Only someone properly trained in Mohs surgery can perform the staged tissue sparing technique of removing the skin cancer on your nose. Having said that, either your Mohs surgeon or a plastic surgeon can perform the reconstruction. Your surgeon will take into consideration the lining, support, and coverage needed to reconstruct a defect on the nose. Depending on the size and exact location of the hole, many different reconstructive techniques are available. Your Mohs surgeon or a plastic surgeon should be similarly able to reconstruct the defect.
Mohs surgery is the ideal method to treat a poorly defined skin cancer on the face.
I would suggest discussing with a Board Certified Dermatologist with expertise in Mohs surgery.
The most important issue here is that Mohs has the lowest possible recurrence rate and that wide local excision (just cutting out what looks abnormal) has a very high recurrence rate. With rare exception, people trained in the Mohs technique are all Dermatologists. Many Dermatologists perform exceptional facial reconstruction but the most experienced recognize when a referral to a Plastic Surgeon is in your best interest. Meet with your Mohs surgeon first and ask their thoughts about reconstruction in their office following Mohs vs. a referral for reconstruction after Mohs excision. I hope this information is helpful for you.
Stephen Weber MD, FACS
Denver Facial Plastic Surgeon
It sounds like you have a decent sized basal cell cancer on your nose, and if it has roots, it might be larger than what appears to be on the surface. Having Mohs surgery is definitely your best bet to treat this cancer with the most tissue sparing procedure and highest cure rate in my opinion. In terms of having the resulting hole or wound closed, both Mohs surgeons and Plastic surgeons are capable of sowing this up. Either way you will have 100% chance of having a scar, the goal is to heal the scar in the best possible way. Mohs surgeons that are well trained and have completed a formal fellowship tend to do much more nasal reconstructive surgery for skin cancer than most Plastic surgeons. There are very few Plastic surgeons who focus exclusively on nasal reconstruction. Both types of surgeons would use similar techniques. However, you will have good Mohs surgeons and bad Mohs surgeons, just like you will have good Plastic surgeons and bad Plastic surgeons so it is far more important that you feel comfortable and trust the doctor that you are seeing.
To do Mohs properly, most physicians will have undergone an extensive training (and fellowship) which includes closures. I personally do all closures myself, but I went through training, a 2 year fellowship, and have performed Mohs for nearly 30 years. So, it depends on your surgeon. If your Mohs surgeon comes highly recommended, I would just ask him/her if they usually do all closures.
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cannot be held as true medical advice, but only opinion. Seek in-person
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