Brent Spencer, MD

First off, 50% TCA is not meant to be an "at home" peel.  It is very strong and should only be used by qualified individuals.  From your picture, it looks as if you did this on your finger.  I would have also advised against that.  A 50% TCA peel is way too strong for that location.

The frost after a TCA peel does not wash away.  You may have over peeled yourself, and there is a potential for you to scar.  I would advise you go see your local dermatologist in the meantime.  Keep the area moist with vaseline and hope for the best.

Yes, a frozen section biopsy can be done prior to Mohs surgery.  I tend to limit this practice to very few situations though.  For example, if there is a suspicious lesion immediately adjacent to where I am working, I want to know what it is, as it could affect my closure.  

The potential negatives include:

1.  A frozen section biopsy does not provide the same cellular detail and can have artifact that a permanent section biopsy does not have.

2.  There may be a bias that develops when reading a biopsy right before surgery...of course the incentive is to read this out as a BCC (when it may be something like a trichoepithelioma instead).  If the biopsy is read by another dermatopathologist, this potential bias is eliminated.

3.  Sometimes it is difficult to make a diagnosis and  you may require immunohistochemistry studies or need a second opinion.  Doing the frozen section biopsy right before Mohs makes it very difficult to do this.

4.  What if your biopsy is negative right before Mohs?  Then the doctor has blocked a large amount of time on his schedule for your potential Mohs surgery which is cancelled.  This is not fair to other patients who are waiting for this procedure and creates a scheduling nightmare.

So there are many negatives with doing this approach of biopsies immediately before Mohs.   

It is impossible to tell you what is going on without seeing the lesion.  You would be best served by calling a local board-certified dermatologist.  The American Academy of Dermatology (aad.org) has a list where you can find one. 

Blue Light is not my treatment of choice for nodular basal cell carcinomas; the light does not penetrate deeply enough to get nodular BCCs.  In low risk areas (like the trunk and extremities), Blue light may be acceptable for superficial basal cell carcinoma.  Blue light in my opinion is never indicated for recurrent BCCs (as is the case on your nose).    Furthermore, I would not do Blue light for the BCC on your forehead.  The cure rate is nowhere close to that of Mohs (which is 99% for primary tumors).

In terms of scarring, make sure that you go to a fellowship-trained Mohs surgeon.  These individuals are extensively trained in reconstruction.  Although you will develop a scar, a fellowship-trained Mohs surgeon should be able to keep this to a minimum.  

I wouldn't call what you are having "Mohs".   You might call it the slow Mohs variant if they are really doing en face sectioning of the tissue.  More appropriately, I would say that you are having staged excisions where they are doing permanent sections with immunohistochemical stains.  This is not abnormal to do for rare tumors.   The staining and processing take time when it is done this way. 

The same day procedure that you read about for Mohs is when frozen sections are done.  In rare instances, immunohistochemistry is done on frozen sections, but for the most part, permanent sections is where you see this utilized. 

Like any other medication out there, Botox's effects wear off with time.  For hyperhidrosis, I find that the effects last from 3- 6 months. The Botox is not "stored" per se in your body.  It binds to the nerves and cleaves a specific protein, thus inactivating that nerve.  Over time, the toxin is metabolized and its effects wear off. 

It sounds like your physician was talking about compensatory hyperhidrosis.  This is where you sweat more somewhere else if you inhibit the sweating in one location.  I really do not see this with Botox that often.  Now if you have the surgery for hyperhidrosis where they cut the innervation to the nerves, you will see this effect.

Iontophoresis is a very good technique for helping with sweating; it requires motivation on the patient's part to learn how to use the machine and sit through the treatments. 

There is another new technique called MiraDry which you could look into.  It is helpful for armpit sweating.

Unfortunately, Texas allows anyone who is supervised to inject Botox.  This leads to several medi-spas with a medical director who is never on site having nurses inject Botox.  It is very scary.  You should only let a core cosmetic specialist such as a dermatologist, plastic surgeon, facial plastic surgeon, or oculoplastic surgeon do your Botox injections.

Do not take the risk; have a physician do your injections.

It is usually acceptable to wait 2-3 months for Mohs surgery for routine nodular basal cell carcinomas.  Now if you had a poorly differentiated squamous cell carcinoma, I would answer this question differently and recommend treatment quicker.  The longer that you wait, the more that you risk that you will have a larger defect, but for the most part, basal cell carcinomas grow rather slowly.

If you can get your surgery done in the next few weeks, you should be fairly well healed up in time for the family wedding in June.  I don't know about the "sautéed graduates" or when that happens though :) .  

Moderately dysplastic nevi are somewhat controversial lesions and you will probably see several dermatologists give you different answers on whether they need to be removed or not. 

In your case, you have a history of melanoma in situ.  In my opinion, that changes what I would do.  I would get it removed.  The risks of local anesthesia are minimal in pregnancy (lidocaine is category B by itself).  Therefore, I believe that the risk to the baby is minimal.   I would not be too concerned about the scarring.  A minimal excision with rather small margins (2mm) is usually adequate for moderately dysplastic nevi.  The surgical site should heal fine.

You need to have the area reevaluated.  Recurrences with Mohs are very uncommon, but they can happen. Without seeing a picture it is difficult to speculate what is going on.