Non-surgical Option to Remove Basal Cell Cancer?

From the sound of your situation, I would strongly recommend Mohs surgery.  Other options, freezing, dessication and curettage, creams, ointments, are usually best for:


Precancerous conditions

Areas that are not cosmetically sensitive

In patients with poor health who are unlikely to survive longer that the cancer grows


From the sounds of things, you have a cancer blister, which implies invasive disease and the bridge of the nose is obviously cosmetically sensitive.  The Mohs procedure is specifically designed to remove the entire cancer (recurrence rates <1%) and save as much normal skin as possible.  Further, after Mohs surgery, a good reconstructive facial plastic surgeon should be able to leave you with a result that will keep you on the dating scene.  The bridge of the nose is especially forgiving and the scars virtually disappear.  I saw a patient today in whom I had repaired a Mohs defect 1 year ago.  The scars had so completely disappeared that I couldn't find where I had done the surgery, and I was the one who made the incisions  Using non-surgical treatment has a high risk of not curing the cancer and leaving you with partially treated cancer and an eventual hole that is far larger than what you would end up with if you treat it right the first time.

Some pieces of advice:


Make sure your dermatologist is Mohs fellowship trained

Make sure your reconstructive plastic surgeon is like-wise fellowship trained

Make sure your Mohs surgeon and reconstructive surgeon is NOT the same person.  When the CANCER doctor is the same as the RECONSTRUCTIVE doctor, judgment is compromised.  You can't be thinking about how you're going to fix it while you're removing it.

Although nonsurgical options such as Aldara and Radiation therapy exist, Mohs surgery remains the gold standard for treatment of any well defined skin cancer (BCCA or SCCA) on anatomically sensitive areas such as the nose, eyelids, lips, ears.  From the stand point of cosmesis and recurrence, Mohs is the better way to go.

Basal cell carcinoma (BCC) often has ill-defined borders and its true margins can sometimes fool even trained eyes of a board-certified dermatologist. Mohs Micrographic surgery remains your best bet medically and cosmetically as the tissues are examined under the microscope prior to reconstruction, ensuring least amount of healthy skin gets removed. With Mohs Micrographic surgery, you should be able to prevent potentially bigger scar down the line as the tumor is successfully eradicated at 99% cure rate versus less effective nonsurgical therapies where parts of the original BCC can be left behind and continued to grow. Nonsurgical options such as cryotherapy/freezing with liquid nitrogen, topical imiquimod (Aldara), and or radiation have significantly lower cure rate but may be considered as a last resort for an elderly patient for whom Mohs micrographic surgery is not advisable.

Basal cell cancers are easy to treat and leave almost inconspicuous scars if removed early. If the lesion is inadequately treated, it may disappear from view for months or even years growing under the skin. When it reemerges, it may require extensive excision and reconstruction. Therefore, the margins of excision the first time must guarantee adequate removal.
Basal cells can be treated with radiation, but this is generally limited to much older patients where the collateral from the radiation is not a consideration and surgery might be hard to tolerate.
Most Moh's surgeons work with a plastic surgeon if the excision ends up needing any formal reconstruction. Most reconstructions in time are almost (but not completely) invisible.

The best way to get rid of the skin cancer is to cut it out. Depeding on the size, the area can be reconstructed using adjacent skin tissue to cover the area. The scars can be put in less visible locations if possible.
Nonsurgical options, such as freezing and topical aldara and radiation, only work for certain early skin cancers and can be temporary with return of the skin cancer, only larger and deeper.
You are young and should consider removing the whole skin cancer by cutting it out (Mohs) with reconstruction.

There are many options for treating your basal cell carinoma. Mohs micrographic surgery will provide the highest cure rate for your type of skin cancer. The cure rate for a previously untreated basal cell carcinoma is approximately 98.5-99%. Mohs surgery will also take out the least amount of healthy tissue around the skin cancer since you start with very thin (i.e. 1 mm) surgical margins. If you pick Mohs surgery, I would recommend picking a fellowship-trained Mohs surgeon who is a member or fellow of the American College of Mohs Surgery. The next treatment option is surgical excision but the cure rate is not quite as high as Mohs surgery and more healthy tissue is sacrificed. The next option is curettage and electrodesiccation (scraping and burning) and again the cure rate is not as high, and frequently the cosmetic result is not as good. Aldara (imiquimod) is a topical medication that might be useful for basal cell carcinomas, and that might be a non-surgical option for you to consider. But the cure rate with Aldara is not nearly as high (probably around 85-90% long-term) either. Radiation therapy is another option. This would require approximately 16-20 treatments with radiation. Cure rate is around 90-93% long term, and while cosmetic result looks pretty good short term, over the long run the treated area tends to appear sunken and the skin thinned out. So there are plenty of options available to consider. See a good dermatologist and talk about your particular situation.

There are many options for treating basal cell carcinoma (BCC) but the cure rate varies greatly amongst these different options.  The treatment with the highest cure rate is Mohs surgery.  Some other options include curettage and dessication (aka: "scrape and burn"), standard surgical excision (taking blind margins without microscopic control--compared to Mohs you would have larger scar without knowing for sure whether the entire skin cancer was removed or not), chemotherapy agents such as Aldara (imiquimod), cryotherapy (liquid nitrogen), lasers, and radiation.  These other methods all have lower cure rates and can be riskier to attempt on the nose.  If the BCC were on the body and you chose to use Aldara, there would be a 70% chance that the Aldara would work and if it didn't, the BCC would come back and possibly bigger for which Mohs surgery would then be indicated for the recurrence.  On the back having a bigger scar may not be a big deal but on the nose it could be disastrous if the Aldara didn't work and the BCC came back even bigger.  Your best chance for the smallest scar and the highest cure rate is to have Mohs surgery from the outstart.  It's not possible to know how extensive the BCC is until it's viewed under the microscope.  There are many different options for scar revision after the intiial surgery.  I would ask the Mohs surgeon to show you before and after photos of other patients with similar skin cancers on the nose and what kind of repair was done and the final effect.

Make sure your Mohs surgeon has proper fellowship training and is registered with the American College of Mohs Surgery.  The American College of Mohs Surgery (ACMS) is the only organization that requires its members to have successfully completed an extensive one- to two-year ACMS-approved fellowship training program after they have completed their years of residency training.  Not all Mohs surgeon are good at doing their own repairs--some have more reconstructive surgery training than others.  Some Mohs surgeons do almost all their own repairs and some refer many of their repairs to plastic surgeons.  There are some Mohs surgeons who do better repairs than some plastic surgeons.  It's common for a Mohs surgeon to do simple and complex repairs including flaps and skin grafts but to refer to other specialists if the repair becomes particularly challenging (ie: involves cartilage and bone grafting, or possible invasion of the eyeball).

There are several options for treating basal cell carcinoma including freezing, curretage, aldera cream, and surgical excision (including Mohs excision). Talking with your dermatologist about your options is best. While surgical excision is has the greatest cure rate, fortunately there is time to try other treatments before proceeding to surgical excision if you are concerned.

Not every basal cell cancer needs to be treated with surgery. Depending upon the location and the histologic nature of the tumor will help your dermatologist offer you different therapeutic options. There are pros and cons to each treatment. Surgery is always the best first option. Other options include aldara cream, effudex creatm, radiation or liquid nitrogen.