Dear Dr. Naderi:
I have a basal cell on the corner of my nose which, obviously, has to be removed. The cosmetic surgeon that did the biopsy here is recommending me to somebody that does Mohs in Richmond. The one that does Mohs here is not a cosmetic surgeon, but I was told that one thing he does is sewing, which few dermatologists do. I know Mohs will allow them to take out as little tissue as possible to avoid deforming the nose as much as possible, and I like that idea, but I am concerned about how much of a scar he will leave, since he is not a cosmetic surgeon ( I don’t think there are any down here that do Mohs). And once I get the procedure done, If I choose to get the scar fixed up, I am sure the insurance won’t pay. I guess my question is, is it worth to you going for the Mohs and getting less taken out, or going to a cosmetic surgeon that does not do Mohs but may be able to cut and stitch me up nicer, keeping in mind that the one that does Mohs here does know how to sew.
I also was concerned about the fact that the biopsy was 3 weeks ago, and a small area of my nose still does not feel back to normal (I guess you could say it still feels a bit numb). I got the stitches out a week and a half ago. Is this normal to feel like this for so long? Or could I have gotten a bit of nerve dammage? Also, I am concerned about the Mohs compounding the effect, if there is the possibility of a bit of nerve dammage. What do you recommend?
Thanks,
Nathalie
Answer:
Dear Nathalie,
I’m sorry to hear you have a Basal Cell Carcinoma but luckily these are very curable and do not metastasize to other areas unlike most other skin cancers. Any plastic surgeon or dermatologist can do the initial biopsy but once the diagnosis is made the best way to treat the cancer is to have a Mohs surgeon do the resection and have a Plastic or Facial Plastic surgeon do the reconstruction.
Mohs surgeons are very specialized Dermatologists who have done additional fellowship training. The Mohs technique allows the cancer to be removed with the highest chance for cure without the needless resection of too much extra tissue which makes it the ideal technique for skin cancer removal from the nose or eyelids where there is not any abundance of extra skin. This technique is not needed in areas with lots of extra available skin such as the stomach for example.
Only Mohs surgeons should perform Mohs surgery and although some other doctors advertise that they do this form of surgery you should check their credentials to make sure they are true Mohs Dermatologic surgeons.
Mohs surgeons do perform some minor reconstruction as well but the best skilled doctors for repairing a defect are plastic and facial plastic surgeons.
I have worked closely with many great Mohs surgeons in the past and my staff coordinates things for the patients to have the patient seen by the Mohs surgeon. He/she will remove the cancer and then the patient comes back to see me the same day to plan closure or reconstruction the same day or even a day or so later.
Any area that has been cut will be numb for some time but the sensation should return in due time.
I wish you luck and let me know if you have any further questions.
