I have been DX with basal cell on my nose and current dermatologist recommending MOHS. I am concerned about cosmetic result. Photo is 6 days post biopsy - can beam be localized or would I lose the mustache?
Answer: IG-SRT for Basal Cell Carcinoma on Nose Hi there! IG-SRT is definitely a treatment option for the Basal Cell Carcinoma located on your nose, however, it would be best practice to consult with your local dermatologist to see if that would be the best treatment option. Your concerns of a scar are very valid, but depending on the skill level of the treatment provider the scar can be minimized. Both IG-SRT and Moh's surgery both have around a 99.3% cure rate, discuss this with your dermatologist of choice to make sure that you make the best decision for yourself! Best of luck!
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Answer: IG-SRT for Basal Cell Carcinoma on Nose Hi there! IG-SRT is definitely a treatment option for the Basal Cell Carcinoma located on your nose, however, it would be best practice to consult with your local dermatologist to see if that would be the best treatment option. Your concerns of a scar are very valid, but depending on the skill level of the treatment provider the scar can be minimized. Both IG-SRT and Moh's surgery both have around a 99.3% cure rate, discuss this with your dermatologist of choice to make sure that you make the best decision for yourself! Best of luck!
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August 7, 2020
Answer: Mohs surgery is your best bet Hi PLMI, I'm sorry to hear you were diagnosed with a basal cell skin cancer on your nose. For this area, which is a very cosmetically important area of your face called the nasal ala/apical triangle, Mohs surgery is considered the gold standard treatment. The reason why this is preferred to SRT is that with Mohs surgery 100% of the margins are evaluated allowing you with the smallest recurrence rate. SRT is considered a "blind" treatment modality and it's impossible to say if all the skin cancer was treated. Mohs will leave a scar, but in the right hands, this area can be repaired and healed so that someone sitting across the dinner table from you a year from now shouldn't be able to notice the scar. Mohs also is done in one day, whereas SRT would require several visits over several weeks and likely costs more. Hope everything works out! Dr. Fathi
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August 7, 2020
Answer: Mohs surgery is your best bet Hi PLMI, I'm sorry to hear you were diagnosed with a basal cell skin cancer on your nose. For this area, which is a very cosmetically important area of your face called the nasal ala/apical triangle, Mohs surgery is considered the gold standard treatment. The reason why this is preferred to SRT is that with Mohs surgery 100% of the margins are evaluated allowing you with the smallest recurrence rate. SRT is considered a "blind" treatment modality and it's impossible to say if all the skin cancer was treated. Mohs will leave a scar, but in the right hands, this area can be repaired and healed so that someone sitting across the dinner table from you a year from now shouldn't be able to notice the scar. Mohs also is done in one day, whereas SRT would require several visits over several weeks and likely costs more. Hope everything works out! Dr. Fathi
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December 9, 2019
Answer: Mohs surgery vs SRT vs other options Hi, Sorry to hear about the basal cell carcinoma- I'm glad it was caught though! In terms of treatment of basal cell carcinoma on the nose, Mohs surgery is the standard of care to get the highest cure rate. Mohs surgeons are trained extensively in reconstruction and maintaining cosmesis; in the location shown in your photo, it is likely that you would get excellent cosmetic result as a scar could potentially be hidden in the nasal alar groove. Another reason Mohs surgery is recommended is that sometimes the basal cell carcinoma extends further than can be seen clinically, and the procedure itself involves examining the margins under the microscope in real time until the entire cancer is removed. SRT is an option for non-melanoma skin cancers however for the above reasons it is not the first line treatment. Was a subtype of basal cell carcinoma listed? If it is a superficial basal cell carcinoma, there are topical medications that are FDA- approved for treatment that would potentially allow you to avoid a surgery. However, the creams are not appropriate for other subtypes of basal cell carcinoma. Hope that helps shed some light on the topic.
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December 9, 2019
Answer: Mohs surgery vs SRT vs other options Hi, Sorry to hear about the basal cell carcinoma- I'm glad it was caught though! In terms of treatment of basal cell carcinoma on the nose, Mohs surgery is the standard of care to get the highest cure rate. Mohs surgeons are trained extensively in reconstruction and maintaining cosmesis; in the location shown in your photo, it is likely that you would get excellent cosmetic result as a scar could potentially be hidden in the nasal alar groove. Another reason Mohs surgery is recommended is that sometimes the basal cell carcinoma extends further than can be seen clinically, and the procedure itself involves examining the margins under the microscope in real time until the entire cancer is removed. SRT is an option for non-melanoma skin cancers however for the above reasons it is not the first line treatment. Was a subtype of basal cell carcinoma listed? If it is a superficial basal cell carcinoma, there are topical medications that are FDA- approved for treatment that would potentially allow you to avoid a surgery. However, the creams are not appropriate for other subtypes of basal cell carcinoma. Hope that helps shed some light on the topic.
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December 9, 2019
Answer: Correct treatment of basal cell The correct treatment of a nasal basal cell based on the picture you’ve shown is excision with or without Mohs surgery with a bilobed flap or skin graft. having radiation is not what I would recommend.Based on what your skin looks like a preauricular skin graft could be harvested it that matches your nose very nicely. I did one of these a couple of years ago. I saw my patient back this year. The area where the patient’s cancer wise looks pretty much like the rest of her nose. If you contact me directly I’ll forward you a picture of her.As long as the provider is good at what they do nasal reconstruction does amazingly well. If the skin color is matched and the contour is layed down accurately than the scars fade away and become virtually invisible. If you have a recurrence the radiated tissue will not tolerate reconstructive surgery well in the future. Why don’t you follow the recommendation of your doctor? i’m a board-certified plastic surgeon and I’m biased towards plastic surgeons doing better reconstructive work then our dermatology colleagues. Historically all complex facial reconstruction was done by plastic surgeons. Dermatologist have hacked away at our turf and now do more of these than we do. You’re probably not going to find a Mohs surgeon who will do the excision and then refer you to a plastic surgeon. Just follow your doctor’s recommendation.I’m sure if you talk to a radiation oncologist they’ll be happy to give you radiation as a treatment options and tell you why it’s a good plan of action. if you’re a hammer The world looks like a nail. Best, Mats Hagstrom MD
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December 9, 2019
Answer: Correct treatment of basal cell The correct treatment of a nasal basal cell based on the picture you’ve shown is excision with or without Mohs surgery with a bilobed flap or skin graft. having radiation is not what I would recommend.Based on what your skin looks like a preauricular skin graft could be harvested it that matches your nose very nicely. I did one of these a couple of years ago. I saw my patient back this year. The area where the patient’s cancer wise looks pretty much like the rest of her nose. If you contact me directly I’ll forward you a picture of her.As long as the provider is good at what they do nasal reconstruction does amazingly well. If the skin color is matched and the contour is layed down accurately than the scars fade away and become virtually invisible. If you have a recurrence the radiated tissue will not tolerate reconstructive surgery well in the future. Why don’t you follow the recommendation of your doctor? i’m a board-certified plastic surgeon and I’m biased towards plastic surgeons doing better reconstructive work then our dermatology colleagues. Historically all complex facial reconstruction was done by plastic surgeons. Dermatologist have hacked away at our turf and now do more of these than we do. You’re probably not going to find a Mohs surgeon who will do the excision and then refer you to a plastic surgeon. Just follow your doctor’s recommendation.I’m sure if you talk to a radiation oncologist they’ll be happy to give you radiation as a treatment options and tell you why it’s a good plan of action. if you’re a hammer The world looks like a nail. Best, Mats Hagstrom MD
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