Just Diagnosed with BCC with Morpheaform Features, on Nose, HELP

Question

After having a biopsy was diagnosed with BCC with morpheaform features on the side almost tip of my nose. Please help....one plastic surgeon traumatized me with his rendition of cartilage from the ear and/or nose to fix. Another said 75% time a bilobed flap would fix, extremely anxious over possibility of forehead flap and scarring...any scarring scares me drastically. Surgeons I am scheduled to see in 4 weeks is a mohs surgeon from John Hopkins, and the plastics is also from Hopkins.

Laurie Jacobson, MD · Answer

You are in good hands and have chosen a fine institution for your surgery.  With a Mohs surgeon, you will know at the end of your surgery day that the tumor has been completely and thoroughly removed which is of utmost importance. 

	It is too soon to know what type of reconstruction is best suited to you since we don't know what the size or shape of the defect will be until after your cancer removal is complete.  Potential reconstruction options for the tip of the nose include various flaps (rotating tissue surgically from adjacent skin to cover the defect) or grafts (borrowing skin from one part of the face to cover the defect).  Also know that any reconstruction scar can be finessed later with lasers, dermabrasion or injection with steroids if needed for cosmetic improvement.

Andrew Kaufman, MD · Answer

Mohs surgery is going to give you the highest cure rate for a basal cell carcinoma. According to the scientific literature, the cure rate for Mohs surgery is 98.5-99% for a basal cell carcinoma not previously treated. If the skin cancer has been previously treated, the cure rate for Mohs surgery is 95%... both of these scenarios is much better than other forms of treatment. In addition, Mohs surgery preserves the greatest amount of healthy tissue because the surgical margins start out smaller than conventional surgery and the roots of the skin cancer are subsequently traced out. In my opinion it is best to pick a member or fellow of the American College of Mohs Surgery. (As point of full disclosure, I am a member of the American College of Mohs Surgery). These individuals have completed a 1-2 year fellowship in Mohs surgery after their residency. This additional training and experience is frequently helpful when dealing with difficult skin cancers on the nose, eyelids, ears, etc. Regarding the repair... I would not predict how to repair the defect until I know what size, shape and depth the defect is, and we won't know that until after the Mohs surgery. Best option is to have a doctor who performs a lot of nasal reconstruction perform yours. Many fellowship-trained Mohs surgeons have extensive experience in nasal reconstruction; another option is a plastic surgeon again so long as they have a great deal of nasal reconstruction experience. Talk to the doctors to make your decision and good luck.

J. Charles Finn, MD · Answer

The first priority for you is to cure the cancer - and Mohs surgery is the way to go without a doubt. Guessing what reconstruction you need is premature until your surgeon knows exactly what is missing. You are in a tough situation, but you are in good hands. Trust your surgeon to give you your options. Depending on the size of the defect, both bilobe flap and forehead flap can give excellent results. Realize that reconstruction is a process that may take a few steps for the best final result. Good luck!

Robert M. Jensen, MD (retired) · Answer

It sounds like you are doing everything right and seeing the correct people to help you with your cancer. Moh's surgery is by far the best way to give you the highest cure rate, it will remove the least amount of tissue to give clear margins. It really depends on the amount of tissue removed that will determine the most appropriate reconstruction. Bilobed flaps have excellent cosmetic results , and forehead flaps are rarely needed. Skin grafts to the nose when placed to cover a cosmetic unit also have excellent cosmetic results. Most plastic surgeons, especially those who do a lot of skin cancer work are very good at what they do.

Just Diagnosed with BCC with Morpheaform Features, on Nose, HELP

Answers (4)

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