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

Ginger,
I certainly agree with the things you said about discussing treatment with your doctor. And, you are absolutely correct in the headaches around the head area. A lady at my dentists office gave me a pointer about restoring the normal feeling regarding the sensitivity of the scar areas after surgery on the head area. She said to take a wet terry cloth dish rag and lightly run it back and forth of the scar that has the kind of numb feeling and it helps bring the normal feeling back quicker. I have to admit it has helped mine since starting it. It’s so nice to find little tidbits of information from others that have been through this journey.

I also am so sorry you have and continue to deal with the cancers. One never knows when something you might think is just a blemish that will go away ends up as cancer.

Im hoping Medicare will pay the rest of the bill that the insurance through my wife’s employment won’t cover. Radiation is between $5K to $50K depending on how large and how much radiation is required. Cancer is expensive in many ways for sure. Thinking about how much of an inconvenience to go in four days a week for five weeks can be, versus the one long day of MOHS and recovery is more important or efficient. Especially in these nice summer days when I stay so busy taking care of the outside of my house. I wouldn’t really care in the winter.

Again, thank you for your insight and valuable information regarding skin cancer treatments.

@elteec98 Welcome to Mayo Clinic Connect and thank you for your service!

Yes, OHSU is considered an awesome place to go, definitely. I had squamous cell cancer removed from the middle of my forehead, and agree the headaches afterwards were no fun. You got to wonder if the thinner skin/less extra skin/closer to your pain center of the brain may be contributing factors for the discomfort? In the past couple of years my face has had several skin cancers removed, and two more MOHs procedures are scheduled mid-July, one on each eyebrow for squamous cell tumors that will not respond to fluorouracil or liquid nitrogen.

It certainly is worth a good conversation with our doctors to determine the best course of treatment for various skin cancers. We are part of the team, so our thoughts do indeed count!
Ginger

I had MOHS done in December 2025 for Melanoma on my temple/forehead area. It’s a very long day. More time waiting between cuts and testing of the sample each time they cut. Recovery was pretty painful for a few days with a lot of headaches bc of the location. I have a pretty good sized scar but I could care less about that. Now, I have a carcinoma on my neck and will do 4 days of radiation a week for 5 weeks. Fortunately, each radiation treatment from the time I check in, get the treatment and walk out is about 10 minutes. I guess the reason I’ll do radiation is bc I can still immediately do the things I normally do daily instead of nothing for two weeks of recovery. I still get headaches and waves of pain in the area of where the MOHS was done at Oregon Health Sciences University which is a very well known and respected cancer facility as well as all medical issues. I spent a long career in the military around a lot of radiation and not concerned about radiation sickness. I guess it’s all personal preference.

@lips702
Agree MOHS at least for me was the way to go. I liked the procedure of not leaving surgery office until all signs of the cancer are removed.

The key to MOHS is getting the diagnosis of BCC and SCC as soon as possible. When not caught early both can spread into muscles and bones. Then it goes way above MOHS surgery to eradicate the cancer.

My Mayo doctors told me the reason leg wounds and surgery take so long to heat is they are the farthest from heart.

I have SCC on my legs and have had numerous MOHS surgeries! Non of them hurt while in surgery, they numb you all up. It's the aftermath that's the worst...lower leg doesn't heal very fast.
I had written on Mayo several months ago and was suggested to go to "wound care" with my open wounds.
It's the Greatest!!!!!!
I am also having infusion of immunotherapy ever 3 weeks to combat my skin issues.
I currently have 2 open wounds on my shins and will be going back to wound care in another week or so.
My bottom line:
MOHS is the way to go, not radiation.

You gave your experience with MOHS, which was greatly different than mine. You felt no pain or discomfort, I did, I have had 5 MOHS surgeries, so that is a pretty good representative number to base my experiences upon.
My experience is just as valid as yours, and needs to be told to someone who might be contemplating MOHS.
Good luck in the future.

@mermaid7272
We on MCC give your personal experiences not the experiences of others.

I gave my personal experience with MOHS surgery. I have had at least 6 of them. I had no pain during the surgery because of the pain medication injected in and around the site. The surgeon then used a sharp instrument to poke around the surgery area and asked can you feel any pain. My answer with all surgeries was no.

I don't think those on MCC should say what others will feel or not feel. What you felt which is not what I have read from many others on MCC as well as what I felt is and was not the same as others that have posted nor mine. It is not saying you did not feel pain or had issue after recovery it is just saying that was your personal experience not what others should expect to be the same from our post nor mine.

MOHS surgery is highly technical and requires specific training to do it. Now I say this as the special training required to do them is a requirement at Mayo Jacksonville. I cannot comment on other medical facilities just what is required at Mayo Jacksonville and my experience with my surgeries and my experience.

When some on MCC asked a question about pain or what we expereience then we reply wiht our experience. And with mine at least 6-7 times I had MOHS and never had any pain during surgery. There was some minor soreness after pain medication wore off but was very very minor.

I intended to give my experience with MOHS surgery and what I experienced with it. I stand by my post and what I experienced. If I can help others with what I experienced with a great surgeon and great medical facility that is what my post was for.

Your expereince with MOHS surgery is your personal experience. I hope that those on MCC will not expect the same as your experience as is a personal experience with what appears a very sensitive area for MOHS surgery.

It is why we on MCC suggest getting second opinions when in doubt over which treatment to get after researching on their own and asking all the questions of your surgeon of all the pros and cons.
Everyone is different. Every surgery is different. The skills and experience of surgeons are all different. Thus a person's experience with any cancer surgery will be different and specific to them.
I had great success with MOHS surgery with no pain at all during surgery. My healing procsss was without pain. MY sugeries all heal quite quickly with exception of the one on my nose that took more time than the others. However not one person could see where I had the BCC removed.

I for one would not hesitate to have another MOHS surgery done. But that is me and we are all diffferent in what we will do or not do based on our personal experience.

I must disagree with your statement that Moh's surgery is NOT painful. It depends on the cancer's location and the surgeon's technique and skill. Of course the "pain numbing meds. hurt". So does the actual surgery, and so does the after-effect and supposed healing of the surgery.
It has been one year since my last Mohs. 1/4 of my top lip is gone & so tight I can't enunciate some words properly. Nerves have been cut & will never regrow.
I have no intention of going back unless techniques in the future have made it possible for the patient not to suffer.

@gustavo1975
I have had about 8 Mohs surgeries to remove basal cell cancer (BCC) and one SCC.

You asked about MOHS. Is it painful. No. The most painful thing is getting the nummy medication into the area around where the MOHS surgery will be. After that you only feel pressure.

Time to heal really deals with where the surgery was done. How much skin was removed, etc. So not having that information can't comment nor would I as that is something a dermatologist should guide you on and/or your MOHS surgeon.

MOHS surgery is taking the diagnosed area and some tissue outside of the the diagnosed area. Then the tissue is sent to pathlology and it is determine if all cancer is gone or a need to take more tissue out. Then when more tissue is taken goes back to pathlology to determine if all margins are clear. You remain in surgery until all margins are clear.

Basal cell cancers grown slowly. Most are not going to metasisies (per my dermatologist) but can. My dermatologist said worst for Basal Cell is not treating and removing but letting grow. It can then invade other tissues, muscles, organs, as it grows and surgery become much more serious.

Why is so important to get it early with ongoing dermatologist inspection of your skin.

@gustavo1975 I had nodular basal cell carcinoma, between my throat and collarbone. What looked like a small spot on the surface had spread out underneath my skin. They did a MOHS surgery to get everything, and had to do 5 passes! That was very unusual. But, here I am, 5 years later, with this very neat jagged lightning-looking scar.

You probably want to get it all removed, so there is less chance of reoccurrence. That is my humble opinion. Any procedure will take time to heal, and everyone is different in their healing times.
Ginger