Is Mohs right for 82-year-old healthy woman?

@hearth
I have not had melanoma. My skin cancers have been BCC and SCC. I had MOHS surgery for all of them.

MOHS surger uses a technique that they remove limited amount of skin/tissue and then examine by pathologist. If pathologist sees all cancer was removed you are done. If there are signs of remaining cancer in margins then the procedure continues until all pathology tests reveal cancer has been remove.

I have not had radiation for skin cancer. Radiation shoots a beam into cancer area damaging or killing the cancer. But it also damages any other tissues, bones, etc. that the radiation hits. Ask the medical professional suggesting it is it photon or proton radiation. The difference is photo will enter body full force, hit the target and continue through body. Proton can enter at what every dose is programmed release is full force where programmed and stop. It does not continue through body and exit it.

It appears from you post that the melanoma has been there for some time and spread. Is that correct? Talk to your urologist about the pros and cons of all treatment options for skin cancers and specifically melanoma.

Thank you very much for your answer. Yes, the melanoma is spreading slowly at first (5 yrs ago) - then more quickly - at first I thought it was an age spot.

Btw, I discovered that SRT Image Guided is not recommended for melanoma - disappointing.

They'd have to use flap surgery after cancer is removed - requires cutting from side of eye to hairline and then down hairline to neck - affording a way to move the facial skin upward to cover the incision site.

@hearth I’m glad you found us here at Mayo Clinic Connect as it can be frightening and confusing dealing with this diagnosis and treatment. I speak from experience as I went through it myself five years ago in my early 60’s. The melanoma was also on my face - from mid cheek down to top of lip - and also required a flap reconstruction. So even though there’s an age difference, the procedure you’ll be undergoing is quite similar.

I’m not certain age factors into the process, do you have underlying medical conditions you’re concerned about? While I can’t address those, if any, I can tell you my dad who underwent several Mohs through his 99 years and had comorbidities (other medical conditions) did not have any issues with the procedure. However, I would encourage you to discuss any of your concerns with your medical professional so you can feel as comfortable and confident as possible beforehand.

Does this help?

@grammato3 Dear Susan,

Thank you very much for your reply = I just learned about 2 weeks ago I had melanoma and I spoke with a plastic surgeon last week who outlined two options: go in and take a bit more tissue than what they deem necessary and then the flap surgery

Or the MOHs surgery, which, as you know, is less invasive to the face and still requires flap surgery. I will see a MOHs surgeon tomorrow to get more information - but I think that is the most effective for me.

My health is quite good although I had eye radiation for choroidal melanoma about 5 years ago - the 'freckle' has been inactive for about 5 yrs although I still have bi-yearly MRI, CT, and blood work to assure there are no radical cells that could attack liver or lungs.

I walk my dog every day and had been an active hiker while living in NH 20 yrs ago.

I do plan to discuss if age is a factor for me - but from the bit of literature out there, it seems not to be a real concern. I do have moments of concern but I counter with there is a real solution to the problem I now have.

Thank you so much for your own experiences - your note really helps quell those 'oh-no' moments!

April

@grammato3 Hi again,

So glad I found this site! People are so gracious and helpful!!
April

@hearth, how did the consult go with your Mohs surgeon? What did you learn and what did you decide?

@colleenyoung Hi Colleen,
Thanks for your concern. This is a wild journey to navigate!
I thought I was going to have the 'traditional' Mohs - ie remove bit by bit and biopsy bit by bit until all gone.

However, the doctor took only a surface amount of cells for biopsy - I don't know why the change in approach - she used an instrument that could 'see' or 'determine' the extent of bad cells.

I had that done about one week ago and have ben changing my bandage daily -

Am scheduled for total removal Monday 8 Dec -

Tentatively scheduled for plastic surgery Friday 12 Dec

It's all so tentative - that is the difficult part - waiting is worse

They will make an incision from corner of my eye to hairline and then down the neck so as to have enough 'material' to cover whatever the wound will be.

Thank you
April

I just had MOHS surgery on top of my hand last Wednesday. The area that was suspicious and where biopsy was taken was about the size of the top of a pencil eraser.

I have had 5 other MOHS surgeries and all were closed with pressure bandages. This one though required stitches. I asked how many but they said one continuous one. It look like to me about 6 times in/out of skin.

I was asked if wanted to look at site before stitching. I said yes. I looked down to see about 2 inches long, 1.5 inch wide and they removed all the skin deep as I saw my tendon with no skin over it. I asked, "Is that my tendon." Yes I was told not much skin on top of hand.

I had a great MOHS surgeon and had plastic surgeon there if needed. The procedure was painless (past the deadening shots) and is healing nicely without pain or discomfort.

Now I see similar spots on my arm and requesting another appointment. I plan to seek dermatologist when I see suspicious areas rather than wait.

I have 78 year old skin that lived in the sun when when growing up. I thought the crusty spots were just old age spots and ignored them. The dermatologist is the one that found the one on top of my hand during my skin inspection visit.

Get those suspicious spots check as soon as possible. I learned my lesson.

@hearth , thinking of you as your recover from surgery. I look forward to an update when you're able.

Hi Colleen,
Recovering from surgery yesterday and today - went well
Anticipation of what was to come was more concerning - Thank you for your concern
/April