What is better for treatment of basal skin cancer radiation or Mohs?

I was dx’d recently with Basel Cell Carcinoma on my upper nose very close to one of my eyes. A Dermatologist office did the biopsy. I wasn’t told it’s any particular type. In fact I have had a rough time getting back in touch with the Dermatologist about it. They set me up to have a Mohs surgery done on it to remove it. Then they want me to drive to a different location of theirs to have an Oculoplastic Surgeon close it up. They have been talking about wanting to do it with a graft. It’s very small compared to a soft tissue Sarcoma I had removed on my upper leg a few years ago where I had to have a Wound Vac to help it close up. I’m beside myself with stress due to having to drive 3 hrs just to get to their Dermatology office and my husband is 76 years old and he does all the driving and we aren’t familiar with the city where it’s at. I mean we have already been to their dermatology group but we are only familiar now with where “they” are at. I had a soft tissue Sarcoma removed from my upper thigh 3 years ago by the same hospital group and they removed it and repaired it all in one hospital visit (it was a large grade III) so I fail to understand why their Dermatology group told me that I would have to have 2 different surgeries at 2 different locations on the same day. I’m trying to get answers but like I said it’s been difficult communicating with this hospital group many times (I should’ve asked these questions when I was at the Dermatologist office but I didn’t think to and it’s not the first time I’ve had to deal with this communication problem with all of them over the years.) I also joined a Sarcoma Study Group with this hospitals Redcap team in the past year and they took 5 vials of blood from me on a home visit they did and I have yet to receive any lab results to do with that when I was expecting I would and phone calls to them have been getting me nowhere. I’m pretty depressed & frustrated.

To; liv38556,
I recently had 2 biopsies. One on my upper chest and the other on the upper side of my nose. It was extremely close to my eye. The biopsy healed okay, it was determined to be basal cell. I recently had the upper chest early melanoma removed with 13-14 stiches. Now they have scheduled me for the removal of the basal cell by my eye. The Dermatologist gave me options of Radiation or Mohs. He explained that the Mohs dissection does not get stiches in this area. Basically, sounds like the wound would heal from the inside out. I want to tell you to reconsider continuing with this/these groups of Dermatologist. The extra travel and the fact that the procedure will be at 2 different places is ridiculous. Adding to this is the fact that they consistently do not communicate to the patient any feedback. Before you call them back write down your exact questions you want answered. Look up this group's recent evaluations. At any appointment, no matter what kind of Dr. you will see... Always ask questions. Using their Patient Portal is a good way to get your concerns in writing and to see your concerns addressed. Please always ask Questions. I'm guessing you have Medicare as your Primary Insurance and Possibly a very positive Secondary insurance. You know that "old" saying "Money Talks?" Well in this current economy MONEY is SCREAMING BLOODY MURDER. Stay well, SJR

I had MOHs for a recurring spot in 1988! It has not come back. I believe it is pretty much the cure for Basal cell.

You could seek a second opinion regarding the basal cell from another Mohs surgeon. Some fellowship trained Mohs surgeons perform their own repairs immediately after margins are cleared. There is no rush to get it done.
Copies of your biopsy report and any photos should be available for you to have the additional consultation.
It is a delicate area for surgeons and the size and depth can be unpredictable. Radiation would require multiple visits to the treatment location most convention to you.
Hope there are closer options for you. Could there be
an option for a telemedicine visit with a Mohs practitioner in your area.?

@mustsell
Basal cell carcinoma is very common. If you are light skin and/or spent a lot of time in the sun (regardless of skin tone) in your life you probably will get it sooner or later. Most medical providers will tell you it is what you did 20,30,40 years ago that is the predominate cause of the cancer.

I have had about 6 basal cells, and 3 squanomous. Getting hard in my old age now to remember them all. I have used the MOHS on all. MOHS surgeon are traiend and very specialiszed surgeons. Having to wait is not uncommon. Basal cells are slow growing so having to wait awhile for a good MOHS surgeon is worth it.

You asked about what is more invasive and what is best treatment. Your dermatologist should be answering those questions as we do not know where, how involved, etc. If you have radiation it is non invasive. But radiation has side affects and damage to other tissues but new proton radiation can reduce this.

MOHS surgery is invasive. A lot of cancer patients like it because the cancer is removed in one visit. So when you leave you are cancer free. It can be a simple procedure or can get involved if you cancer is large or spread to more than a small area. Thus you could have a minor surgery or major one with stitches.

With MOHS the surgeon is looking at your biopsie and then will try to surgical remove the cancer and remove skin/tissue surronding cancer to ensure the cancer is removed. This requires the surgeon to remove the cancer and some surrounding tissue and then it is send back to pathology. Pathogy and surgeon will determine if all the cancer has been removed. If so then you are done and surgeon will determine best way to close wound and follow up care.

If the pathologist and surgeon see that there is still some cancer left in the surrounding tissue they will come back to you (as you wait on surgeon table) advising you of their findings and surgically remove the area found ot have cancer. Then this tissue is sent back to pathology and surgeon and pathologist confirm if all cancer has been removed but if not the procedure continues.

You won't leave until all your cancer has been removed. This is why I choose MOHS each time I am diagnosed with either basal or suganamous (spell).

Good luck. If you choose MOHS just make sure you have an experienced MOHS trained surgeon to do your surgery. Radiology for skin cancer is not something I am familiar with. I know my dermatologist gives me about 5 different treatments and goes over the pros and cons of each. Again I chose MOHS.

I go to Mayo Jacksonville who have excellent dermatoligist, expereinced trained specialized MOHS surgeons, and a great pathology department.

Hi @liv38556, I just wanted to check in on you. At the time of this last post, you were very frustrated and somewhat deflated with the run around you were getting. Did you have the MOHS surgery? How are you doing?

My new doctors says she does not do MOHS on small Basil cell sites. I have previously had MOHS on my collarbone area and my forehead. Both my MOHS are thin barely visible scars 1 inch and 4 inches was 2 passes, dr had microscope tech in office and I waited with open wound to see if all cancer was gone, it was after 2nd pass. Also Melanoma last Sept 2023 it has a big ugly scar it was on my back and less than a pencil eraser and the scar is two inches and thick looking. Now another Basil cell and I am not ready so I am waiting to have it removed. Was thinking about checking into SRT.

Small basal cells can be deceiving. I had a tiny pearly one on my forehead and it ended up being 3 layers.
My Mohs surgeon and I were both surprised it had some
sclerosing features. Healed beautifully so the closure repair skill of your surgeon is important.
If the small ones are on the nonvital appearance sites they don’t require Mohs.
SRT is useful if there are other reasons to avoid surgery
such as problems with bleeding or infection and in
older patients with areas that don’t heal well. The cosmetic results are usually good.
I agree with your doctor that Mohs is not always
necessary. When we see medical pictures of treatment
outcomes they are usually showing us the best case scenario.

I'm seeing this and replying about three weeks after you made your post. I hope your situation turned out ok or is about to. My eye doctor found a basal cell carcinoma on my right lower eyelid a couple years ago. The biopsy said it was a BCC and she referred me to their dermatology department which was 60 miles away in Sacramento. I eventually had a response and an appointment from them for surgery two months away. The letter said it would be a MOHS surgery at one location with reconstructive plastic surgery about two miles away with a second surgeon. As the growth looked pretty small to me I didn't think it would be a big deal. I have also had at least a half a dozen BCCs removed by office surgery over the years and a major surgery for large melanoma on my back 30 years ago. The MOHS surgery took 3 goes at it to get a clear margin and went pretty well. Even the chair was plush and comfy. Not seeing a mirror, I didn't realize most of my lower eyelid was gone. My daughter drove me to the second place, after stopping at Micky D's for lunch. The second surgeon stunned me with the news that my right eye would be stitched for 6 weeks. I was kind of pissed that I hadn't explored what was going on earlier. This was in the middle of the pandemic so I kept my mask on and suffered through two more hours of somebody taking skin and flesh from my upper eye lid to reconstruct my lower eye lid, all in the most uncomfortable chair I'd ever been in. The right side of my face looked like I had been beaten with a bat or something. It dripped blood for a couple days causing my wife to panic and call the doctor's office several times. It was a miserable 6 weeks with no depth perception I can't see that it ever happened and my other eagle eyed daughter from out of town can't tell it happened. Radiation, as far as I know was never an option but I would have gone for surgery anyway. Good luck.