fragile if I needed more surgery in that same area at another point. I have a new Mohs Dr from last time, as I’ve moved. This time Dr just removed one layer (last time it was at least a couple layers and cartilage from ear was used for reconstruction…turned out well, but ear was painful for a few days, as lots of nerves there). Dr this time is letting surgical wound heal naturally for a couple weeks (secondary intention healing) so the wound bed will be more likely to take a skin graft. So I’m not finished this time around. All the wound care is done twice weekly in Dr’s skin surgery center by surgical assistants, checked and photographed by PA each time. This time my cheek area has remained swollen and numb near the excision, causing my left side of upper lip, vertically below excision, to droop like Bell’s Palsy. I was told there are no facial nerves where the cutting was done. Thankfully my regular smile is returning - I’m doing mild facial exercises to strengthen muscles around the somewhat numbed and puffy area. Too soon to judge if this time around will be overall as successful as fifteen years ago.

Maybe I was a little too negative. The Mohs surgeon theoretically only takes as much as is needed to get a clear margin so it's probably better to have Mohs than to have someone use the WAG method and take too much or have it grow back. Reconstructive surgery is probably covered by insurance but you'd better believe the doctor would make sure it is long before the surgery. Purely cosmetic surgery is almost never covered.

I have had 5 Moh's surgeries, so your description is not too negative! Three on my face, but the recent one on my lip was, and still is, beyond the Pale. The lip area if full of nerves and is a very sensitive area. My doctor does not use general anesthesia. It also does not look so good. It was done in Feb.
That's why I wonder if the radiation would be a better method in case another cancer pops up.
Which is highly possible.

I had basal cell cancer on my shoulder. They did not do Mohs. Surgeon removed the margins and stitched. Healed well.

At the same time I had pre-cancerous lips. Effudex was the treatment as it has been the previous 4-5 times I have had pre-cancer lips. Not a pleasant treatment but I would assume preferred over surgery on the lips.

I think insurance would pay for cosmetic surgery to restore your lips. Keep us posted and best of luck!

My Efudex Photo Journey: Topical Chemotherapy | SkinCancer.net

All I can say is %^#@, Wow, I don't think I could use that treatment after looking at the pix and comments of the link above, I will have to try a plastic surgeon in a nearby town, as we live in the country and do not have much choice of dermatologists.
You are one brave guy, and I really appreciate your information.

This is correct link:
https://skincancer.net/life-with-skin-cancer/my-journey-with-efudex-in-photos

Jakefix here. Basal Cell carcinoma removed with Mohs about 9 days ago. Surgeon wants to let wound heal on its own and do skin graft probably in another 5-6 days. Her office staff (Skin Surgery Center) of surgical assistants do all wound care twice weekly until completely healed; PA monitors healing as well. I’m not required to do any at-home bandaging or cleaning. My biggest concern is the loss of my smile - left side of smile beneath excision droops a bit (facial muscles are weak, maybe?). Below are images of my smile -following Mohs surgery and my normal “before surgery” smile. Tap on first image to bring up 3 screenshots

I had Basil Cell Carcinoma at the tip of my nose, had to go in twice before they got it all, did Moh's surgery, had to remove much of the side of my nose and grafted. skin from my cheek, was 87 years old when I had it done, healed beautifully, can't tell I had anything done there, so far so good, was remarkable what the Moh's surgeon did, all in one day!

You must have had an exceptional surgeon.