DermHelpCentral

Treatment Options for Basal Cell Carcinoma

Three common treatments for basal cell carcinoma (BCC) are shown and described in this video, with pros and cons discussed.  These include excisional surgery, electrodessicaton and curettage and topical imiquimod.

Mohs Micrographic surgery and radiotherapy are not covered. 

This video does cover the most pertinent options for most patients and is a valuable educational resource.

Mohs Micrographic Surgery: Buyer Beware

photo from NYT article referenced here

Mohs surgery is the best approach for patients with skin cancers in specific areas.  These include the eyelids, and certain areas on the nose and ears and scalp.  It can be a very expensive proposition, so the prospective patient should be aware of the charges beforehand.  In addition, some Mohs surgeons will perform the procedure on lesions that can be removed by simpler procedures.

This topic was addressed in a recent NY Times article: "Patients’ Costs Skyrocket; Specialists’ Incomes Soar" by Elisabeth Rosenthal.  In our opinion, Ms. Rosenthal's article is accurate although it may generate some heat from Mohs surgeons and the American Academy of Dermatology.

The article centered on the experience of a woman in Arkansas.  It described "a daylong medical odyssey through different private offices on the manicured campus at the Baptist Health Medical Center that involved a dermatologist, an anesthesiologist and an ophthalmologist who practices plastic surgery. It generated bills of more than $25,000."

Caveat emptor.  If you are referred for Micrographic Mohs Surgery, it is probably appropriate.  But read the article carefully and ask questions.  If your skin cancer is not around the eyes, nose or ears or on the scalp, get a second opinion.

 

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Patients' Costs Skyrocket; Specialists' Incomes Soar

Mohs Micrographic Surgery (MMS)

Dermatologist Dorinda Shelley wrote this short poem a few years back:

Who knows
Whose Nose
Needs Mohs?

The answer, of course, is "Your Dermatologist."  Kidding aside, here are some thoughts about MMS that may be helpful in your decision making process.

“Mohs surgery depends on 2 very important concepts: 

• The first is that microscope slides need to be prepared with en face sectioning, not a technique that is done rapidly or reliably in the pathology lab.  It takes us over 6 months to train a technician to get the full face of the tissue, including epidermis, reliably.  Without full face examination of the tissue, the procedure is simply excision with rush sections. 
• The second crucial component is that the surgeon be the pathologist.  This allows the greatest ability to excise the correct spot on any second or third stage.  It is also important to understand the path, so you can excise to the correct layer.

No one has ever done a study to show that pseudo-Mohs is as effective as real Mohs.  Imagine, depriving your patients of the real thing."

Here is a longer explanation: Download Mohs Micrographic Surgery

DermNet has a fine page on MMS.  It concludes with this sentence: “The Mohs surgeon needs to have skills in dermatology, oncology, pathology and reconstructive surgery."  We feel that plastic surgeons who perform pseudo-Mohs simply do not have the interest, training or expdertise to handle tumors in certain critical sites.