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

Posted by mustsell @mustsell, Dec 14, 2023

I have basil skin cancer on my forehead.
What is the best treatment radiation therapy or mohs therapy. And what is more invasive? How long can I wait to start treatment as mohs surgery doctors have long waiting times.

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@gustavo1975

Hello, I have been diagnosed with lobular basal cell carcinoma. The biopsy confirmed the same. The surgeon attempted to remove the entire tumor during the biopsy, but the biopsy reported positive margins, a very deep lesion. It is located in the upper right eyelid.

I'm putting off seeing the doctor for other reasons. I'm saying this now, since if everything hasn't been removed, I'll have to undergo Mohs surgery.

Is it painful? Does it take time to heal? Since it hasn't healed, do you have any idea if it will reappear superficially or could grow inward?

I hope you understand my English; it was written with Google.

Greetings to everyone.

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This is my second reply. I reread your message and thought of a couple more things.
In 1992 I had a large melanoma on my back and my dermatologist sent me to a plastic surgeon friend of his. The pathology report after the surgery said the margin was not wide enough. My wife insisted I go to the John Wayne Cancer Institute to see a surgeon who had removed one of her adrenal glands a few months earlier. His organization performed all kinds of tests prior to the second surgery and enrolled me in a clinical trial. It all worked as I'm still here 33 years later.
My BCC was on my lower eyelid. Going to the appointment I had no idea what was involved in the reconstruction surgery by a second surgeon and was really pissed when I found out my eye would be sewn shut for six weeks. I should have looked into it before I went. Live and learn. Good luck with your second surgery.

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@gustavo1975

Hello, I have been diagnosed with lobular basal cell carcinoma. The biopsy confirmed the same. The surgeon attempted to remove the entire tumor during the biopsy, but the biopsy reported positive margins, a very deep lesion. It is located in the upper right eyelid.

I'm putting off seeing the doctor for other reasons. I'm saying this now, since if everything hasn't been removed, I'll have to undergo Mohs surgery.

Is it painful? Does it take time to heal? Since it hasn't healed, do you have any idea if it will reappear superficially or could grow inward?

I hope you understand my English; it was written with Google.

Greetings to everyone.

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I am wondering if you meant Nodular BCC rather than Lobular. I can only find Lobular in relation to breast cancer.
Mohs surgery is your best option for BCC. It's possible for BCC to return but less likely with Mohs surgery as they make sure the margins are clear before they stop cutting. The surgery itself doesn't hurt, thanks to the slightly painful shots you get beforehand. Depending on where the surgery is located, it could be sore after the surgery. My lower eyelid surgery was sore and ugly for six weeks until the stitches were removed. I had one on my shin that got infected and took 10-12 weeks to heal. It never really hurt very bad.
My suggestion is to get the Mohs surgery before the BCC gets larger.

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Hello, I have been diagnosed with lobular basal cell carcinoma. The biopsy confirmed the same. The surgeon attempted to remove the entire tumor during the biopsy, but the biopsy reported positive margins, a very deep lesion. It is located in the upper right eyelid.

I'm putting off seeing the doctor for other reasons. I'm saying this now, since if everything hasn't been removed, I'll have to undergo Mohs surgery.

Is it painful? Does it take time to heal? Since it hasn't healed, do you have any idea if it will reappear superficially or could grow inward?

I hope you understand my English; it was written with Google.

Greetings to everyone.

REPLY

How thoughtful of you to find those surgery photos, I hope they didn't bring back memories!
Getting through that wins you a Brave Heart award, and I'm sure the others here agree with me.
Skin cancer surgery, MOHS or otherwise, especially on the face and head is a real bummer. We can only hope that someday in the near future, a more gentle method will be found.
Hope you find good health and a peaceful life in the future.

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@mermaid7272

A terrible experience, @itchyrich! But I'm amazed that your eyelid has healed so well.
I've had several facial Mohs surgeries but nothing like what you went through.
My last one, exactly one year ago, was on my lip & still bothers me daily; about 1/4 of
my upper lip is gone.
I've often wondered what might happen if a patient had to have Mohs on their eyelid or very close to their eye, now i know!
You're a brave guy & I'm glad to hear everything worked out for you.

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I'm catching up on emails. When I originally read your message I thought I would be able to easily find some photos. Not so. Anyway, I've now found them. The first one is immediately after the Mohs surgery. It's hard to see, but the lower eyelid is pretty much gone. The second one is the day after the reconstruction surgery, which was the bigger deal. The eye was sewn shut for six weeks.

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Mohs surgery. The dermatologist should be a graduate from the american college of Mohs surgery. They look under the microsope to ensure that the margins are clear and they got it all.

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@mustsell
There are so many options for treating skin cancers. Are you going to a major medical facility?

You mentioned radiation and MOHS. There are many more methods for treating skin cancer.

Radiation (I was treated for prostate cancer) does carry risk of damage to surrounding tissues. However it is an option. If you have a choice of what type suggest proton. Again requires some research but look up photon and proton radiation treatments.

You mentioned you have basal cell. That is a very common cancer and the spot you have it on top of head is very common also. Basal cell is very slow growing and rarely metasisis if caught early. The major risk from basal cell (this all comes from my Mayo dermatologist) is growing into surrounding tissues and organs.

I have had at least 8 MOHS surgeries. Yes that is a lot. I grew up in Florida where getting a sun burn was how much fun you had over weekend. I chose MOHS surgery because it only requires one office visit and you do not leave until no signs of the cancer remain.

What they do if you have not been told is the take tissues around your biopsy and pathologist gives a finding of whether there is any signs of cancer in the margins taken off. If no then you are done. If yes, then they remove more tissue and back to pathlogist for getting a clear. If not clear than continues. This type of surgery allows the minimum of amount of good tissue being taken off because it can be done in ingrements.

Out of the 8 or so cancer MOHS surgeries I had I only had one surgery where had to take more tissue. It was not basal cell though is was squamous (SCC). I only have had one SCC all rest basal cell (BCC).

Look up and research the methods of treatments for skin cancer. It has to be a personal decesiion. Yes it does take some time and usually have to wait. Why? MOHS ia a very specilized dermatologist surgery and surgeon goes through a lot of training to be certified to do them. Just remember basal cell is very slow growing.

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@itchyrich

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.

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A terrible experience, @itchyrich! But I'm amazed that your eyelid has healed so well.
I've had several facial Mohs surgeries but nothing like what you went through.
My last one, exactly one year ago, was on my lip & still bothers me daily; about 1/4 of
my upper lip is gone.
I've often wondered what might happen if a patient had to have Mohs on their eyelid or very close to their eye, now i know!
You're a brave guy & I'm glad to hear everything worked out for you.

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@windyshores

I had Moh's surgery. The basal cell lesion was on my lower eyelid, very difficult location. A plastic surgeon (the one who did the first face transplant) worked on me right after the Moh's. Noone mentioned radiation. I didn't think basal cell spread....but it can grow!

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Yes it can. Mine came back after 5 years and then I had Mohs surgery. Right in the middle of my chest. Looks like a bullet hole

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@liv38556

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.

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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.

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