Had a lesion removed from left temple area. Dx was bcc. Recurred ~ 8 months later but smaller-about 5mm diameter. 2 schools of thought: 1. because recurred go directly to Mohs. 2. Since recurrence smaller why not a 2nd round of ed&c. Comparing these procedures would Mohs result in a larger surgical scar as it is deeper/larger surface (my assessment from photos posted) than ed&c? Is Mohs obligatory after recurrence. Why are multiple ed&c not advised if end result (bcc gone) the same. Thank you
Mohs Vs Electrodessication & Curretage for Recurrent Bcc?
Doctor Answers 6
Treatment of Recurrent Skin Cancers
A study published by Rowe and coleagues in the late 1980's examined this very issue. Their study showed that treatment of a recurrent basal cell carcinoma with EDC has about a 40% chance of recurring. Using Mohs surgery to treat a recurrent basal cell carcinoma has about a 6% chance of recurring. Mohs surgery is thought to minimize scarring after surgery and provide optimal cosmetic results. I typically recommend Mohs surgery for recurrent tumors.
Mohs when there is recurrence.
Both approaches are reasonable and the choice will ultimately be yours to make.The cure rate with retreatment with the original modality often drops to 50% or less. ( It may be slightly higher cure with superficial lesions.) Mohs offers 95% or better cure rates even with recurrent lesions. If you have access to a qualified Mohs surgeon I would strongly encourage you to take this path.
Mohs Surgery vs. Surgical Destruction of Recurrent Basal Cell Carcinoma: Treatment Options
It is possible that both would work; however, Mohs would work more often. As quoted by Doctor Mamelak, Dan Rowe and colleagues published a number of articles in the late 1980's that looked at the recurrence rate of Mohs, surgical excision, electrodesiccation and curettage and radiation therapy. I believe there were 3 articles, one on primary (not-previously-treated) basal cell carcinoma, another on recurrent basal cell carcinoma and a third on squamous cell carcinoma. The articles were a retrospective study of previous articles describing the treatment success of various modalities for these cancers.
The chance of recurrence following electrodesiccation and curettage of a recurrent basal cell carcinoma was about 40% (i.e. 60% cure rate). The chance of recurrence following Mohs surgery for a recurrent basal cell carcinoma was about 6% (i.e. 94% cure rate). Recurrent tumors may be more difficult to clear because the tumor cells could be shielded by scar tissue (reason why radiation therapy not as good for recurrent cancers) or the tumor cells could be deeper or separated by normal tissue. In the temple area a branch of the facial nerve called the temporal branch becomes very superficial in the temple. Depending on the location of your skin cancer, if the tumor continues to recur the chance of involvement or injury to this branch of the facial nerve increases.
In regards to your comment that "...Mohs result(s) in a larger surgical scar..." all I can say is that if a defect is larger than you expect after properly-performed Mohs surgery then the cancer must have been larger than expected. Mohs surgery starts with a 1-2 mm margin which is smaller than the margin recommended for standard surgical excision for basal cell or squamous cell carcinoma. If you choose Mohs surgery, I would recommend that you see a dermatologist who has completed a Mohs surgery fellowship and is a member or fellow of the American College of Mohs Surgery.
Your best option is to discuss your situation with your dermatologist and/or your Mohs surgeon and talk about your particular case. Based on your physical examination, your subtype of basal cell carcinoma, and your concerns, you and your doctor should be able to determine the best treatment for your recurrent skin cancer. Good luck.
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Treatment for recurrent basal cell cancer
I would recommend Mohs surgery for a recurrent basal cell cancer. The problem with recurrent skin cancers is that they can actually be much larger than appears on the surface. Sometimes there will be recurrent cancer growing within or underneath a scar which is not obvious on the surface. For this reason, I often remove the entire scar from the previous procedure when performing Mohs surgery on a recurrent basal cell cancer. Typically the temple heals beautifully and any scar after Mohs surgery is hardly noticeable.
Mohs is the best treatment for clearing a recurrent basal cell skin cancer
Studies show a higher clearance rate with Mohs for basal cell cancers, especially recurrent ones. in addition, your dermatologic surgeon should do a lovely repair of it afterwards giving you a much nicer scar than what would be seen after an ED&C. Best to you,
Mohs for Cancer Recurrence
Certainly Mohs will provide a higher cure rate and a better looking scar. Another reason to consider Mohs is that a careful dissection in that area may avoid the temporal nerve (unless tumor has already invaded it).
That said, basal call cancers are almost never serious and you are not dealing with a location such as on an eyelid where a recurrence would be especially problematic. So, in my office I would do either depending upon patient preference.