Treatment of Basil cell carcinoma

@sportyridr: You've had interesting healing experiences with your Mohs vs. the scraping procedure you described. That's what's called curettage and electrodesiccation - EC&D or excision and cauterizing (a medical term meaning to burn off tissue). Either of these treatments can be used to treat basal cell carcinoma (BCC), although generally the EC&D tends to heal much faster. That's because MOHS usually takes off a few layers of skin and needs to be examined microscopically prior to completion (suturing). MOHS is typically used if the basal cell carcinoma is larger or extends deeper into the skin; typically, basal cells tend to be more superficial - therefore, the EC&D is more commonly used - especially for those lesions on the chest, back, hands or feet. MOHS the usually reserved for larger, deeper or more advanced types of skin cancer and/or squamous cell or melanoma, however, both approaches can treat basal cell effectively.

You may want to inquire about are other options, such as cryotherapy (freezing), topical ointments (those obtained by prescriptions to be applied directly to the lesion(s) for an advised amount of time) or radiation; and as you noted, individual preference should be considered. Dermatologists base options on their assessment of the skin cancer, including the size, location, and whether it's a first-time or recurring case, and ideally these are all discussed with the patient.

The short answer to your question is both techniques are used equally and with the same general efficacy to treat basal cell carcinomas (in full transparency, I'm going for my own EC&D for my most recently detected BCC coincidentally also on my back, in two weeks). As far as needing a new dermatologist, I'd need to ask you: Do you feel fully comfortable discussing your concerns and preferences with your current dermatologist and do you feel he/she is receptive? Or do you feel you'd like to a "second opinion" meeting with another dermatologist?

I don't really know what would happen if I talked to another dermatologist. The one I'm currently seeing, seems quite confident that only his opinion counts. I asked him about MOHS on several places. He said he didn't allot time for any procedure, except scrape and burn. I told him, DONT BURN another place. I have 2 that haven't healed in almost 60 days. Again he said,I didn't allot time for MOHS. I kinda at a crossroads. I would just as soon leave everything alone, as go back. I received a rather urgent call about making an appointment. They mentioned, it may take 45 to 60 minutes for the procedure.When I called, I was told, the Dr. doesn't like to rush. My appointment is for 30 days out. If it was urgent enough for them to make a detailed call, why put it off for another 30 days?? I'm kinda confused and put off by their attitude.

@sportyridr: Sometimes it's hard to leave a practice that has been providing care and where a relationship of any kind has been established - it's almost as if one feels a sense of loyalty to continue in the practice, or the thought of going elsewhere seems to be an enormous undertaking. Or they may feel that being a "patient" puts them in a subservient position, where they're not able to question the authority figure.
As a result, people often have hesitancy about seeking another opinion. This article may help: https://connect.mayoclinic.org/blog/cancer-education-center/newsfeed-post/tips-for-seeking-a-second-opinion/

In addition to the points in the article, I want to add that if one looks for what makes a positive-doctor-patient dynamic, it would be defined as one that shares a mutual trust, open communication, and shared decision-making, leaving the patient feeling empowered. It's your right as individual seeking treatment from a provider to ask questions about your treatment plan and let your desires be known. Either the doctor or the staff called with what you describe as an urgent call to schedule the appointment - did they elaborate, or did you inquire - as to the nature of the urgency? Are you feeling empowered or pressured? You've stated in your last sentence that you feel confused and put-off by your doctor's attitude. So now knowing what a healthy doctor-patient relationship ideally consists of, has this helped to clarify what next steps you'd like to take?

I have been dealing with both BCC and SCC over the years (actinic keratosis). My dermatologist is extremely thorough and I trust her explicitly. She takes many biopsies just to make sure her diagnosis is correct. For the most part she uses liquid nitrogen (freezing) the basil and has me do MOHS for the squamous. Thank the Lord I have never been diagnosed with a ‘melanoma ‘. Also, depending on the size of the BCC, she will use liquid nitrogen (freezing) or I have also used Efudex/Fluorouracil (5-FU) cream over a recommended period of time for a basil. I did use this chemo cream on my face. I had so much sun damage that my doctor was concerned it could eventually become cancerous. I treated 1/2 of my face at a time. Believe me, it was extremely painful and it took about 6 months to heal completely but the end result was amazing so I opted to treat the other side of my face. I’m 79 years old and yet my face is baby smooth. I even took progress pictures. My dermatologist now uses those pictures to explain the procedure to her patients so there are no surprises. I was amazed at all the people posting that they weren’t told much about the affects of this treatment.
To answer your question; I think I would want a 2nd opinion. You must remember to put yourself and your health first. Doctors are use to having their patients get 2nd options and then sometimes leaving. It’s your prerogative.

I don't know how you were able to do the chemo creme.
I experience so MUCH excruciating pain, I just can' do it again unless they are willing to medicate me.

I also had the blue light treatment and that was so painful and they refused to give me pain medication for that either...

How do you tolerate all the pain with this stuff? It lasts so long.

I hate the freezing procedure, also.

Anytime they find a spot now: I have a plastic surgeon take them off, send to pathology.

My face looks terrible, but I can't stand the pain; I wish I could do the creme all over my face....

I ended up going to plastic surgeons when I find a spot; they send it to pathology. I am blonde and blue eyed and have many spots on my face both basal cell, squamous cell, one on my arm was "melanoma like" - whatever that means.

I found one on my leg and the dermatologist at the VA swore it wasn't anything but acetic keratosis....but I insisted she biopsy it. Yup: squamous cell...

Dermatologists are freeze happy people IMHO and it is so darn painful. My husband thinks it does not hurt. I've had four babies and anything done on my skin without medication to me just hurts so badly. I feel like a wimp, but I had four babies, three natural and it hurt like hell, but I dread pain from skin lesion treatments.

Oh, it was excruciatingly painful. Many a night I was ready to rip off my face. It actually got worse once I stopped the cream application. It was almost like my skin was going thru withdrawal……no more chemo cream!! At least that’s how my dermatologist explained it. There were a few days when even droplets of water burned. My dermatologist suggested warm water and white vinegar to soothe. It actually worked and also reduced the redness as it healed. We were masking up at the time I first started (Covid) so I didn’t have to hibernate. As I said in my post, the result was so amazing that I made the decision to do the other side. But I waited until the winter so it as easy to stay inside. I must give my husband due credit as he was very tolerant during my really bad days. I did have the blue light treatment years ago (different dermatologist) but it was more like a bad sunburn and I didn’t notice much improvement.

I also am the red head, freckles and blue eyes who worshipped the sun growing up and early 20’s. Baby oil and all. Who knew!! And yes ‘actinic keratosis’ is just a fancy name for sun damage be it BCC, SCC or Melanoma. Never overlook the spots no matter how innocent they look. After going through the chemo cream treatment on my face, I’ll take the liquid nitrogen.
It’s all in what our pain level.

I did the chemo cream twice. Once on my forehead and once on my nose and cheek. It looked so bad. I think at one point I sent my doc pictures and she told me to stop using it. There was a bit of burning, but not significant pain. I am going in next month and I think she will either freeze the areas again bc its back, or recommend MOHS. She said all from the sun. I am 70 so no sunscreen back then. Hope your situation is resolved without any further pain.

@jpeters6930 Another one here with redhead, and blue eyes.

I have had the freezing with liquid nitrogen. Initially very painful, need to keep it a bit moisturized as it heals/peels. Also the fluorouracil topical cream. As was explained to me, the topical is going to cause a reaction at the location of the bad areas, whether or not you put it on there! As @slarson14 commented, either treatment can cause uncomfortable responses from us. In my mind, that means it is working!

Next week I go in for MOHS procedures on squamous cell areas contained within both eyebrows, that are not responding to liquid nitrogen to stop them. The result will be interesting to see; may need to get my bestie's daughter involved to show me how to make it look like I have eyebrows!
Ginger