Is Mohs Surgery Overreaching for a Tiny Basal Cell Cancer?

Thank you for your question. Mohs surgery is typically reserved for squamous cell cancers and basal cell cancers (and some other more rare types of cancers as well) on the face in areas where preserving normal and unaffected tissue. I hope this helps.

Single basal cells should be biopsied and removed surgically to be sure the cancer has been completely excised.  MOHs or conventional excision depends on specific indications. If the wound is surgically closed by a plastic surgeon you will be back on the golf course  in a few days. Efudex  is used for extensive precancerous lesions and extensive superficial basal cell lesions that make surgical excision unfeasible.  The problem with treating actual basal cell cancers with Efudex is that you do not know if the cancer is gone after treatment.  Yes, there is MOHs abuse, but do not let that deter you from getting the best possible advice from your Board Certified Plastic Surgeon. Best wishes. knowledge is power.  Luis F. Villar MD FACS

There are many alternative treatments to basal cell carcinoma. Generally Mohs is reserved for poorly defined cancers on the face. Alternatives do include excision, EDC, and Aldara. You must rely on your surgeon to recommend best option for you.

Mohs is a very specialized surgery which is indicated for treatment of certain skin cancers based on their size, biologic behavior, location, and if they are in high risk areas or are already recurrent.  Alternative treatments may be appropriate for a BCC if it does not fit the guidelines.  You will need to discuss these with your dermatolgist and make an informed decision based on information received.  As much as I love 5FU for treatment of precancerous actinic keratoses I have never been inclined to encourage patients to use 5FU for BCCs unless they are very superficial and in an area where the 5FU can be used for longer periods of time and sometimes under occlusion if it is possible.

There are many good indications for Mohs surgery including recurrent skin cancers, locations on areas important for tissue preservation and at higher risk of recurrence (e.g. nose, eyelids, ears, lips), aggressive types of skin cancer (e.g. morpheaform, infiltrative basal cell carcinoma), large size, poorly defined margins, immunosuppressed patients.

Best option is to discuss with your dermatologist what is the best option for you and for your skin cancer and why. Mohs provides the highest cure rate and preserves the greatest amount of healthy tissue, but there may be other options that would be better given other factors.

Most of my patients wait about 1- 1 1/2 weeks before they go back to playing golf. Good luck.