Is Mohs Surgery Necessary For Basal Cell Carcinoma

Basal Cell Carcinoma Recurrence After Mohs Surgery

Basal cell carcinoma is the most common skin cancer in the US and can cause significant adverse effects.

Mohs micrographic surgery, the treatment of choice for higher risk BCC, allows for removal of lesions with preservation of healthy tissue. Although the BCC recurrence rate post Mohs surgery is estimated at 1-2%, recent data is lacking to validate this historical measurement.

Our purpose is to determine the current recurrence rate of BCC after Mohs surgery.

The Mohs surgery technique is associated with a low recurrence rate for BCC and is preferred for higher risk tumors and for tumors in cosmetically sensitive sites on the head and neck. While recurrence rates of BCC post Mohs are 1-2% for primary basal cells, recent data is not available to validate this historical assessment. Currently, comprehensive rates of recurrence are not available because a national registry of recurrence rates for BCC and squamous cell carcinoma does not exist.

Is Mohs Surgery Really Necessary

Treating all skin cancers with Mohs surgery is not necessary. Mohs surgery is reserved for skin cancers that grow back after previous treatment, cancers that are at high risk of recurring, or cancers that are located in cosmetic areas where preservation of the maximum amount of normal skin is important, like the face.

Mohs Surgery For The Newly Diagnosed: What You Need To Know

If youre reading this, you or someone you care about was probably diagnosed with skin cancer, and a doctor may have recommended Mohs surgery as the best treatment option.

Youre not alone. More than 5 million cases of basal cell carcinoma and squamous cell carcinoma are treated in the U.S. each year. Of these skin cancers, approximately 80 percent occur on the head and neck, locations that get significant sun exposure. Mohs surgery may be recommended by doctors for treating skin cancers in these cosmetically challenging locations, as well as other areas of the body.

The good news is that when detected and treated early, the vast majority of skin cancers are curable. At the same time, words like cancer and surgery can be frightening. Learning what you need to know about your condition and treatment can help put your mind at ease.

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One Week After Mohs Surgery

After a week I went back to the surgeon to have the stitches removed. It was a quick procedure and not too painful. I was mostly uncomfortable while she removed the sharp stitches. Once the stitches were removed the surgeon assessed how I was healing. He said the scar looked great, but I would still need 4-6 weeks to heal completely.

The nurse applied steri strips to cover the scar which fell off two weeks later. Showering and sleep became a bit easier, but the area on my face remained sensitive to touch. I could also feel pain underneath the skin on my face .

Its been six weeks since I had Mohs Surgery to remove skin cancer on my face. In a few days I will see the surgeon for my final post op appointment. The scar feels bumpy and I hope its healed well. I will be back with an update soon!

NOTE: There are different treatments for Basal Cell Carcinoma based on the stage of the skin cancer. Some treatments include Curettage and Electrodesiccation, Excision, Mohs Surgery, or Radiation. The first two procedures are not as invasive as Mohs Surgery and can be done in office. Mohs surgery is especially useful in treating cancers that are at higher risk for coming back, such as large tumors, tumors where the edges are not well-defined, tumors in certain locations .

Surgical Procedures For Basal & Squamous Cell Skin Cancers

Basal or squamous cell skin cancers may need to be removed with procedures such as electrodessication and curettage, surgical excision, or Mohs surgery, with possible reconstruction of the skin and surrounding tissue.

Squamous cell cancer can be aggressive, and our surgeons may need to remove more tissue. They may also recommend additional treatments for advanced squamous cell cancer, such as medications or radiation therapyenergy beams that penetrate the skin, killing cancer cells in the body.

Basal cell cancer is less likely to become aggressive, but if it does, our doctors may use surgery and other therapies to treat it.

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Targeted Therapy Or Immunotherapy For Advanced Basal Cell Cancers

In rare cases where basal cell cancer spreads to other parts of the body or cant be cured with surgery or radiation therapy, a targeted drug such as vismodegib or sonidegib can often shrink or slow its growth.

If these drugs are no longer working , the immunotherapy drug cemiplimab can sometimes be helpful.

Prepare For The Possibility Of Grafts

I have had several squamous cell cancers on my face, including 3 around and on my nose. You cant see scarring. The only time I had pain was when I had a large one removed from my forehead and down around my eye and nose with a skin graft on my nose. If I get anymore, I certainly wont hesitate to have them removed. So you can do this! Bonnie

I had Mohs about the size of a dime At the end of my nose. Didnt feel a thing. Took graft from behind ear to fill hole. Only took Tylenol for pain. Bolster bandage the first week to hold graft in place was just annoying and thought I might pull off in sleep, but I didnt. You will be ok. If you are anxious tell them, usually the assistants will put you at ease. Good Luck! Jeanne

I had basal on my nose. I can tell you it by far was the most painful surgery of all skin cancers that I have had. The nose is a VERY sensitive area and the anesthesia wears off very quickly. Had to be injected too many times to count. My cancer was there since childhood . The result: a dime-sized hole on top of my nose and the entire inside of nostril was filled with cancer. Had skin grafts and left with part of my nostril missing. No one knows unless I point it out. Doctors are amazing and the procedures they can do are as well. I hope I dont scare anyone, just want to share that if I had known so much earlier this wouldnt have been as invasive. Had it been squamous I dont think I would be here. Stay on top of your skin! Vickie

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Mohs Surgery Scar Pictures

The doctor liked how the scar was looking so he put something called a steri strip on it. They glued it to my skin and it would fall off on its own in 1-3 weeks. When it fell off, I was to go back to the dressings again.

I did everything I could to make sure that steri strip stayed on so I didnt have to put that awful tape back on.

It stayed on until my follow-up appointment about 3 weeks later. They removed it and were very pleased with the progress. They told me I didnt need to use dressings any more which was a dream come true. I was okayed to exercise. Eff that.

I am so grateful for my family for taking such good care of me. My husband was a trooper and was so strong. He comforted me, he let me sulk, he handled the boys. I really couldnt have done it without him.

A very dear friend, Kayla, was a rock for me. She let me cry, she always knew what to say and she would just send me texts letting me know she was there for me.

But I also thank those people who would have been there for me had they known. I know there are many more people who would have dropped everything to help me if I had given them the chance.

My head was just so jumbled. I was in a pretty dark place for those couple of weeks.

This is how the basal cell carcinoma scar looked on Christmas . I had minor pain for a month or so. And because of the placement on my neck, sweaters would rub right there.

You can see how my basal cell carcinoma scar looked a year after this surgery in this post.

What Happens After Mohs Surgery For Basal Cell Carcinoma

Thankfully the Basal Cell Carcinoma did not enter any bones or spread over a larger outer surface area. The lesion was the size of a quarter before the surgeon removed all of the cancerous cells. The cancer free area after surgery was three times the size as the original spot. What happens during Mohs Surgery?

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The Most Effective Technique For Treating Common Skin Cancers

Mohs surgery is considered the most effective technique for treating many basal cell carcinomas and squamous cell carcinomas , the two most common types of skin cancer. Sometimes called Mohs micrographic surgery, the procedure is done in stages, including lab work, while the patient waits. This allows the removal of all cancerous cells for the highest cure rate while sparing healthy tissue and leaving the smallest possible scar.

It began as a technique called chemosurgery, developed by Frederic E. Mohs, MD, in the late 1930s, but was not widely known. In the mid 1960s, Perry Robins, MD, studied the procedure with Dr. Mohs, and recognized that it had great potential for the field of dermatology. He brought the technique to NYU, where he established the first fellowship training program to teach dermatologists this skin cancer surgery. Dr. Robins helped advance the procedure into what is now called Mohs surgery and went on to teach and promote it around the world.

for a skin cancer that has not been treated before

Answer: Mohs For Small Basal Cell Cancers

Mohs is a very specialized surgery which is indicated for treatment of certain skin cancers based on their size, biologic behavior, location, and if they are in high risk areas or are already recurrent. Alternative treatments may be appropriate for a BCC if it does not fit the guidelines. You will need to discuss these with your dermatolgist and make an informed decision based on information received. As much as I love 5FU for treatment of precancerous actinic keratoses I have never been inclined to encourage patients to use 5FU for BCCs unless they are very superficial and in an area where the 5FU can be used for longer periods of time and sometimes under occlusion if it is possible.

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Basal Cell Carcinoma Before And After Pictures

To start, they marked and measured me. The red area in the circle is the basal cell carcinoma. Not that big of an area, or so I thought. Remember the front office gal I mentioned?

Well, she was like the best hostess ever. She brought me coffee. And teased me with treats she would be bringing around later. It was nice to spend some time with my husband. It was all very relaxed and enjoyable.

My husband and I, still in good spirits, took joke pictures to send to his mom. He doesnt do well in medical situations so we thought this photo, of him pretending to have passed out, seemed appropriate.

The dermatologist did round one. They laid me back, numbed me up and made an incision. It took just a few minutes. It wasnt awesome, but it was manageable. They removed some cells and took them to their onsite lab to evaluate.

Just a little bit of cotton and tape were put over the incision while we waited to see what would happen next. We were told results would take about an hour so we just had to relax and wait.

Sweet, sweet lady. First my husband and I were brought warm cinnamon swirl bread from the front office gal. Then an hour later she came by with these abelskivers from Trader Joes! I loved this place! They really did their best to make you comfortable.

But I wouldnt be there that long. At this point I just needed to be stitched up. So while the original red mark appeared to be very small, the cancer was actually much larger below the surface.

What Is Mohs Micrographic Surgery

The Mohs surgical procedure consists of two basic components: a scalpel and a high-powered microscope. This procedure aims to fully eliminate the tumor while minimizing damage to the surrounding healthy tissue. In order to achieve these goals, the practitioner removes one layer of the lesion at a time, examining the each specimen underneath the microscope to understand the depth and direction of the cancer. Once there is no more evidence of cancer to be seen, the procedure is complete and the damaged skin is repaired.

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Answer: Mohs Surgery For Small Basal Cell Cancers

Mohs surgery is a specialized procedure that enables the surgeon to remove the skin cancer with the highest cure rate and lowest recurrence rate all the while sparing as much normal skin as possible. Having said that, it is not alway indicated for every basal cell cancer. However, it would be helpful to know where your skin cancer is located. Is it located on the face? Specifically on the “mask” area like accross the nose, around the mouth, eyes and the ears. Also, mohs is often chosen for treating skin cancers in young patients, irrespective of the location. There are other treatment options. However, using Efudex may not be appropriate if you basal cell cancer is not superficial and it is not an overnight treatment either and will likely keep you out of commission longer in playing gold since sun exposure becomes a huge issue. I would discuss these options with your dermatologist

Why Is Mohs Surgery Performed

Mohs surgery commonly addresses skin cancer that:

• Is located on any sensitive area where it is important to minimize the removal of normal healthy tissue, such as the head and neck, fingers, toes or genitals

• Is of an aggressive subtype

• Develops in patients with suppressed immune systems

• Was previously treated and has come back

• Is growing quickly

• Is large

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What Does Basal Cell Carcinoma Look Like

When the DNA in the basal cells is damaged and a basal cell carcinoma develops, it will appear as a change in the skin, such as a growth or sore that wont heal. The lesion will have one of the following characteristics. It will look like

• A pearly white, skin-colored, or pink bump on the skin. It will be translucent, meaning you can see through it slightly, and you can often see blood vessels in it.
• A brown, black, or blue lesion or a lesion with dark spots. It will have a slightly raised, translucent border.
• A flat, scaly, reddish patch of skin with a raised edge. These will occur more commonly on the back or chest.
• A white, waxy, scar-like lesion without a clearly defined border. This morpheaform basal cell carcinoma is the least common.

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What To Expect During Mohs Surgery

Use this infographic to learn what to expect during mohs surgery.

The visible tumor and a thin layer of surrounding skin are removed.

The tissue is examined under a microscope to see if any cancer cells remain at any of the edges.

If any cancer cells remain, additional skin is removed and examined under the microscope.

This process continues until no more cancer cells are found at the edges.

ImagesImage used with permission of Journal of the American Academy of Dermatology: J Am Acad Dermatol. 2007 57:832-5.

ReferencesNouri K, Patel AR, et al. Mohs micrographic surgery. In: Nouri K. Skin Cancer. The McGraw-Hill Companies, Inc., China, 2008:482-490.

Schaeffer M, Geisler A, et al. Patient-reported preferences associated with Mohs micrographic surgery of nonmelanoma skin cancer: Relative importance of factors pertaining to surgeons and staff during the perioperative course. Poster presented at: 74th Annual Meeting of the American Academy of Dermatology 2016 Mar 4-8 Washington, DC. Commercial support: None identified.

Stigall LE, Brodland DG, et al. The use of Mohs micrographic surgery for melanoma in situ of the trunk and proximal extremities. J Am Acad Dermatol. 2016 Nov 75:1015-121.

Walker E, Mann M, et al. Rapid visualization of nonmelanoma skin cancer. J Am Acad Dermatol. 2017 Feb 76:209-16.

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How Does Mohs Surgery Work

Unlike routine excisional surgery, Mohs surgery is an outpatient procedure that surgeons perform in stages while the patient waits between each stage.

Before surgery, the surgeon may outline the patients lesions with a body-safe ink to map the tumor. Once they have injected the patient with a local anesthetic, they will remove the smallest layer of cancerous tissue.

As the patient waits, a team will process the layer of removed cancerous tissue in an onsite pathology laboratory.

After processing, the surgeon examines the tissue to determine whether or not any cancer remains. If cancer remains, the surgeon will repeat the process until they have removed all the cancerous tissue.

All surgeries come with some degree of risk.

Potential risks of Mohs surgery include:

• pain or tenderness around or at the surgical site
• discoloration

notes that a surgeon may ask an individual to prepare for Mohs surgery by:

• wearing comfortable clothing
• refraining from taking aspirin and other nonsteroidal anti-inflammatory drugs or other blood thinners 10 days before surgery
• avoiding alcohol a few days prior to surgery
• avoiding taking vitamin E a few days before surgery
• getting a good nights sleep
• eating a normal breakfast
• bringing a book, magazine, or something else to help pass the time
• clearing their schedule on the day of the procedure
• asking a friend or family member to accompany them to their appointment