I have a basel cell infiltrative carcinoma on the bridge to side of the nose. I am 75 yr.

Thanks for the
question. This is one of the more common and more difficult problems that we,
as dermatologic surgeons face on an almost daily basis. You have the most
common of skin cancers and that is the good part; the fact that it is
infiltrative makes things a little more complicated. While Moh’s surgery is the
best option to remove the cancer itself, it is the repair that makes the
procedure more difficult and something you are trying to avoid. Moh’s surgeons
can allow the wound to heal by itself – we call that secondary intention – this
will take time and the cosmetic results with this is variable. Or perhaps they
can devise a different closure that would avoid a large flap – this you can
discuss with your surgeon.



You can also opt for
radiation therapy although this is not done too much these days but still an
option. And one more thing – some are using photodynamic therapy – the use of a
photosensitizer and light – to treat this. While this is not FDA approved in
the US for this indication, there are many reports of topically applied PDT or
intralesional use of PDT to treat skin cancers – although infiltrative basal
cells are not the best responders here.



So Moh’s is your best option – and hopefully you will have
a non-eventful post-operative recovery period.

This is an extremely common problem. Basal cell carcinoma is the most common form of skin cancer. The nose is an extremely common location, due to the amount of sun exposure one gets there. There are several types of basal cell carcinoma. The infiltrative type grows as little fingers that weave between the collagen fibers. Therefore, treatment can be difficult. Mohs' Surgery would be the best option for removing this tumor, with the least risk of recurrence. Alternatively, radiation could be considered, although this would be slightly inferior in terms of recurrence rate.As far as reconstruction goes, there are always options. Typically, forehead flaps are used for very large tumors that are on the lower part of the nose (the tip). Use of this flap on the bridge is not common. There are always other options, including local flaps, skin grafts, and the option to let it heal in by itself. I recommend that you discuss all of these options with your surgeon, or get a second opinion regarding the reconstruction after Mohs'.