Mohs Surgery vs. Excision Surgery (My Personal Experience)
My first experience with skin cancer was in 1995, when I received a diagnosis of basal cell carcinoma. I had made an appointment with a dermatologist for a small area under my eye that would bleed and scab over but would never fully heal. I’d never before been to a dermatologist and I went there rather naively, assuming I’d get some sort of cream or lotion to put on the area and all would be well.
Researching skin cancer treatment options
Unfortunately, that is not what happened. The doctor looked at my face and said rather bluntly “You have skin cancer and I’m going to do radiation.” I was shocked to hear that I had skin cancer, but not shocked enough that I readily agreed to radiation. The thought of having radiation so close to my eye was unsettling, and this began my journey of researching skin cancer treatment options. This also began my journey of having surgery to have areas of skin cancer removed.
Experience with cryosurgery and excision surgery
For the first 25 years of my skin cancer, treatments consisted of cryosurgery on areas of actinic keratosis, some laser surgery for precancerous areas and basal cell areas, and excisional surgery for removal of basal cell carcinomas and squamous cell carcinomas. And I was happy (well, relatively speaking) with having excisional surgeries. My doctors have done a great job with them, and I’ve healed well from all of them.
Mohs vs. excision surgery
Then came a basal cell area that was in a spot where I’ve not previously had skin cancer. It was just under my nose, and the diagnosis was an infiltrating basal cell carcinoma. My dermatologist and I were both in agreement that she would not do this surgery, as it was on my face. She wanted me to have Mohs surgery. I wanted an excisional surgery because that’s what I knew. We compromised; she referred me to two plastic surgeons so I could get their opinion, and I would then meet with a Mohs surgeon if necessary.
Why Mohs was the best for my situation
I wasn’t crazy about the first plastic surgeon I met with. We just didn’t click, and I didn’t feel completely comfortable in his ability to do the surgery. I met with the second plastic surgeon, and she said she’d be happy to do an excisional surgery if it were anywhere else but where it was. She told me there wasn’t enough skin and tissue in the area for her to work with and that I needed Mohs. She referred me to a Mohs surgeon whom she highly recommended, telling me that he has thought of innovative ways to perform Mohs and do the closures that even she, as a plastic surgeon, wouldn’t have thought of.
But I still prefer excision
The Mohs surgeon was excellent and I am very happy with how I’ve healed. However, now that I’ve had Mohs, I can honestly say that I still prefer excisional surgeries over Mohs for several reasons.
One is convenience. I can be in and out of my dermatologist’s office in 30-60 minutes for an excisional surgery, including numbing and stitching, and then go into work after. The day I had Mohs, I was at the doctor’s office for seven hours. It took three rounds to get all of the skin cancer and numerous shots to numb me since there were multiple procedures and gaps in time between each procedure. I couldn’t imagine going into work after having that surgery.
The healing from my excisional surgeries seemed faster. When I’ve previously had an excision on my face (performed by my plastic surgeon) to remove skin cancer, within a couple of weeks I was looking almost back to normal. With the Mohs, it was several months before my mouth went “back into place” and the redness in the area subsided.
There was a large difference in cost. With my insurance plan, the excisional surgeries done by my dermatologist in her office cost me $25, which is my copay for an office visit. The bill I received for the Mohs surgery was almost $14,000 total, and my portion was over $2,200.
I’ve heard that Mohs is the gold standard as far as cure rate, but an excisional surgery also has a high cure rate. I’ve never had skin cancer come back after I had an excisional surgery to remove it.
For me, the benefits of excisional surgery outweigh the benefits of Mohs surgery. It’s important to keep in mind, though, that sometimes we don’t really have a choice (like in my instance). If you need surgery, talk with your dermatologist about treatment options. You may find out that you have more than one choice, and you can then make the decision based on what you are most comfortable with.
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