BCC removal advice

I had BCC punch biopsy 6 months ago and there is no clear margin. It has been suggested that more needs to be taken and the wound left open to heal itself. Other options are a graft or flap. I do not know anyone who has had wound left to heal and no photo's to see what this will look like and how long to heal, just the surgeons opinion. Would be grateful for advice on best option. My concern is I will take this route and cancer still not clear many thanks community member.

Doctor Answers 3

Leaving a Mohs site to heal by secondary intention

You didn't state where your biopsy was done or what area we are talking about. So I will generally answer this question. Sometimes leaving a site to close on its own or "by secondary intention" is the best option. On the scalp and nose in particular your surgeon may not be able to stretch the skin there to put stitches in and close it. So the options would be a graft/flap, or secondary intention healing. In many cases secondary intention healing actually looks better than doing a graft or a flap. And there is less to heal. So your best bet is to talk to your surgeon about why secondary intention healing is being recommended for your specific BCC. Your skin cancer will be cleared by a Mohs surgery because that is part of the surgery. Your surgeon will remove small pieces of tissue, slides will be made in the office and then read, and more tissue will be taken depending on what is shown on the slides. This is why we do Mohs - to get to clear margins and remove cancer while preserving tissue.

"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."

Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

Wound Healing Following Skin Cancer Removal

There are many options for wound healing after removal of a skin cancer:
1. Allow the wound to heal by "second intention" healing. This is basically allowing the wound to heal by itself; i.e. let Mother Nature take care of the healing. In many areas including the concave areas of the temple, ears, eyes, nose and on the balding scalp or some areas on the trunk and extremities, this is a good option.
2. Side to side repair or linear closure. If the wound is small enough (i.e. closure doesn't distort), this may be a good option.
3. Flap repair. Tissue from nearby the wound is recruited or moved into the surgical defect. Basically, borrowing from a nearby area and bringing into the wound. This adds additional incisions or scars, but if well planned, the cosmetic results can be excellent.
4. Graft repair. Taking a thin piece of tissue from somewhere else (i.e. donor site), removing it and sewing it into place. Grafts only reconstruct the surface, unlike flaps which reconstruct depth as well.
Your best option is to discuss these options with your doctor. Choice of repair is dependent upon the location, depth, nearby structures, patient factors and of course the doctor's training and experience.  If you don't have confidence in the doctor, it doesn't hurt to seek a second opinion. Always best to have the doctor that you feel is "best" able to give you a superior cosmetic result actually perform your surgery. Good luck

Andrew Kaufman, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 16 reviews

Mohs surgery

Mohs surgery is indicated for poorly defined biopsy proven basal cell cancer on the face. 
I would suggest discussing with a Board Certified Dermatologist with expertise in Mohs surgery.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon
5.0 out of 5 stars 4 reviews

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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.