Trying to Decide Between RDT and MOHs Surgery for Basal Cell Morphea on Right Ala?

When you have a basal cell carcinoma on the nose especially one that is morpheaform. I would mostly advocate for Mohs surgery unless you are a poor surgical candidate. Here are the reasons why: 1. Radiation therapy can cause DNA damage and result in more skin cancers down the line. If you were 100 years old that might not be an issue but if you plan to live another 20+ years then that is an important thing to consider is that you may develop additional cancers in the radiation field. 2. Morpheaform basal cells are aggressive and Mohs surgery is the gold standard to treat them. You want to do the procedure that has the best cure rate the first time around, if this recurs, it can turn into a much larger procedure.  3. Mohs surgery is less time intensive and more cost effective than radiation therapy.

As far as scarring, yes you would have a scar from Mohs surgery, regardless of who does the reconstruction. Fellowship trained Mohs surgeons who belong to the American College of Mohs surgery are trained in the reconstruction aspect and perform more facial reconstruction for skin cancer defects than any other specialty, including plastic surgery. 

Good luck with your treatment. Make sure you followup with a good dermatologist for regular skin checks afterwards. 

I agree with Dr. Ibrahimi.  If you were in your late 80's or 90's I would probably suggest radiation therapy, however at your age you need a more definitive treatment. Alar reconstruction isn't that hard in the hands of someone who knows what they're doing.  The hard part is finding the right surgeon.