Second bcc op needed on nose - should I travel afar to have MOHS procedure, or have it done locally in the old fashioned way?

Personally I would go with the surgeon you trust rather than start all over again at a new hospital.  I had a flap surgery at the bottom of my nose upper lip in January and has healed well.  I had a skin graft surgery on a basal cell near my eye at the top of my nose 8 weeks ago and this is healing now, although was messy and scabby for a while.  The surgeon took skin from down the side of my face by my ear which is hardly visible now.  I think flaps are best if can be done as they have their own blood supply but the graft is fine now.  I am still massaging both of them with Bio oil which helps.  Keep in touch and ask any questions you need to and good luck with your decision.  Where abouts on your nose is it. 

Sorry to hear about still having cancer cells, that sucks.  I had Mohs on my scalp. Prior to the surgery it was thought that the tumour was 3cm. However, it eventually transpired that the tumour/cancer cells extended to 5cm.  Having Mohs meant that they kept cutting until they got them all out.  However I am not sure how or whether this is helpful for your situation since you already had an excision done.  Mohs is more likely to avoid the need for further surgery due to the constant testing on the day..

I decided to ask for a referral to Leeds for MOHS treatment after thinking and reading about it, only to be told that the waiting list was through the roof and I wouldn't be seen for possibly a year and a half. So it's back to plan A and a traditional excision. My consultant was reassuring that when they did the first op, they carefully map how the cancer was positioned so will be fairly certain about removing the cells that were left behind. I'm relieved in a way to be going back to my local hospital to a consultant I've seen before, but think that there should be more access to the 'gold standard' MOHS treatment for everyone. I've also got a creeping idea of raiding my precious savings to have the MOHS done privately...  Any comments?

Hi Woodsider.  I have had 2 bcc's removed with skin flst and skin graft neither with MOHS.  Luckily both skin margins were cancer free.  I had themj both done privstely by a pastic surgeon.  My reason for not havibng MOHS was my plastic surgeon wouldn't have done the MOHS surgery he would have just been called in to do the reconstruction surgery.  I wanted him to do everything as I liked him, had confidence in him and trusted him to look after me.  I just hope your original surgeon will look after you and get the results you want, but if you don't feel confident enquire about going privately.  The waiting times at your NHS hospital are not good.  I just wish Drs would take these skin cancers more seriously than they do as I feel they are not trivial, well mine certainly weren't.  Good Luck and keep in touch x

Hi Woodsider

I assume that your comment that Mohs micrographic surgery, to give it it's full name, is the "gold standard" means that you think it's the most successful form of treatment for skin cancers but that isn't the case. If you take a look at the British Association of Dermatologist's leaflet on BCCs you will see that it says 

"Mohs micrographic surgery is a surgical procedure used to treat more complex BCCs such as those present at difficult anatomical sites or recurrent BCCs." and "This is a time consuming process and is only undertaken when simple surgery may not be suitable."

Ordinary surgery removes all of the cancer, just as Mohs surgery will, and if your surgeon has recommended this and you want to stay with this surgeon then I'm sure you'll be pleased with the result.

I've had a BCC removed by normal surgery. All of the cancer was removed at the first attempt and the scar is barely visible now. 

Personally I'd save the money it will cost you to pay for Mohs privately, likely to be over £3000 based on previous posts, and use it to treat yourself to something nice after the op to celebrate.

Edit - just to add I didn't need a skin flap so can't comment on that

x

Thanks for the reply Latchbrook, it's settled me down a bit as I've been wondering again about MOHS privately. I'm just hoping to get the call from my local hospital soon, as I'm struggling to think about anything else. I'm worn out 'keeping busy'!! All the best to you all on this thread - fellow sufferers!

Hi Woodside

Once my basal cell on side of my nose was eventually correctly diagnosed I was referred to head and neck plastic surgeon.

He gave me three choices of treatment.

One was excision with reconstruction 

The other was slow mohs surgery where they put a dressing on for a couple of weeks and wait for histology 

He also arranged for me to see the mohs surgeon who was very nice who said if I really wanted mohs he'd do it but it was a ten month waiting list and he felt that looking at it a normal excision would be fine.

Both consultants gave me a choice so I was wondering if your consultant would give you options?

Sorry about the delay in replying - logging in difficulties! My consultant out me forward for radiotherapy, but the team refused this saying it would be too disfiguring. I was then only offered excision as MOHS is not done in our area. He did try to refer me to Leeds for MOHS, at my request, but the waiting list is very long, and as my cancer was described as aggressive, it's not sensible to wait too long. He told me that the look of the second surgery won't be as good as the first (bilobal flap) as I'll have to have a skin graft. I'm worried that my nose will be lop sided. Just been reading about facial disfigurement and it's a big thing to deal with. Thanks for your reply - it's good to have a chat with someone who's been through it already. 

Hi Woodsider asI have said before I had skin flap for one procedure and skin graft for another.  Both are healing ok now. My plastic surgeon took the skin from the side of my face from top of ear to ear lobe. The area where my cancer was was just where your glasses nose piece sits as I thought they had rubbed me. By the time I had surgery it was quite large.  The area went across my nose and right up to my tear duct and a bit under my lower lashes.  It is settling but when the dressing was removed I was horrified as it was a huge black gungy scab. The Nurse held my hand before showing me.  After a couple of weeks it still looked awful so sent my Consultant a picture.  He told me to vaseline it to get the scab off. Since then it has started to heal and is looking fine.  I asked should this have happeneded and he said not really but sometimes it does, from blood and skin debris and he did think perhaps it had failed, but fortunately it hadn't but needed longer to get better.  I am sure in time and with lots of massage with bio oil and nivea creasm your scars won't be too bad.  Where abouts on your nose is your cancer, is it basal cell.  I will send you a friend request and perhaps you would like to see some pics of mine.  I would just go for it and not mess about waiting for MOHS as I am sure your surgeon will get it all this time.  Good luck and keep in touch xx

Hi Woodside

I have difficulty logging on too

It's so difficult making the right decision isn't it? I think in some ways it's made worse because so many of these cancers are in a visible place and also there's often a delay in getting a diagnosis.

My consultant gave me a choice of treatment but did say he felt mohs wasn't essential so I'm having slow mohs tomorrow.

Im terrified I have to admit. 

Do you know what kind of basal cell cancer you have?

I'm so grateful for all I've read on here it's inspiring to a nervous wreak like me who has a nose phobia I think.

Do you have any idea of how long you need to wait for treatment. It's a difficult decision to make. Have they given you their opinion on which treatment will be best for you?