Basal Cell and Mohs Surgery

[Badger]

I'm not sure what the concern is about Mohs surgery. It is so much better than regular surgery that generally removes more tissue to make sure they get all the cancer. I have had 7 Mohs surgeries (upper chest, back, scalp, face and ear. Also 4 regular skin surgeries. No pain during the surgery and minimal to none after surgery.



Take a book to read if after the first round they need to remove a little more to make sure they get it all.



Evidently I have a lot of pre-cancer that has to be monitored. 3 or more visits to the dermatologist each year for the past 20 years or more. Used a variety of treatments on my scalp including Efudex cream which starts burning after a few days as you continue for 3 weeks or more. Very painful. Also had a "Blue Light" treatment that involves a chemical application. Then you wait for an hour or two before an 18 minute exposure to a blue light. That is so painful that they even have a blower with cool air to help get through the treatment. The up side is after staying out of the sun for a few days you are good to go. All of those treatments leave you with looking like you have the plague for a couple of weeks. At least with the Mohs you have one small area covered by a bandage for a few days and you are done.


I've been lucky to have a great dermatologist that keeps on top of all this.



Cheers!

 

[ronin]

How was the one on the scalp discovered?
I had one on the bridge of the nose four years ago. My scalp seems to itch from time to time which never happened before. I am also using Neutrogina T-gel which prevents itching on the scalp.

The dermatologist exams my scalp. Sometimes things will scab over and bleed a little. I let her know and she zooms in on it. So far everything except the one on my hair line/forehead has been basal cell. That one was squamous cell.

 

[kannon]

I'm scheduled for Mohs on my nose this coming Monday. The more I read about it, the more I'm not looking forward to the experience.


Will report back this time next week. If I can see past all the bandages, that is ....

Just a lesson learned from me, Moh's on the nose. On hindsight, if had to do it again, would have it done by a plastic surgeon vice a dermatologist. While the dermatologist was specifically trained in Moh's, the cutting required a followup plastic surgery reconstruction. I think if it was all done by a plastic surgeon, the results would have been better and less medical intervention. Just my two cents. Best of luck.

 

[bmcgonig]

Just a lesson learned from me, Moh's on the nose. On hindsight, if had to do it again, would have it done by a plastic surgeon vice a dermatologist. While the dermatologist was specifically trained in Moh's, the cutting required a followup plastic surgery reconstruction. I think if it was all done by a plastic surgeon, the results would have been better and less medical intervention. Just my two cents. Best of luck.

Many if not all Mohs surgeons are skilled in reconstruction. Of course the skill can vary. Anyway a plastic surgeon can't do Mohs surgery. Has to be a specially trained dermatologist.

I do know of a case where the Mohs guy referred someone to a plastic surgeon after the surgery because he felt that it would be better. So you could possibly do that.

 

[ronin]

I was fortunate in that I was referred by my dermatologist to another dermatologist who is also a board certified plastic surgeon so it was all done in one (long) session.

 

[bmcgonig]

I've had a number of Mohs too. Be careful, some of the basal cells come and then disappear on their own. Very strange. But they can be still growing underneath undetected.

I had one excised by regular dermatologist a few years back. It was seemingly gone then it came back two years later. Went for Mohs and what looked like a pimple on top was literally the size of a quarter underneath. I was stunned. It was on my side forehead and he did a great job of stretching the skin to make it now undetectable with no graft. Although the area is still numb three years later.

 

[pacergal]

My wife had multiple basil skin spots removed and one melanoma surgery. However her younger sister (52) needs our prayers because she has only few month to live. Liver cancer quietly spread to lymph nodes, lungs, bones and her oncologist gives her no more then few month. No treatment could do anything. She worked at Stanford and had best medical coverage, planned to retire by 55 on Standford pension but now this. Our family is devastated.

My prayers to your family, so sorry to read this.

 

[MrsHaloFIRE]

So sorry to hear of the sister's illness. Prayers for your family during this time

 

[jcretire77]

Two Mohs, One in the middle of my forehead and one on the crown. I am one of the biggest medical babies around, but both of these worked out just fine. The forehead does not look like there was ever anything done. Blended perfectly with normal lines.

Good Luck.

 

[TeeRuh]

Electronic Brachytherapy

I went to a MOHS specialist for surgery on my nose. He described the rather scary surgery and follow-up reconstruction and then offered the subject alternative. 5 weeks of twice a week radiation. Some pain and bleeding towards the end. Now no evidence of any scarring or discoloration. Would recommend you look into this latest alternative. Supposedly about 95% success versus 98% for MOHS.


t.r.

 

[bmcgonig]

I went to a MOHS specialist for surgery on my nose. He described the rather scary surgery and follow-up reconstruction and then offered the subject alternative. 5 weeks of twice a week radiation. Some pain and bleeding towards the end. Now no evidence of any scarring or discoloration. Would recommend you look into this latest alternative. Supposedly about 95% success versus 98% for MOHS.


t.r.

Given that in mohs they need to keep cutting until no cancer is found i.e., they don't know how far the cancer extends until they test each cut, I wonder how they know how far and wide to aim the radiation?

 

[Potstickers]

My wife had multiple basil skin spots removed and one melanoma surgery. However her younger sister (52) needs our prayers because she has only few month to live. Liver cancer quietly spread to lymph nodes, lungs, bones and her oncologist gives her no more then few month. No treatment could do anything. She worked at Stanford and had best medical coverage, planned to retire by 55 on Standford pension but now this. Our family is devastated.

I'm so sorry. That is a tough reality.

 

[Potstickers]

Just a lesson learned from me, Moh's on the nose. On hindsight, if had to do it again, would have it done by a plastic surgeon vice a dermatologist. While the dermatologist was specifically trained in Moh's, the cutting required a followup plastic surgery reconstruction. I think if it was all done by a plastic surgeon, the results would have been better and less medical intervention. Just my two cents. Best of luck.

The nurse at the derm's office casually mentioned that some patients with Mohs surgical sites like mine preferred to have a plastic surgeons do the repair. I took the hint, had a consult with a local plastic surgeon, and arraned for the repair to be done the day after the Mohs surgery. Insurance paid for it. Interestingly, the plastic surgeon had me knocked out for the repair -- he said he didn't want his patients talking to him during surgery. My Moh's surgery took out a chunk around the size of a nickel or a bit larger extending up to my cheekbone. The repair took time to heal, but is basically invisible.

There ae some nifty silicone patches you can use after the initial healing to reduce scarring and flatten the area. I wore them at night for several months.

 

[Dtail]

Had melanoma on my back at age 40. Had regular surgery, but was stitched up by a plastic surgeon.
Nevertheless, have a 4 inch scar now. No issues, as I wasn't going to be a back model anyway.
Understanding that the face surgery is a scarier proposal in one's mind.

 

[ShadowBloom]

If you choose to see a plastic surgeon, try to see one with a sub-specialty in facial plastic surgery, not a general plastic surgeon who also does breast enhancements and tummy tucks.

 

[TeeRuh]

Given that in mohs they need to keep cutting until no cancer is found i.e., they don't know how far the cancer extends until they test each cut, I wonder how they know how far and wide to aim the radiation?

The width (area) is controlled by a "mask" (for lack of a better word) placed over the effected area during the radiation treatment (about 3 minutes). As far as how they calculate the total dosage I'm not sure. Though the equipment is new the concept (brachytherapy) has been used on other types of cancer. This option can NOT be used for melanoma.


t.r.

 

[bmcgonig]

The width (area) is controlled by a "mask" (for lack of a better word) placed over the effected area during the radiation treatment (about 3 minutes). As far as how they calculate the total dosage I'm not sure. Though the equipment is new the concept (brachytherapy) has been used on other types of cancer. This option can NOT be used for melanoma.


t.r.

But how do they know how big the mask should be? What's confusing me is how do they know the width/size for the radiation if the Mohs surgeon has to cut and test many times to get the same info?

 

[TeeRuh]

But how do they know how big the mask should be? What's confusing me is how do they know the width/size for the radiation if the Mohs surgeon has to cut and test many times to get the same info?

The MOHS surgeon drew a circle around what he felt was the cancerous area (a biopsy was done initially). It is a radiation so I'm sure the "edge" is not as controlled as with a scalpel. I don't want to claim to know all of the "science" behind this. You may want to google more info or if a candidate find a doctor to counsel with. I am happy with the overall procedure. There is a lack of long term studies following this approach. My age (69) was a factor in my decision.


t.r.

 

[bmcgonig]

The MOHS surgeon drew a circle around what he felt was the cancerous area (a biopsy was done initially). It is a radiation so I'm sure the "edge" is not as controlled as with a scalpel. I don't want to claim to know all of the "science" behind this. You may want to google more info or if a candidate find a doctor to counsel with. I am happy with the overall procedure. There is a lack of long term studies following this approach. My age (69) was a factor in my decision.


t.r.

I'm sure it works. Lots of studies seem to back it up. My questions were just out of curiosity.

 

[Animorph]

I did have that option once of Moh's or excision, so I assume the dermatologist has some idea of the probable extent of the cancer, for radiation or excision. I don't remember if they did a followup biopsy for the excision.

DW had her nose Moh's yesterday. Got it with one cut, but we had to wait an hour for the biopsy and another hour and a half for the repair. DW was a little surprised at the additional cuts made for the repair (so it doesn't pucker). Guess I forgot to warn her about that. A little sore yesterday, but less sore today. She did feel weird walking through Costco and having a hot dog for lunch with gauze over her nose, but did fine.

 

[imoldernu]

Fluouricil

In our CCRC, dozens of regulars who go for tests, scrapings, suspicious skin reviews.
Some in their 90's who go almost weekly. Haven't asked, but continuous visits must run into the multi thousands of dollars.

My one and only time.... 8 years ago... 100 miles, $200, cut and stitch. ok , as far as that was concerned, but an "unauthorized scraping"...of nose for suspicion. Call to return the next week, for results. Didn't go.

Tube or jar of fluourocil, $100 to $200...

Use daily suspicious spots as needed... probably 100 different times.... took care of all. Often, a short term redness for a week or so. More for use on head or other body parts, but can be used for facial cancers.... just need a band-aid cover.

Suggest you ask your regular doctor. It requires a prescription.

 

[irishgal]

One of the benefits of Mohs is that it not only is able to get good clean margins, but the scarring after healing is very minimal. This is why only specific surgeons do it, they are being very aware of the "cosmetic" impact on the area being treated.
I think the anticipatory anxiety is awful but you will be relieved once its over.

Good luck!!