I Have Squamous Cell Carcinoma in SITU on the Tip of my Nose. MOHS or Other Procedure?

Thank you for your question. Typically for this location, Mohs is the best choice for surgical treatment and intervention, as tissue conservation and ultimate cosmetic result (with complete removal of the cancerous tissue) is of utmost importance. For this location, this is usually the best recommendation, for an individual who is otherwise healthy and can handle a surgical procedure. Of course, this usually has to be determined by both the physician and the patient together, on a case by case basis. I hope this helps.

Squamous cell carcinoma in situ are superficial skin cancer that effect the very top layers of the skin. These tumors can sometimes be treated effectively with topical creams, such as imiquimod and 5-fluorouracil, light based treatments like photodynamic therapy, or curettage and electrodesiccation, or a standard surgical excision. When these therapies are used, there is a higher chance of the skin cancer coming back compared to Mohs. Mohs surgery is designed to spare healthy tissue and minimize the amount of surgery required - that's why it's often recommended for areas like the nose tip and other cosmetically sensitive areas. If you are hesitant about undergoing Mohs surgery, I recommend speaking to your physician to see if one of these alternatives might be right for you.

There are many alternatives available for treatment of a squamous cell carcinoma in situ on the nose. Mohs surgery would likely give the highest cure rate and will most completely evaluate the surgical margins and conserve the greatest amount of healthy tissue (compared with surgical excision without Mohs). Other options include curettage and electrodesiccation where the tissue is scraped and burned. That would work, but there is a chance that some of the skin cancer may extend down along hair follicles or oil glands and not be reached by the treatment. Topical therapies like imiquimod or 5-fluorouracil may work, but again there is a risk that the treatment may not reach the cancer cells. Your best option is to discuss with your doctor your particular case and discuss your concerns about Mohs surgery. Good luck. 

you could be a candidate for topical therapy

You should be seen however to ensure the biopsy agrees with the clinical

Dr. Malouf

Historically, this was referred to as Bowen's disease. This refers to intra epidermal squamous cell carcinoma. (This is an actinic keratosis gone bad) Bkz of the superficial nature of this lesion, MOHS surgery is a bit of an overkill. The issue here is that this that this early skin cancer can go down into oil glands and hair follicles and may result in a slightly increased risk of recurrence after non MOHS treatment.

 

Ask your dermatologist about possible alternative treatments including Aldara, photodynamic therapy, and even aggressive cryotherapy. The nice thing about this disease is that it is low risk and if it comes back, more aggressive treatments can be used.

My first question is why you are afraid of Mohs. It has the highest cure rate and will remove the least amount of skin, saving your nose from unnecessary scarring and worse marks. Currettes are fine in many in situ cases, but the problem would be the margins. If the biopsy came back and said the site is fairly deep, a significant amount of tissue may need to be scrapped out, and will leave a hole. You don't suture or close after a currette, it's left open. Plus, the removed skin can't be tested to confirm that all the cancer was removed - so you may be created a big divet, and still end up with cancer there. Topical treatments can be good, but again, it can't be determined that all the cancer will be gone because it gets destroyed in the process. So, again, you'll go through it and just have to hope it's all gone and watch for any site on the nose to reappear. With Mohs, your doctor will remove the most minimum amount of tissue possible, make slides of it, and confirm the cancer is gone (or remove more tissue) before ending the procedure. This is the best way to assure your SCC will be gone!