Nodular Basal Cell post biopsy photos - I still have stitches from the biopsy? (Photo)

I have been told MOH's is my only OPTION and I hear that, however, not all MOH's surgeons leave the best result . I just want to know if one this size, even a nodular, would be best taken care of after MOH's with some reconstructive elements. I have read and seen post MOH's only photos and still get no answers.I'm finding that the more questions I ask, the more I am told "This is your only option--just get it taken out and deal with the scarring. Thanks so much. I really need an honest opinion.

Doctor Answers 4

Best treatment option for a basal cell carcinoma of the cheek

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Th best treatment option for a skin cancer on the face may be different in individual patients. Your physician is likely recommending Mohs because it has the highest cure rate of any treatment option (99% for your tumor) and it leaves the most normal skin behind. This is truly the best of both worlds, and it likely is the best option in the large majority of cases. 

Part of an informed consent discussion that you should have with your physician before he or she performs any procedure is a discussion of the risks, benefits, and alternatives to the procedure you are consenting to. In addition to those benefits of highest cure rate and tissue sparing, there are associated risks as with any procedure, but your scar and risk of recurrence are likely best with Mohs. There are alternatives, and that discussion should also happen with your surgeon.

Bottom line, it's all about communicating and aligning expectations, then your surgeon can help you make a choice that's best for you. 

Spokane Dermatologic Surgeon
4.9 out of 5 stars 122 reviews

Options for treatment of basal cell carcinoma of the cheek/ lip

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I agree with my Dermatologist colleagues that Mohs is not the only option but is likely the best option. Most fellowship trained Mohs surgeons perform excellent skin cancer removal and reconstruction. Further, most know when a patient will benefit from referral to a Plastic Surgeon for repair. If your Dermatologist recommends Mohs excision, ask to look at their before and after photos. If you have concerns about the results, you can request referral to a Plastic Surgeon. However, in the vast majority of cases, your Mohs surgeon can be expected to perform very good reconstructive surgery for you. 

Stephen Weber MD, FACS
Denver Facial Plastic Surgeon

Is Mohs my only option?

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Mohs is not your only option, but it is your best option. Here's why: Mohs has a 99% cure rate. That's because the most minimal amount of tissue will be removed, slides created in office, and tested for any more cancer. If there is cancer, more tissue is taken and the steps are repeated until the slides show the cancer is gone. The issue with nodular BCCs is that they have roots, like a tree. This means that the cancer is growing underneath the skin at a more rapid pace than at the surface. Treating only the surface means the BCC will still grow under the skin, and thus, in time, it will pop up in another area. But the cancer will stretch through the whole area - from your initial nodular site, to a new site that's appeared, sometimes years in the future. This is the worst case scenario. So, we opt for Mohs because it means your surgeon can get all the pieces of affected tissue out and send you home knowing the cancer is gone, and that as much tissue as possible was preserved during the surgery. Just like anything, not all Mohs surgeons will be the same, or will have the same levels of experience. There are board-certified Mohs surgeons, and non-board certified Mohs surgeons. If I had a diagnosis like yours, I would opt to see a board-certified Mohs surgeon because I would know they went through more training, a fellowship, and had extensive surgical experience in facial anatomy and closures. And personally, I would always want to know my cancer had a 99% cure rate. That would be the most important thing of all.

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Basal Cell Carcinoma and treatment options

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You have a variety of treatment options for your basal cell carcinoma on your face. You can choose to not treat it, to use a cream, to have the lesion scraped and burned, to have the lesion surgically removed without Mohs surgery or to have Mohs surgery. With no treatment, the cancer will likely continue to grow and chew up more and more normal skin and become a larger size. The cure rates for the other treatment options all vary but Mohs surgery is considered the gold standard to treat a skin cancers because it has the highest cure rate and spares as much normal skin compared to other surgical methods. This generally leaves as minimal a scar as possible. 

I would recommend finding a fellowship trained (member of the American College of Mohs Surgery) Mohs surgeon who also have extensive training in reconstructive surgery for skin cancer defects. There are good doctors and bad doctors in every single specialty so if you are nervous about your results, make sure you see a Mohs surgeon who you feel comfortable with. Generally speaking you will have a scar but if you have reasonable expectations, the cosmetic outcomes are generally pretty good if you are good about taking care of the area afterwards. 

Good luck. 

Omar Ibrahimi, MD, PhD
Stamford Dermatologic Surgeon
4.9 out of 5 stars 28 reviews

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.