Is It Too Early to Get MOHS Surgery?

I have two very small (size of a pinhead) squamous cell carcinomas on my face. The biopsy report was conclusive for both areas but the details noted that the cells were in a very small area and neither area is visible to the eye, since the biopsy removed the surface scaly skin. Is it too early to get MOHS surgery? I figure why wait at all if in fact the cancer cells will do nothing but multiply.

Doctor Answers 6

Mohs for Small Skin Cancers

I suppose that you could treat them with Mohs surgery, but there may be many other options that will cure your skin cancers. If they are as small as you describe, they may be easily treated by cryotherapy or curettage/electrodesiccation or topical creams like imiquimod or 5-fluorouracil. Best option is to talk to your dermatologist and discuss the various treatment options.

Mohs surgery is best for recurrent skin cancers or skin cancers that are large (e.g. about 1.5 cm on the head/neck or 2.0 cm on the trunk or extremities). It is also useful for skin cancers located where there is a higher rate of recurrence or where it is necessary to preserve as much healthy tissue as possible (e.g. eyelids, ears, lips, nose, digits, genitalia). Mohs is also good for skin cancers whose borders are very poorly defined or agressive types of skin cancer (e.g. morpheaform or infiltrative or sclerosing basal cell carcinomas or for acantholytic or poorly differentiated squamous cell carcinomas).

Talk to your dermatologist about what is the best choice for you. Good luck.

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 16 reviews

Squamous cell carcinoma requires surgery

I'm sorry you have been diagnosed with two skin cancers.  The biopsy tells you the diagnosis but does not tell you how deep the cancer resides nor how wide it is.  While the biopsy site may appear to have fully healed, there certainly could and likely are remaining cancerous cells that will continue to grow if left untreated. 

Treatment of squamous cell cancer of the face is ideally done with an excision or Mohs surgery.  Mohs surgery would be appropriate if you are young (under 40), immune suppressed, if the location is in a high-risk area (such as the lip, ears, nose, eyes), or if the tumor is aggressive.  I would not wait for treatment as squamous cell carcinoma can spread if left untreated. 

I hope your surgery goes well. 

Laurie Jacobson, MD
Seattle Dermatologist
4.7 out of 5 stars 11 reviews

MOHS Surgery

When choosing a surgeon to perform your Mohs surgery, trust your face to a Board Certified Facial Plastic Surgeon specialist who is uniquely trained and expertly qualified to perform the Mohs Surgery.  It is important that the Surgeon you choose understands the importance of removing a cancerous tumor while maintaining both the integrity and cosmetic appearance of the healthy tissue and skin. The most precise method for removal of the cancerous tissue spares the greatest amount of healthy tissue. For this reason, the Mohs surgery may result in a significantly smaller surgical defect and less noticeable scarring, as compared to other methods of skin cancer treatment. Talk to your Facial Plastic Surgeon to assess whether Mohs Surgery is the most appropriate treatment option for your particular diagnosis. Best of Luck!  Dr. Clevens

Ross A. Clevens, MD
Melbourne Facial Plastic Surgeon
4.7 out of 5 stars 117 reviews

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Mohs surgery for small cancers

It is not unusual for the biopsy to remove the surface tumor yet there still remains significant tumor under the skin. In this case, Mohs would be ideal.  I would suggest you have your dermatologist help you make this decision.

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

Pinhead sized SCC

It is not uncommon for the actual size of the skin cancer to be significantly larger than what may appear to you.  The analogy "tip of the iceberg" applies. 

Sam Naficy, MD, FACS
Seattle Facial Plastic Surgeon
4.7 out of 5 stars 221 reviews

Did your physician recommend Mohs surgery?

I'm a bit confused by your question, because this really isn't a procedure to undergo unless your physician feels it's necessary... did your physician recommend Mohs and you aren't sure you want to do it? Or are you thinking you need the procedure simply because your result came back as an SCC? Thus, my answer is this: talk to your physician. Depending on exactly what your biopsy report says, it may mean you need Mohs because the site, or sites, are showing roots under the surface. Or your sites may be able to simply be scrapped with a curette and resolve on their own. Unless your physician said you need Mohs, I wouldn't be trying to decide that on your own. 

F. Victor Rueckl, MD
Las Vegas Dermatologist
4.6 out of 5 stars 17 reviews

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.