I would like to know if I am just prolonging having MOHS surgery by using zyclara for 6 weeks? (photo)

I was diagnosed with basal cell precancerous after a biopsy in 2014. I was given a cream to use on it but it never fully healed. During the last year and a half I have been on a roller coaster with my health.Today when I went back to the dermatologist he says he is pretty sure it has turned into cancer but because I was so anxious he said we would try the cream for 6 weeks. The first biopsy was very painful so if I have to get MOHS surgery is there anything they can give you to lessen the pain?

Doctor Answers 3

Basal Cell Carcinoma

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I would suggest going to the doctor who did the original biopsy and getting clarification on your diagnosis. Basal Cell IS skin cancer, it is NOT precancerous. As you stated the nose is very sensitive. I normally have my patients take something for pain and/or an antianxiety medication by mouth prior to my injections them to numb them up on the nose. Ice can also be applied to the area prior to injections. After the injections, patients normally only feel a little pressure or pulling, but nothing painful. I would also suggest that you see a facial plastic surgeon to close the site if further surgery is required. They have specialized training that will help give you the best scarring possible.  From the picture you included the site appears to have gotten rather large, Please don't let this go any longer than absolutely necessary. Best of Luck

New Orleans Facial Plastic Surgeon

Do I need Mohs?

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I'm not sure why your biopsy would have been very painful. The site should have been numbed prior and you would have felt next to nothing. Are you just so anxious and get such anxiety that causes you the pain? Or was it post procedure healing pain? It's hard to say without having a proper current biopsy to say if you need Mohs or not. Zyclara can work for actinic keratosis and very superficial BCCs, but not if the site is deeper. Only a new biopsy can confirm proper diagnosis and then you can go from there with the right procedure for you. I'd recommend that you get proper diagnosis so you can proceed accordingly. Best wishes. "This answer is for advice only and should not be taken as medical diagnosis. Please see a trained professional for an in-person examination and treatment options."

James Q. Del Rosso, DO
Las Vegas Dermatologic Surgeon

Biopsy question...

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It is somewhat difficult to answer exactly without knowing the precise biopsy result.  You mentioned "basal cell precancerous" - this is not an accurate term, although I assume that this implies actinic keratosis, which is indeed a precancerous lesion.  Zyclara is useful for actinic keratosis and for superficial basal cell carcinomas; however, as you suggest, it does sound like if has not healed yet that there may be more to it.  Mohs surgery and radiation therapy are the two primary methods to treat this.  Each has its pros and cons and there are factors that push us to recommend one over the other.  A repeat biopsy will provide the most information and allow the best decision to be made.  It may mean Mohs surgery but it could also mean that you don't need surgery.  As for the pain of the injection, there are methods to help but I suggest you discuss this with the individual performing the biopsy.  It may be possible to take an oral medication prior to the biopsy to help so long as your physician is aware and you have someone else driving you.  There are also tricks to helping it hurt less such as holding an ice cube on the site for 10-20 seconds.

Joshua E. Lane, MD, MBA
Columbus Dermatologic Surgeon

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.