What Should I Ask About Nodular BCC on my Ala?

I have a nodular basal cell carcinoma (BCC) on my nasal ala. It is 5mm across and primarily flat. I will be having Mohs surgery in a couple weeks to remove it. I am a 46-year-old woman, and this is my third BCC The last one was diagnosed 7 years ago. I've had one on my back and one on my shoulder. I am concerned about reconstruction and would like to know what questions you might recommend that I ask my surgeon about it. Thanks!

Doctor Answers 7

Nodular BCC and Mohs Surgery

One way to help gauge whether your Mohs surgeon does good reconstructive work is to ask for before and after photographs. You can ask your surgeon how long he or she has been performing Mohs surgery reconstruction.

The reconstructive options depend on the size of your final surgical defect and whether or not the underlying cartilage is involved. Your surgeon may or may not perform all of the reconstruction procedures him/herself. More frequently, however, for more complicated repairs, your surgeon may coordinate with a facial plastic surgeon. The question really becomes, do you trust your surgeon to make decision based on your best interest. I would express all of your concerns to your surgeon who would almost certainly want to know.

Good luck.

San Diego Dermatologist
5.0 out of 5 stars 5 reviews

Mohs surgery on the nose

It is very difficult to choose a surgeon. First, you want to find someone who does a lot of Mohs' Surgery--the method of tumor removal. It may be best to choose someone who had training specifically in Mohs' (i.e. a one-year fellowship). Regarding reconstruction, sometimes no reconstruction is best. A good Mohs' surgeon is not always a great reconstructive surgeon and a great cosmetic Plastic Surgeon is not always a great reconstructive surgeon. As with any surgeon, you may find 5 patients who love the doctor and 2 that did not like their experience. Photos are great, but they do not tell the whole story. They showcase the "best" results. What about the not so great results.

Robert S. Bader, MD
Boca Raton Dermatologic Surgeon
5.0 out of 5 stars 3 reviews

Find a Doctor that You Trust

The best advice I can give you regarding the reconstruction is to find a doctor that you trust. Nobody can say what type of repair is best because nobody knows how large, how deep or what shape your skin cancer will be. Talk to the doctor about their experience and training and pick the doctor that you feel will give you the best cosmetic and functional result the first time. Fellowship training in Mohs surgery or plastic surgery are good qualifications but beyond that you need to feel comfortable with your specific doctor.

Andrew Kaufman, MD
Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 16 reviews

You might also like...

Mohs on the nose

If you have a fellowship-trained Mohs surgeron they will be experts in removing the cancer and reconstructing the area.  If you are still concerned after verifying their credentials, you should ask for before and after pictures to see what their work looks like. In general, if they were trained in a one year fellowship for Mohs surgery, they are required to be experienced in this area and should be able to do the work you need in the outpatient setting with local anesthesia and in one day. 

Shawn Allen, MD
Boulder Dermatologist
5.0 out of 5 stars 1 review

Basal cell carcinoma on the nose

The best treatment for basal cell carcinoma on the ala of the nose is mohs surgery. This is because Mohs will enable the surgeon to conserve tissue, confirm removal and give you the highest cure rate. Another option not as effective for small basal cells in cosmetically sensitive areas would be Aldara cream.

In general small lesions that undergo Mohs surgery often heal great with no repair, in other words, secondary intention healing. I prefer this to any repair given the natural result. However, ultimately the size of the hole after surgery will determin if you are a candidate for that. If you are concerned with the possible scar then you should also discuss the options of plastic surgery for closure.

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

Basal cell carcinoma of nose

I'm assuming  that this is a histolological diagnosis in addition to the clinical diagnosis(I can't see a biopsy site in your pic). This is a difficult  3-dimensional defect to reconstruct without leaving a bridge or web, and is usually dealt with by a plastic surgeon working with the Mohs surgeon.

Barry H. Dolich, MD (Retired)
Bronx Plastic Surgeon
4.0 out of 5 stars 1 review

Leave It Up To The Mohs Surgeon

Mohs surgery is the most effective means of removilng a basal cell, especially in potentially tricky spots such as where yours has planted itself.

I would leave it up to your Mohs surgeon. If it turns out that if your basal cell is not that extensive, he or she should be able to perform the repair quite easily. Otherwise and the talents of a plastic surgeon are required, then your Mohs surgeon would know which plastic surgeon would have the best expertise in that area.

One other piece of advice. Do not be alarmed who this looks immediately afterwards, or even weeks afterwards. I have seen numerous cases where the cosmetic result looked terrible for weeks but eventually the patient had a supurb cosmetic result.

Good luck.

Arnold R. Oppenheim, MD
Virginia Beach Dermatologist
4.7 out of 5 stars 14 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.