Moh's Surgery or Blue Light to Treat Basal Cell Carcenoma?

I agree with my colleagues that Mohs excision will be your most effective option for complete removal of your basal cell carcinoma. This also will have the lowest rate of recurrence which is important given your history of recurrent facial skin cancers. Your Dermatologist alone or working with a Facial Plastic Surgeon should be able to give you a relatively aesthetic closure of your facial skin cancer defects. I hope this information is helpful.Stephen Weber MD, FACS

Moh's surgery is the gold standard treatment for most types of skin cancers, including basal cell and squamous cell carcinomas.  It usually involves a trained dermatologist whereby the lesion is removed layer by layer, with confirmation under microscope in the same setting, to insure its complete removal while preserving the greatest normal tissue possible.  The reconstructive surgeon then will reconstruct the hole/defect in the tissue.  It is the most effective treatment method.

Blue light photodynamic therapy can be used to treat superficial basal cell carcinomas. For other types of basal cell carcinoma, the results are not nearly as good. In addition, this treatment is not commonly used in the United States for the treatment of basal cell carcinoma.

Although there are multiple types of treatments for different kinds of skin cancers surgical excision is still the mainstay of treatment for most skin cancers. Being that said every patient is different and it would be very difficult for me to advise you against blue light therapy without knowing the full story. Like I stated, surgery is still the mainstay of therapy but you should discuss other options with your MOHS surgeon.

Mohs micrographic surgery is the treatment of choice for recurrent basal cell carcinoma. According to prior data in the scientific literature, the cure rate for Mohs surgery for a recurrent basal cell carcinoma is approximately 95%, which is much higher than the cure rates with surgical excision, curettage and electrodesiccation, and radiation therapy.

Levulan and blue light would not be a good option for treatment of a recurrent basal cell carcinoma. While this procedure might be a good alternative for selected cases of actinic keratoses, I would recommend Mohs for recurrent basal cell carcinomas as well as basal cell carcinomas on the nose/eyelids/lips/ears and poorly defined basal cell carcinomas and agressive types of basal cell carcinoma (e.g. perineural, infiltrative, sclerosing, metatypical).

Best plan is to meet with your doctor; discuss your options and choose an appropriate treatment. Good luck.

Mohs surgery is considered the gold standard for treating skin cancers, such as basal cell carcinoma, because it provides the highest cure rates, lowest recurrence, spares healthy tissue, and minimizes scarring. This is why Mohs is often recommended when skin cancers develop on the face. Having said that, a minimal scar is still a scar, and it is not the only way to treat these cancers. Blue light ALA photodynamic therapy has been used to treat basal cell carcinoma. In general, the best results were obtained when it was used to treat small and superficial tumors. One study showed that Blue light treatment of basal cell carcinoma failed in 25% of cases. This is compared to Mohs which has a less than 1% recurrence rate. In my own practice, I use Blue Light to treat precancerous lesions and Mohs to treat skin cancers on the nose and other sensitive areas. If you have already had 4 skin cancers, you might still benefit from Blue Light for its preventative benefits. I recommend speaking to your dermatologist about these different options.

Blue Light is not my treatment of choice for nodular basal cell carcinomas; the light does not penetrate deeply enough to get nodular BCCs.  In low risk areas (like the trunk and extremities), Blue light may be acceptable for superficial basal cell carcinoma.  Blue light in my opinion is never indicated for recurrent BCCs (as is the case on your nose).    Furthermore, I would not do Blue light for the BCC on your forehead.  The cure rate is nowhere close to that of Mohs (which is 99% for primary tumors).

 

In terms of scarring, make sure that you go to a fellowship-trained Mohs surgeon.  These individuals are extensively trained in reconstruction.  Although you will develop a scar, a fellowship-trained Mohs surgeon should be able to keep this to a minimum.  

The simple answer is: Mohs. While blue light levulan therapy can be great, it's only good for superficial lesions. If you have recurrent BCCs, you need to undergo a surgical procedure - Mohs - to fully remove it. Otherwise you will only remove the superficial portion of the cancer, and the roots, which are causing the recurrences, will still be there.