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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Profile picture for susan49 @susan49

I was just "diagnosed" with bcc. The p.a. said I had 2 options, mohs or radiation (gentlecure). She seemed to recommend radiation. The lesion is on the side of my nose, very near my eye, and a second small bump near my nostril. I wonder if it is because the wait for mohs is long.

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@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.

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Profile picture for legeke @legeke

I have a lower eyelid basal cell that derm recommended mohs followed by plastic reconstructive surgery following mohs. Neither said anything about IG-SRT to me either. A friend suggested I look into it and as you said, the papers are split, but professional organizations have said Mohs surgery is the gold standard currently. Some research says depends on lesion size, type of basal cell. I spokecto the rep. From Gentle cure (gentlecure.com) to locate a rep in your area. Their view is that in our area, there is a push to train Mohs surgeons and IG-SRT has equal cure rates, less risk. So for me, I have to decided to go with Mohs given the professional associations Gold standard of treatment designation—since I was having issues interpreting the research. Very interested in everyones thoughts..

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I was just "diagnosed" with bcc. The p.a. said I had 2 options, mohs or radiation (gentlecure). She seemed to recommend radiation. The lesion is on the side of my nose, very near my eye, and a second small bump near my nostril. I wonder if it is because the wait for mohs is long.

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Profile picture for Susan, Volunteer Mentor @grammato3

@legeke: Glad to hear all of this! Well thought out and executed. Continued good health to you and in caring for your mom.

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Thank you

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For me it depends where it is located. I had 35 treatments to get rid of a Basel cell on my Achilles’ tendon. I have lymphedema and a Mohs procedure would have been hard to heal.

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Profile picture for legeke @legeke

Hi @grammato3
There is a dermatologist and radiation tech in the group I used for the Mohs surgery. The consensus of the group is to get a cure by actual tissue examination at time of surgery given the possible devastation if margins arent clear. This friday marks 2 weeks and I have been well healed by day 7. After day 3, I could move, bend as usual but was to avoid sunlight on incision until after a week. The plastic/reconstruction surgeon did a beautiful job and most people cant tell I had surgery. When I was thinking about pros-cons of each procedure, I also felt that 3 trips a week = 9 hrs of time traveling back/forth x6.5 weeks…easy to have something come up and miss an appointment. I take care of my mom, so time is valuable given the current demands on me. I am very happy with the surgical choice and would probably only opt for the radiation therapy if I weren't a surgical candidate.
Thank you for checking back on me!

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@legeke: Glad to hear all of this! Well thought out and executed. Continued good health to you and in caring for your mom.

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Profile picture for Susan, Volunteer Mentor @grammato3

@legeke: it's been a few weeks since your post and I was checking back to see how you're doing since you've decided upon Mohs to treat your basal cell carcinoma (BCC). Personally, I've had several to treat both BCCs as well as squamous cell carcinomas (SCC) without incident, however, in neither case have I required reconstruction - although I did have that for melanoma and healed well.

I wonder if both of the dermatologists with whom you consulted were more in favor of Mohs due to the location of the BCC, or perhaps due the difficulty in locating radiation oncologists or dermatologic oncologists who specialize in this procedure in your immediate area. You did well in performing your research and hope you're pleased with the outcome.

Jump to this post

Hi @grammato3
There is a dermatologist and radiation tech in the group I used for the Mohs surgery. The consensus of the group is to get a cure by actual tissue examination at time of surgery given the possible devastation if margins arent clear. This friday marks 2 weeks and I have been well healed by day 7. After day 3, I could move, bend as usual but was to avoid sunlight on incision until after a week. The plastic/reconstruction surgeon did a beautiful job and most people cant tell I had surgery. When I was thinking about pros-cons of each procedure, I also felt that 3 trips a week = 9 hrs of time traveling back/forth x6.5 weeks…easy to have something come up and miss an appointment. I take care of my mom, so time is valuable given the current demands on me. I am very happy with the surgical choice and would probably only opt for the radiation therapy if I weren't a surgical candidate.
Thank you for checking back on me!

REPLY
Profile picture for legeke @legeke

I have a lower eyelid basal cell that derm recommended mohs followed by plastic reconstructive surgery following mohs. Neither said anything about IG-SRT to me either. A friend suggested I look into it and as you said, the papers are split, but professional organizations have said Mohs surgery is the gold standard currently. Some research says depends on lesion size, type of basal cell. I spokecto the rep. From Gentle cure (gentlecure.com) to locate a rep in your area. Their view is that in our area, there is a push to train Mohs surgeons and IG-SRT has equal cure rates, less risk. So for me, I have to decided to go with Mohs given the professional associations Gold standard of treatment designation—since I was having issues interpreting the research. Very interested in everyones thoughts..

Jump to this post

@legeke: it's been a few weeks since your post and I was checking back to see how you're doing since you've decided upon Mohs to treat your basal cell carcinoma (BCC). Personally, I've had several to treat both BCCs as well as squamous cell carcinomas (SCC) without incident, however, in neither case have I required reconstruction - although I did have that for melanoma and healed well.

I wonder if both of the dermatologists with whom you consulted were more in favor of Mohs due to the location of the BCC, or perhaps due the difficulty in locating radiation oncologists or dermatologic oncologists who specialize in this procedure in your immediate area. You did well in performing your research and hope you're pleased with the outcome.

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I would recommend Mohs. I have had multiple basil cell carcinoma taken off..

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Profile picture for windyshores @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!

Jump to this post

I have a lower eyelid basal cell that derm recommended mohs followed by plastic reconstructive surgery following mohs. Neither said anything about IG-SRT to me either. A friend suggested I look into it and as you said, the papers are split, but professional organizations have said Mohs surgery is the gold standard currently. Some research says depends on lesion size, type of basal cell. I spokecto the rep. From Gentle cure (gentlecure.com) to locate a rep in your area. Their view is that in our area, there is a push to train Mohs surgeons and IG-SRT has equal cure rates, less risk. So for me, I have to decided to go with Mohs given the professional associations Gold standard of treatment designation—since I was having issues interpreting the research. Very interested in everyones thoughts..

REPLY
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