Alternatives to Mohs procedure?

Question

Dermatologist took a biopsy of a suspected BCC on the right side of my nose near the tip. No results as of yet. But in doing my research on the web, I see that if any extensive damage is done around the nose tip by Mohs procedure, the reconstuction will involve some very extensive forehead flap procedures. Not something I would like to undertake. Are there not alternatives, such as chemotherapy, radiotherapy, etc... that would be better for this type of area?

Stephen Weber MD, FACS · Answer

The extensive damage that can occur around the nose is not related to the Mohs technique. That results from removal of the tumor itself. The problem is not Mohs surgery. Rather, the problem is that you have a tumor that needs to be surgically removed. Mohs results in the smallest possible defect and the lowest possible recurrence rate. Radiation is an option with serious downsides and potentially extensive nasal/ facial tissue damage. This is typically recommended for people with unresectable tumors or those who have a high likelihood of not surviving tumor removal and reconstruction. The internet is a wonderful resource but it does not replace the advice of a highly trained Mohs surgeon and a facial reconstructive surgeon. They can discuss your options and make recommendations that will result in the best possible outcome for you. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Gary L. Ross, MBChB, FRCS · Answer

Yes there are options and I would consult with a plastic surgeon / dermatologist  and a radiation oncologist about the pros and cons of the different options. The problem always in making the decision is that there is no way of knowing how large the defect will be following surgical excision.

J. Charles Finn, MD · Answer

In short, no. MOHs surgery will achieve the highest cure rate with taking the least amount of tissue. i am sorry to say te damage has already been done by the cancer. Other less effective treatments will only delay treatment and give the cancer more time to grow. Don't waste time as the cancer will grow 1 mm per month. Get the Mohs done, then see an experienced reconstructive surgeon.

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