BCC on Side of Nose - Mohs or Laser Removal?

You have two indications to treat your Basal cell carcinoma with Mohs micrographic surgery. One is the location.  The nose is an area in which basal cell carcinoma is more apt to recur after standard therapies, such as scraping and burning (curettage and electrodesiccation), freezing with liquid nitrogen (cryotherapy), laser treatment of photosensitized skin (photodynamic therapy) or burning it with laser (laser ablation), excisional surgery which requires a 4 millimeter margin to get a 96 percent chance of cure may remove too much or too little while Mohs surgery starts with a 1 millimeter margin and continues to trace out the extent of the tumor based on microscopic evidence of its location and has greater than a 99 percent chance of cure with primary (not recurrent) basal cell carcinomas while providing the greatest tissue conservation (not removing unnecessary good skin).  You are too  young to consider radiation therapy as the treatment might cause a worse squamous cell carcinoma twenty years later. Mohs surgery does not mean no scar. It means tissue conservation with the greatest cure rate and at your young age you deserve what Mohs offers.  Reconstruction can create a very aesthetically-pleasing scar most of the time and there are treatments, including laser resurfacing, laser for redness, massage exercise and special dressings that can help the scar improve in appearance over time. If you had laser treatment to avoid a scar, you would get a shiny patch, maybe even indented, permanently from the laser and if the skin cancer is not fully treated it would be growing underneath for possibly several years and when it would clinically recur, it would be much larger than now, leaving you with a possible bad cosmetic result. Basal cell carcinoma does not metastasize, or spread, to other body parts via the lymphatic vessels or blood circulation, but it can invade the local neighborhood by direct extension and create problems internally over a decade of persistent growth despite having multiple non-invasive and non-curable treatments.

Mohs surgery is your best option. You are very young and this was caused by sun exposure you had when you were younger.  You must wear a good sunscreen, ultraviolet A and B protection, and avoid sunburns because today's sun exposure weakens your skin's immune system's ability to fight off the DNA damage (from years ago of sun damage) that is trying to grow a cancer today. You may have less than a one percent chance of having this skin cancer recur on your nose if you elect to have Mohs micrographic surgery, but there is a 33% to 50% chance of having a new primary skin cancer on sun exposed skin in the next five years. See a dermatologist every six months, at least, to have your sun exposed skin examined, and the non sunexposed skin should be checked every year.  In between appointments with your doctor, you should examine yourself every month with two mirrors to see your back  and the posterior view of your legs and if there are new spots they should be checked prior to your next appointment. Furthermore if you have a new spot that bleeds, or looks irregular have that checked. New skin cancers may look red, white, brown, flat or raised.

At your young age practice Safe Sun.  Be outside early or late, not midday if you can avoid it.  Wear a hat, long sleeves, sunscreen (but remember to take your vitamin D3 [at least 1000 IU per day] as you won't make the vitamin D in your skin from sun exposure any longer).

It is often tempting to consider non surgical options for treating skin cancer. However, mohs surgery is clearly the winner here. The most important thing you can do is to remove the bcc in its entirety the first time... and mohs is the best and most conservative way to do that.

Basal cell carcinoma is the most common form of skin cancer.  While it typically does not spread to another part of the body, it can be locally destructive.  A Mohs procedure is the treatment of choice to ensure that all of the abnormal cells are removed.  With laser treatment, it is not possible to be sure that the skin cancer has been completely eradicated.

With the Mohs Surgery, your surgeon provides the most precise method for removal of the cancerous tissue, while sparing the greatest amount of healthy tissue. For this reason, the Mohs surgery may result in a significantly smaller surgical defect and less noticeable scarring, as compared to other methods of skin cancer treatment. I recommend the Mohs Surgery for the removal of skin cancer in areas where maximum preservation of healthy tissue is desirable for cosmetic and functional purposes, such as the face.I may also recommend the Mohs Surgery for lesions that have recurred following prior treatment, or for lesions which have the greatest likelihood of recurrence.

• Mohs micrographic surgery is the most effective and state-of-the-art procedure for skin cancer today, which offers the highest potential for recovery - even if the skin cancer has been previously treated by another method and recurred. Select from the following pages to learn more.

• Mohs surgery has the highest success rate of all treatments for skin cancer - up to 99 percent. The Mohs technique is also the treatment of choice for cancers of the face and other sensitive areas as it relies on the accuracy of a microscopic surgical procedure to trace the edges of the cancer and ensure complete removal of all tumors down to the roots during the initial surgery.

Mohs surgery would be the treatment of choice for skin cancer on the nose. I would recommend this procedure over any other initially.

Basal cell carcinomas are very common the nose. The treatment of choice would be Mohs micrographic surgery, giving you the highest cure rate. Most Mohs surgeons are trained in reconstruction, and if you needed, will send you to a plastic surgeon for closure of the defect/hole. The end result would be removal of the tumor, with sparing of the normal tissue.

There are many different ways of treating a BCC, depending on the type. If it is very small and superficial BCC then Aldara might be a great option, giving the fact that you understand that the cure rate is not 100% and recurrence may occur. Mohs is the gold standard but will leave a scar. It has the highest cure rate of 98 percent. Mohs, if performed correctly, will not spread the cells through the blood stream.  In fact, the point of Mohs is to make sure that you get the entire skin cancer so that none is remaining in the body, decreasing the risk if local and distant metastasis. Also, BCC for the most part is a localized skin cancer and rarely does it metastasize. Other options do include using a CO2 laser for the BCC, however this might leave a worst scar than all the treatments above. So, I would first figure out if its superficial BCC or nodular BCC, and then talk about the options, cure rates, potential of scarring with your dermatologist. Hope this helps. Dr Behnam.

Choosing a treatment for basal cell carcinoma (BCC) involves balancing the cure rate, and expected cosmetic result.  For example creams (such as Aldara) can cure some superficial BCC with a cure rate of 75-80% in some cases.  Because recurrent BCC can be much more difficult to treat, many people usually favor the approach with the highest cure rate which for your tumor would be Mohs surgery.  Your consulting Mohs/dermatologist can give you some idea of what the surgery is likely to involve and what the reconstruction might entail to help you decide.

There are no lasers approved by the FDA for the treatment of basal cell carcinoma.  Photodynamic therapy in which a medicine is applied followed by exposure to a special light (usually not a laser) is available and can cure some superficial BCC.  It is not approved for this use by the FDA and has the same issue as Aldara with respect to lower cure rates.

This is a good discussion to have with your dermatologist to review the specifics of your case....

Firstly, all basal cell carcinomas are not the same. There are different types, which would change the options available for treatment. For example a morpheaform or sclerosing basal cell carcinoma warrants Mohs' Surgery, while a superficial basal cell carcinoma "could" be treated with Aldara.  I recommend getting a consultation to discuss your treatment options that are precise to you and your cancer. If you ask a surgeon for his/her advise, most likely surgery will be recommended. If you ask an opinion from a non-surgeon , a minor procedure may be recommended. That being said, it is important to get your advise from a trustworthy source.

First off, performing Mohs surgery or a biopsy or any type of surgery to your skin cancer is not going to spread it through your body. So don't be concerned about that...

Second, Mohs surgery provides the highest cure rate and preserves the greatest amount of normal or healthy tissue. Both of these are very good considerations when you're thinking about treating a skin cancer on the nose. Laser ablation of superficial skin cancers may be fairly good, but you won't be able to examine the tissue to assure that all of the tumor is gone.

Third, in my opinion I would pick a Mohs surgeon who has completed a fellowship in Mohs surgery after their dermatology residency. So ask your dermatologist who would be the best mohs surgeon in your area to treat and repair the skin cancer on your nose.