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

@gingerw @sef26
The tight skin is a bummer for me as a aging senior. However the skin will stretch. Probably why they did stitches on my hand and did not do on my nose or other areas.

What is important is that skin will stretch. If I had not had another SCC on same hand discovered after the first MOHS surgery would not have been a problem. But I got a double whammy with two on the same hand. The second MOHS was about 1.5 inches from first SCC so was not part of original SCC. If I had not been monitoring my first surgical site would not even have noticed the spot.

When I had my first MOHS on left hand there was a plastic surgeon there. The MOHS surgeon and plastic surgeon were there to discuss best way to close the incision.

I see the Mentor had mentioned skin graft after MOHS.

My MOHS surgeon discussed differences in SCCs. The in su tru (Spell) means the cancer was spreading out horizontally. The well differentiated meant was growing downward. I had one SCC on back of elbow that was in su tru and they removed it regular surgery. The ones on my hand were the well differentiated and thus the MOHS. I hope I got that right but what I was posting was the SCC can grow outward or downward.

@gingerw the post about golf size hole seems strange to know would be that big unless the biopsy was already very wide and deep and SCC still remained.

Without MOHS is really hard to see how far the cancer has grown outward or downward. That is determined when they remove the margins around the biopsy site then view after removal to see if cancer is still present beyond what was removed.

Your biopsy must have showed you had SCC beyond where the margins were taken when skin was removed for biopsy. I pass this along as by now have had about 10 skin cancers removed.

Mayo Jacksonville dermatology did offer me several ways to treat the cancer. I discussed those options with them and both the dermatologist and I decided on MOHS. Why? Because you will not leave table until the SCC is gone and no signs of it remain. With other methods especially radiation you are damaging and killing the cancer cells not removing them. I hope you can see the differences.

I am looking at my left hand now 1.5 months after first surgery and 3 weeks after second. The first surgery is completely healed and don't see a scar just some rough skin. The second surgery is still healing in one area but I don't see a scar on the other areas already healed. There is a slight line on my skin but unless I knew I had SCC MOHS surgery would not even have seen it with the age of my skin and all my discoloration with age.

For me MOHS meant cancer gone. There was no pain at all during surgery. What is the discomfort is that Lanacane (spell) put in to numb the areas. The shots are like a bee sting but does not last. But you feel nothing during surgery. At least for skin surgeries. The other only negative is the wait after they remove the skin (about 1 minute for actually surgery) and go back to pathology on it to make sure non SCC remains in or around the surgery site. That takes 30 minutes as they use dyes and pathological microscopes to analysis.

@sef26 Welcome to Mayo Clinic Connect! I see that @jc76 and others have already responded to you. Each person is unique, as is the site of nodular BCC. Mine was right near my collarbone, and was done with MOHS procedure. There was quite an adjustment period to get the skin to heal, and stretch. My mammogram done 6 months later was a painful one! I have never had a radiation treatment in lieu of a MOHS. The [several] procedure sites have been on my face, hands, arms, and at the collarbone.

It sounds like so much is based on if there is enough skin left behind to confidently do a MOHS surgery. Has your doctor suggested a skin graft after the MOHS?
Ginger

@sef26 My mom had mohs on her shin in her early eighties. She's tiny petite and nobody has thinner skin. The end results was a golf ball size hole which took a good six months to heal. And yes, was painful. Our dermatologist has never offered radiation in lieu of mohs procedure.

I am in the same situation for squamous cell. It is on my shin bone, which is a tough area to do Mohs on so considering the Radiation. Do your research, when I did that I found out the Radiation is rated slightly better than the surgery like 99% success rate versus 98% success rate. I think the key is “ image guided”. Now I went to government sites and.org sites to make this conclusion. Of course, if you go to the Radiation site, they’re tooting their own horn.

@sef26
I have had MOHS surgery 4 times. I also have had non MOHS surgeries. I am not familiar with the IG-SRT treatment. Is that radiation? If so I have had radiation treatments for prostate cancer but not skin.

Basal cell carcinoma (BCC) is very common especially for those of us who grew up in the sun. I probably have had 4-5 BCC over the years and now 4 SCCs. I was told the cause was what I did 30-40 years ago and damaged caused by skin burns and constant UV damage to my skin.

I have not had problem with MOHS on my nose and other areas. Healed quickly and skin not a problem. But the recent two on my hand a different issue. I am 78 so my skin is very thin on my hand. The first MOHS there I had stitches to close. They were the dissolving ones. Took about 2 weeks for stitches to start coming out and area along incision not pretty.

The second surgery on same had they used regular stitches. After on week had them removed and immediately the incision site started to separate. I was told this was normal but has caused a long longer healing process.

But that is the negative the positive is that MOHS surgery removes the cancer at that office visit. The surgeon will remove enough skin around the biopsy and then study under microscope with a dye. If there is not sign of cancer around the margins of the removed skin you are done. If there is any sign then they remove more and this process continues until no sign of cancer.

If you have radiation that is not the method done and the radiation is used to kill the BCC. The type of radiation used is important (Photon, Proton) and can cause radiation damage to surrounding tissues. Since never had radiation for BCC best to talk about the pros and cons of the other procedure.

The MOHS surgery will remove the cancer and will only take enough tissue to get all of it out. Good luck on your decision.

I have been diagnosed with basal cell it’s nodular. It is on my lower leg. Considering IG-SRT. Was offered both Mohs or IG-SRT. Dermatologist said with Mohs I would have a large hole that would take few months to heal. Also said I have very tight skin in that area & can’t pull skin together.
So that’s why I am considering the IG-SRT but also concerned about side effects or cure rate.

Hi, apparently.There is a radiation station nearby which is good because I have to go there a lot! On the other hand i'm not sure there are many trained mohs surgeons here in rural Humboldt count, CA, And surgery may be backed up for months. I waited way too long, so I may make the three hour drive to UCSF.

@susan49: Thank you for reaching out and commenting on Mayo Clinic Connect. As you can see, there are various options for treating the different types of skin cancers, mentioned in the discussions here and outlined in these helpful documents: https://www.mayoclinic.org/diseases-conditions/skin-cancer/diagnosis-treatment/drc-20377608 and https://www.mayoclinic.org/diseases-conditions/basal-cell-carcinoma/diagnosis-treatment/drc-20354193

I don't see that you've asked a specific question but I'm wondering if you're curious as to why your doctor has indicated a preferance towards radiation over Mohs surgery. I am presuming your doctor is a dermatologist, a specialist who is certainly well qualified to to both diagnose and treat skin cancers, including Mohs - which, as described, requires removal of skin tissue for microscopic analyisis followed by suturing. When superficial lesions - such as can be the case with BCC (basal cell) are on areas of the face which can be more subject to scarring, radiation is an acceptable and occasionally preferred option for that reason as the cosmetic effect is more desirable. This is one instance in which case a radiologist would be performing the treatment. I cannot comment on the specifics of your situation but there is potential it may be a factor influencing your doctor's recommendation.

Would it help to ask your doctor if this is the reason she has recommended radiation for your case?

Sorry you are dealing with this @susan49. The wait wasnt long for Mohs but it does take more coordination, especially if you need the reconstruction after the mohs. Best wishes and please give us an update if you choose the radiation.

@susan49
She should have gone through the pros and cons of each for you. You can still do your own research on them going to major medical facilities web sites and WEBMD.

The reason MOHS is so long is that it takes a special ENT surgeon trained and certified to do these. Even at Mayo Jacksonville there is a wait there also as limited number of MOHS surgeons.

I did not have radiation have always had MOHS. I can comment on my experience with MOHS. There is no pain during surgery. The area is numb so you should feel nothing. That does not me you won't feel something after pain medication wears off. But for me very minor later on.

MOHS: based on your biopsies will remove the skin and very small margin. Then that is sent to pathlology to see if any signs of cancer in the margin cells. If none then surgery over. If still have cancer cells the surgeon will come back and take more tissue and the process goes on until you are clear of and sign of cancer cells. So you leave with no sign of cancer which for me was what I wanted.

I have had about 8 MOHS surgeries. Only one did they have to come back with a second surgery and that was for a SCC not a BCC. The wait for the pathology report (I was given choice to stay on table to go to waiting room) can be a litle stressful as for me I was hoping over.

Radiation. I did have radiation on my prostate cancer. I chose proton as it can be regulate how strong coming in and stops at the point physic department programs. It does not continue through the body like photon. I would thing they would use proton on the area by your eye as well as your nose so radiation does not continue into head and brain. This would be something to asked your dermatologist of which they use if you are considering radiation.