Basal Cell On Hairline?

Thank you for your question. Either a Mohs Micrographic Surgeon or a Plastic Surgeon is the correct choice to handle this. The difference is that the Mohs surgeon is able to check the margins while you are still in the office and prior to closure of the defect, while a plastic surgeon will have to again send out the slides and wait until the pathologist reads them to see if the wound margins are indeed clear of tumor. This said, either kind of surgeon would be a correct choice. I hope this helps.

It may not be a bad idea to have a plastic surgeon complete the excision and perform layered closure of the scar. Raffy Karamanoukian Los Angeles

I would recommend Mohs surgery by a Mohs  trained dermatologic surgeon done in an outpatient setting under local anesthesia.  Mohs surgeons are well trained in skin cancer surgery on the face and would be very capable to perform the surgery and repair of the area. Mohs surgery is the gold standard for skin cancer removal in this area and would give you the highest cure rate and smallest surgical defect possible. Best Wishes.

Did the doctor perform 3 different biopsies on the same site for sampling or did you already have an excision done?  In either situation, you would want Mohs surgery at least for the removal of the tumor, but especially if the tumor has already been excised and had positive margins.  The benefit to Mohs is two-fold--you will save the most healthy tissue as the surgery is targeted to the cancer only AND you will have the highest cure rate. For the reconstruction of the 'defect', or what is left at the surgical site after the tumor has been removed, either the Mohs doctor or a plastic surgeon can do it.  Do see a member of the American College of Mohs surgery for your treatment so you know you are in expert hands. The good news is this is completely treatable. 

In my opinion your best chance of removing this cancer, getting the highest cure rate and preserving the greatest amount of healthy tissue is to have the skin cancer treated by Mohs surgery. You already had it excised once, and the surgical margins are positive. You might have the same result if the cancer is re-excised without the Mohs surgery. This technique (Mohs surgery) traces out the roots of the cancer so there is no chance that the surgical margins will be involved when the wound is repaired. I'm not sure why the Mohs surgery would be performed in the hospital. Generally, Mohs surgery is done in the doctor's office. In Mohs surgery one person acts as both surgeon and pathologist. If either of those duties is delegated to another doctor, it is not Mohs surgery. My recommendation for Mohs surgery is that you have a Fellow of American College of Mohs Surgery perform your procedure. Fellows of this College have completed an additional 1-2 year fellowship in Mohs surgery and therefore are well trained and experienced in the procedure. The repair can be performed by whomever you wish. You could have the Mohs surgeon perform the repair, or if you prefer, you could have a plastic surgeon do the repair. Good luck.

In my opinion the most appropriate treatment for a basal cell carcinoma on the hairline that has been cut out and still has positive margins is Mohs surgery. Mohs surgery is best performed by a dermatologist who has completed a Mohs and reconstructive surgery fellowship and is a member of the American College of Mohs surgery. With Mohs surgery, the pathology is done live so there is an immediate answer and skin cancer can be removed without removing too much normal skin. Plastic surgeons do not have the formal training in reading slides to perform Mohs surgery, so while they are experts at many different things, Mohs surgery is not one of them.