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I seriously was just telling my Pilates teacher on MONDAY that it's quite amazing I'd never had skin cancer yet, given my childhood history of growing up in Texas... baby oil, tanning beds, etc. And also, being a redhead and having fair skin. Was at the aesthetician at my dermatologist's office yesterday when I asked her about a spot on the bridge of my nose (I thought it was a pimple coming on, although I rarely have acne). She told me it was above her pay grade, and said after she finished with me, she would talk to the derms that were in yesterday afternoon to see if someone could squeeze me in. I really wasn't worried, but she said, "As long as you're already here, let me work something out." So, biopsy yesterday, and basal cell carcinoma diagnosis today.

They wanted to schedule me for MOHS, but I'd been hearing about a new(er) treatment, IG-SRT (image-guided superficial radiotherapy). It requires quite a few visits, but there's no cutting like MOHS. I had a friend who had MOHS on her nose and said it was incredibly painful - scar ran almost the entire length of her nose, and she couldn't sleep the first night because the pain was so bad. She said she'd never do MOHS again, that she'd find a practitioner who does IG-SRT.

I'm looking for personal experiences from people who have had MOHS on their face, and even better, from people who have had IG-SRT.

Sorry to hear you got that diagnosis like I did, side of my nose on the flared nostril. I'd gone for an annual skin cancer check because I'd had a SCC removed from my arm, and the derm doctor missed this BCC during his check! But since he'd taken care of some spots on my face cosmetically, I made a follow-up appt. with him to do even more, and I pointed this tiny red spot out to him and he said " That looks like skin cancer." It was so small, a red dot.

MOHS went fine until it was time to stitch up and I'm a bleeder. Two surgeons were looking rather worried and talking in a language I didn't understand about me. You know when that happens it's not a good sign. Anyway, the one surgeon put a torniquet stitch up next to the bridge of the nose to slow down the flow. My nostril on that side got slightly deformed for a while but is okay today, except for a small horizontal scar.

Thanks for mentioning this new technique!

[This message edited by Superesse at 4:18 AM, Thursday, November 14th]

Mohs is one and done.
Mohs is proven to get clear margins and is covered by insurance.
Not sure about the newer tx.
I would.ask for photos of similar surgeries and results. A decent surgeon is usually proud of minimal.scarring.

N4,

I just had the MOHS done yesterday, on my nose. The worst part was the numbing shots, but even those were tolerable. I had a slight headache for a few hours, but didn’t even need to take anything for it. I’m sure I’ll have a small scar but nothing glaring. My daughters say he did a great job on the flap 🤔

I will take the one and done every time! 😂

Good luck.

I maybe could have added to my post (and I think I've shared this elsewhere) that I have a cleft lip - the plastic surgery as a baby did a wonderful job, but when you look close, you can see it. I'd rather not have any kind of scar along my nose.

My friend I mentioned in my original post went to a wedding of a friend who had the IG-SRT done on several spots on her face. My friend said she couldn't see any scarring whatsoever, even looking closely.

Also, my insurance will cover the IG-SRT. I think I'm going to move ahead with a consultation with the derm who does the IG-SRT. I know the MOHS surgeon will believe her treatment is best, while the IG-SRT derm will think theirs is best. I mean, worse comes to worse, the IG-SRT derm could conceivably say I'm not a candidate, but at least I will have the full story.

Hi,
I had a MOHS on my forehead, close to the hairline. It was much more painful than I expected for the recovery, but that only lasted about a day and was helped greatly by ice. I do have a small scar, but I’m freckle-y anyway so it’s minimally seen. :)

I had Mohs surgery in just about the same spot you mentioned - bridge/tip of my nose. I also thought it was a pimple, but when it didn’t go away after a couple of weeks, I had it looked at right away. Went to a very good dermatologist specializing in Mohs surgery and immediately went to plastic surgeon same day to reconstruct. The plastic surgeon remarked that the nose is a very difficult spot to work with. Apparently the dermatologist removed quite a bit of tissue even though the basil cell was small. Plastic surgeon created a flap and the result is pretty good. Not 100% happy with it and really should have gone back and have it tweaked. I still might do that. Telling you all of this to suggest you really speak to your doctor about the end result, and how you want it to look. Maybe look at some photos of similar surgeries. Good luck with this and best to get it out right away. I have had three basil cell carcinomas, but this one was the most difficult in terms of removal and reconstructing. Others were on my leg and my hairline. Good results with both of those . I am extremely diligent now about using a very high-quality sunscreen whenever I leave the house.

I would be looking at potential drawbacks closely - potential secondary malignancies/darkening of skin/thinning of skin etc. MOHS is gold standard for a reason, that reason being full eradication. My husband had MOHS this time last year, a cut from just under his eye down his cheek, maybe 3 inches. After a Rocky start, he now has a barely visible scar. What he does have is the complete confidence it was completely removed.

The effects of radiation treatment shouldn't be underestimated, make sure you are fully informed. I
Best of luck whichever method you choose.

So I decided to go with Gentle Cure after lots of research and discussion with various health care providers... my PCP, the Mohs surgeon and the Gentle Cure derm. I also had a couple of conversations with my therapist, who is also a psychiatrist, so has some non-related medical knowledge (she also had Mohs surgery a few months ago).

As for recurrence, the derm that offers Gentle Care said there's always the risk of recurrence with Mohs, too - he also does Mohs, so it doesn't really matter to him that much which treatment patients pick because both have a risk of recurrence. He also told me he has a patient right now that is getting Gentle Cure after a recurrence after Mohs.

The other hesitation I had was wondering why this treatment wasn't available in academic centers, but before I asked him, he told me Mass General is in the process of getting it. So that settled that concern.

He told me honestly the only drawback is the cost of time. It will take six weeks, three times a week. Each appt only lasts five minutes and you actually watch the necrotic cancer area slowly get smaller on the ultrasound the radiation therapist does each visit. After all treatments are done, you go back in five weeks to make sure they got it all. They also use a small lead nasal plug during the appt to keep the radiation from getting into tissue that is not cancerous.

As for time, D suggested I get an audio book to listen to on my drive. It's about 28 miles away, but we're less than a mile from the interstate and the office is less than five minutes off the highway on the other end. It took about 35 minutes for us to get there. When I was going to Dana-Farber for breast cancer radiation (three weeks/every day), it would take us on average 40 minutes to get there because there was no direct highway route, and the area of the medical center is so congested.

I will have my simulation appt. mid-January, and start on the 27th after we get back from our vacation.

Good luck!!!there are tons of great podcasts too.
Everything from any topic that you find interesting

Thanks for posting this. I’ve had a couple run ins with BCC, and a non-scarring treatment option sounds amazing as I anticipate future occurrences, even with hats and sunscreen. Let us know how it goes.

I’ve had a couple run ins with BCC, and a non-scarring treatment option sounds amazing as I anticipate future occurrences,

I too, anticipate future occurrences. If it happens anywhere but on my face, I would probably do Mohs because it's one and done. But on the face, I will opt for Gentle Cure when appropriate.

number4, good to read this report! I wonder if I should look into that, in case I ever need it again. My nose still has a perceptible little side bump and small horizontal scar I can see, so I'm going to have the doctor keep an eye on it. I'm not sure if he does the GentleCure technique, but after my experience, I have to think I'd be better off without scalpels on my face.