I Am 49 Years Old. Diagnosed with BCC on Bridge of Nose, What's Best for Least Scarring?

Skin cancer specialist advised marginally removing BCC, send me home with a hole in my nose, back next day, if biopsy ok, wound closed like an icecream cone, extending down the side of the nose and zig zag up between the eyes. This allows the skin edges to be drawn together. The plastic surgeon said that he would remove skin from my check and graft it to my nose. I see a dermatologist re MOHS surgery next week. For the least scaring, what's best?

Doctor Answers (7)

BCC on nose

+1

There are a number of elements that need to be considered in deciding the best technique for reconstruction of the nose.  Photos of the defect are the most helpful.


Seattle Facial Plastic Surgeon
5.0 out of 5 stars 138 reviews

Basal cell cancer

+1

The best treatment for a BCC on the nose is Mohs surgery.  Mohs surgery controls the skin cancer by using a microscope to check the margins during the day of the procedure.  It gets rid of the skin cancer and  leaves behind as much normal skin as possible leaving a much smaller defect. A smaller defect after taking the skin cancer out leads to a smaller reconstruction with a better scar.  Dr. Halem

Monica Halem, MD
New York Dermatologic Surgeon
4.5 out of 5 stars 6 reviews

Mohs surgery

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Mohs surgery is the best choice for skin cancer on the nose - it has the highest cure rate for the treatment of skin cancer -- up to a 95 -99 % cure rate.

In addition Mohs conserves as much normal tissue as possible as the Mohs technique examines 100% of the tissue margins -- all the lateral (wide) margins and the deep margin (the base) are examined. 

 

I recommend a fellowship trained Mohs surgeon with (American College of Mohs Surgery).  Also the Mohs surgeon not only performs your surgery, but also examines your tissue under the microscope.  The type of repair and the size of the scar will depend on how much tissue was taken.  I wish you the best of luck.

Elizabeth F. Callahan, MD
Sarasota Dermatologist
5.0 out of 5 stars 1 review

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Mohs surgery for skin cancer on the nose

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The treatment of choice for skin cancer on the nose is Mohs surgery. If you want to minimize scar, this is also best option and have closure by dermatologicsurgeon skilled in reconstructive surgery.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

Mohs surgery for basal cell cancer on the nose

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I agree that Mohs surgery is the best treatment option for the basal cell cancer on the nose.  That should give the highest cure rate with the least amount of tissue removed.  The wound will need to be reconstructed afterwards and the exact reconstruction depends on the size and depth of the wound and the location on the nose.  I agree that most of the time, the nose heals very well, particularly in women.  Men who have very oily, sebaceous noses with enlarged pores sometimes heal with more visible scarring on the nose.   

Richard Ort, MD
Lone Tree Dermatologic Surgeon

Least Scarring and Best Cure Rate for Skin Cancer on the Nose

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In my opinion Mohs micrographic surgery provides the best option for skin cancers on the nose when you're considering surgery. Mohs surgery starts with the smallest surgical margin around the skin cancer and traces out the roots of the skin cancer. Generally for a skin cancer on the nose the Mohs surgeon would start with a 1-2 mm margin around the skin cancer. For routine surgical excision without Mohs the surgical margin should be 3-4 mm. By examining a higher percentage of the actual surgical margins the Mohs surgeon can trace out the skin cancer. The result is the highest cure rate (approx. 98.5-99% for previoulsy untreated skin cancers per the scientific literature) and preservation of the highest amount of normal healthy skin. By creating the smallest defect and preserving healthy tissue, the reconstruction should be the simplest possible, but the key thing is to make sure that the person performing the Mohs surgery is well-trained and experienced in Mohs surgery and nasal reconstruction. Fellows of the American College of Mohs Surgery require additional training in Mohs, reconstruction and interpretation of pathology slides. Of course, there are many other options available including topical chemotherapy, curettage and electrodesiccation, surgery without Mohs, radiation therapy. Best to talk to your dermatologist about all of these options and then talk to the surgeon about their training and experience. Good luck.

Andrew Kaufman, MD
Los Angeles Dermatologic Surgeon
4.5 out of 5 stars 6 reviews

Skin Cancer on the Nose

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You may be surprised to read this, but I see less scarring on the nose than anywhere else on the body. That is because the skin there has many oil glands and a rich blood supply.

So as long as you go with someone who is experienced and careful, you should heal with little or no scar.

T. Wayne Day, MD
Nashville Dermatologic Surgeon
5.0 out of 5 stars 1 review

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.