How can I find a doc who can give a good cosmetic result for excising a 2mm basal cell cancer from the neck? (Photo)

I expect a scar. Neck doesn't qualify for MOHS. [doc is certified for MOHs.] I told Dr. I don't want a cosmetic result like my leg, [ dented with cross hatch marks] on my neck. Dr. said the area would look like my leg . Dr. had months earlier removed a 5mm. dysplastic nevus on the back of my calf - the scar has folds of skin at one end. It also has the cross marks. I am asking for a cosmetically acceptable result. Dr. says, "no".

Doctor Answers 4

Good result from basal cell excision on neck

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First, you shouldn't have cross hatches anywhere unless your stitches were left in far too long, or were put in too tight and pulled. Of course Mohs can be done on the neck - this is perfectly acceptable; however, a good excision can also be done. You should not expect a poor result and you might just want to find another doctor. The answer you were given is ridiculous. Of course you can and should expect it to look good!

"This answer has been solicited without seeing this patient and cannot be held as true medical advice, but only opinion. Seek in-person treatment with a trained medical professional for appropriate care."

Excision and repair two different procedures

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The ideal way to treat a poorly defined tumor of the face is mohs surgery. The defect may be closed by the Mohs surgeon, depending on their level of expertise, or a Plastic Surgeon.

Either way a scar is likely.
And this may vary by practitioner, I would suggest discussing with a Board Certified Dermatologist with expertise in Mohs surgery.

Steven Hacker, MD
West Palm Beach Dermatologic Surgeon

It is "appropriate" to do Mohs on the neck for BCC

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In general, the best cosmetic result (and highest cure rate) would be from Mohs followed by reconstruction.

It is considered appropriate by most any standard (including Medicare and most insurances) to perform Mohs on cosmetically sensitive areas (face, scalp, neck, hands, feet, etc).  

The reconstruction should be done by somebody who does a lot of skin cancer reconstructions.  In general for a BCC on the neck, this would be a dermatologic surgeon or plastic surgeon or ENT (head and neck) surgeon.  

A cosmetically acceptable result, with some sort of a scar which should be inconspicuous, is a realistic expectation.  It may be time for another consultation.

Best, Dr McNeill

Anne Marie McNeill, MD, PhD
Newport Beach Dermatologic Surgeon
5.0 out of 5 stars 1 review

Basal cell carcinoma and treatment

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What does certified for Mohs mean? I would ask your doctor if they are a member of the American College of Mohs Surgery. That means they have formal training in Mohs surgery through a approved fellowship. There are doctors who belong to the Mohs Society who DO NOT have formal fellowship training in Mohs. In my opinion there is a big difference between those who do formal training with 1-2 years of fellowship training and those who do the procedure with a weekend course and minor exposure during residency. If you see someone who does a lot of skin cancer surgery and has a focus of cosmetic procedures, you can feel comfortable they are comfortable treating the lesion and are cosmetically sensitive to maximizing the end aesthetic result. 

Omar Ibrahimi, MD, PhD
Stamford Dermatologic Surgeon
4.9 out of 5 stars 28 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.