An Alternative to Mohs Surgery for Basal Cell Carcinoma

Last summer I started to notice a spot on my nose. It looked a bit like a pimple but it didn’t go away. After a few weeks I went to a dermatologist and had a biopsy. Bad news: basal cell carcinoma, not the worst kind of skin cancer but not to be ignored. Doctors call BSC “the rat cancer” because it burrows under the skin, out of sight; there is no way to tell how much (or even where) it has spread.

The dermatologist told me that I should have Mohs surgery to remove the cancer. The procedure is for the surgeon to shave off skin a layer at a time, testing each layer as she goes, until a cancer-free layer is reached. There is no way to know ahead of time whether the surgeon will remove one layer or seven. In an area as delicate and contoured as the nose, a seven- layer procedure would leave a large wound that would take weeks or months to heal completely and might require plastic surgery. For me, that would mean canceling the annual scuba diving trip and possibly ending up with a permanent, unsightly mess at the end of my nose. Surely, I thought, there must be a better way.

And there is. It’s called superficial radiation therapy and it has become available within the last ten years. It is distinct from an earlier form of radiation therapy that was commonly used before the introduction of Mohs surgery, which became the standard treatment for BSC in the 1970s. SRT is not available everywhere and has advantages and disadvantages compared with Mohs. The experience of having an SRT treatment is similar to having a dental x-ray and takes about as long.

-  SRT is non-invasive, painless, and non-scarring. Like any surgery, Mohs causes bleeding, pain, and an unpredictable amount of scarring.

-  SRT requires 12-15 very short visits for treatment. Mohs surgery requires 2 visits, one of which may last all day. If there are unforeseen complications, further visits may be needed and, possibly, treatment by a plastic surgeon.

-  The cost of both types of treatment is about the same and both are covered by insurance.

-  The cure rate of Mohs is slightly higher, but both are above 90%.

-  SRT may increase the likelihood of getting cancer again, decades in the future. (If I’m around then, I expect that there will be much better forms of treatment available.)

For me, the good news was that SRT is available in Indiana. The bad news is that the best qualified facility is in Muncie, more than 2 hours from my house (more like 2.5, with road construction at both ends). But I did it anyway – 14 round trips between late September and early November of last year. The facility had an oncologist to determine the dosage but the actual treatments were done by a technician. At the time of the last few sessions I had some mild bleeding from my nose but that was the only discomfort. I’m so glad I did this!