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

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.

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.

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.

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.

@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.

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.

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

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.

Small basal cells can be deceiving. I had a tiny pearly one on my forehead and it ended up being 3 layers.
My Mohs surgeon and I were both surprised it had some
sclerosing features. Healed beautifully so the closure repair skill of your surgeon is important.
If the small ones are on the nonvital appearance sites they don’t require Mohs.
SRT is useful if there are other reasons to avoid surgery
such as problems with bleeding or infection and in
older patients with areas that don’t heal well. The cosmetic results are usually good.
I agree with your doctor that Mohs is not always
necessary. When we see medical pictures of treatment
outcomes they are usually showing us the best case scenario.

My new doctors says she does not do MOHS on small Basil cell sites. I have previously had MOHS on my collarbone area and my forehead. Both my MOHS are thin barely visible scars 1 inch and 4 inches was 2 passes, dr had microscope tech in office and I waited with open wound to see if all cancer was gone, it was after 2nd pass. Also Melanoma last Sept 2023 it has a big ugly scar it was on my back and less than a pencil eraser and the scar is two inches and thick looking. Now another Basil cell and I am not ready so I am waiting to have it removed. Was thinking about checking into SRT.