Had Two Opinions on Basal Cell Carcinoma on Nose. Small Nose Two Not Very Visible Spots One Dr. Absolutely Reccomends Mohs Surg?

followed by plastic surgeon same day Plastic surgeon (different one) recommends Not Mohs . Takes dime size piece sends it out If OK lets it heal naturally then if plastic need do it then What should I do?

Doctor Answers 4

Surgery vs. Mohs Surgery for Skin Cancer on Nose

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In my opinion Mohs is the preferred method for removal of skin cancers on the nose. This is an area where the preservation of healthy tissue is very important. Mohs preserves the greatest amount of healthy tissue by starting with a smaller surgical margin (usually 1-2 mm vs. 3 mm or greater margins for standard excision). Then the Mohs surgeon traces out the roots of any remaining skin cancer so it's a more precise method of skin cancer removal. This is accomplished by processing the tissue so that virtually 100% of the surgical margins are evaluated. According to the scientific literature, the cure rate for Mohs surgery for a basal cell not previously treated is approximately 98.5-99% whereas for standard surgical excision the cure rate is about 92%. In my opinion it is preferable to have the procedure performed by a doctor who has completed a fellowship in Mohs surgery as this helps to assure that he/she has the training and experience to perform the procedure properly. Good luck.

Los Angeles Dermatologic Surgeon
4.8 out of 5 stars 16 reviews

Basal Cell Carcinoma on Nose

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Thank you for your question. If there is a biopsy proven cancer on the nose, then Mohs might be their right choice, depending on the size of the tumor(s) and location. For a smaller nose size, Mohs is often elected so as to reasonably clear the margins of the tumor with assurance that the tumor has been completely excised, while preserving as much normal tissue as possible. I hope this helps.

Why undergo Mohs surgery for skin cancer?

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Without question, Mohs surgery gives a patient the lowest risk of recurrence of the cancer while preserving the most normal tissue.  I would be sure that the Mohs surgeon is fellowship trained and I would consider having a different surgeon, such as a facial plastic surgeon, repair the defect once the Mohs surgeon has removed the cancer.

P. Daniel Ward, MD
Salt Lake City Facial Plastic Surgeon
4.9 out of 5 stars 50 reviews

Surgical excision vs Mohs on nose

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I agree with Dr. Kaufman. Mohs should be used in areas where the conservation of the most healthy tissue is possible, like the nose. If you have a small nose, this would be extremely important. The other physician is recommending cutting out around it - into what appears to be the healthy tissue - and removing possibly more skin than needed, just to clear the margins. The second way you could end up with a much larger area removed than necessary, and hence, a worse scar or mark. Mohs will be able to preserve as much healthy skin as possible, and remove only what is cancerous, thus, you'll have a better result and more tissue to help it heal.

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.