Has Anyone Had a Basal Cell Removed?

[+ FreshFluff]

So I had my annual skin exam on Thursday, and my derm found something on my upper back that may be a small basal cell. He took a biopsy, and I'll get the results back on Tuesday.

 

Basal cells are not malignant but do need to be removed. So my main concern, if it's a basal cell, is avoiding or minimizing scarring from the removal process. After doing some reading, I'm confused about the different extraction methods and which are less likely to leave a scar. The only thing that's clear is that superficial BCs can be removed in less invasive ways than deep ones.

 

If you've had a basal cell removed, was it extracted, frozen off, or burned off? Or did you use the Effudex cream? How was the scarring as a result?

[Ronp608]

Mine, near the tip of my nose, was extracted, sliced ... Only a slight indentation remains ... No probs

[doitb4ugo]

My wife has had 3 surgeries on her face. the treatment type was called Mohs surgery where layer by layer of skin was removed and examined until no cancer remained. the results were excellent and left no visible scar on her face after several months of healing. It is one of the least invasive sugical options. Hers was performed by a plastic surgeon who specializes in this procedure....

[EZEtoGRU]

I had one removed from my shoulder 4-5 years ago. I have to be honest, it left a slightly reddish mark....although no indentation. I am totally OK with how it turned out. How timely your thread is. I'm seeing my skin doctor on Tuesday after two years of not seeing him.

[ErieBear]

I need to correct something that you said. Basal cell is considered cancerous, but most of the time, it's caught early and it's not a big deal. It's considered the best case scenario of all the skin cancers. The others being squamous cell and melanoma. Generally basal cell and squamous are removed, they check the edges to make sure that they got it all, and it's done forever. But you do need to be checked frequently for other sites that might break out.

[MscleLovr]

I had one on the side of my nose removed. No scarring but I went to a plastic surgeon for the removal.

[+ Charlie]

I had one removed from my nose. The doctor recommended that he harvest skin from inside my ear for a graft, since it was such a prominent place. The result was smooth, but the ear skin is slightly different color from the nose, which bothers me, even if no one else seems to notice. by the, it's worth noting that insurance will pay for the MOHs surgery, but may not pay for the cosmetic work afterward, so if it is on your back, it might not be worth doing too much.

[jeepman]

I had one removed from my chin last year. The doctor, as was I, was concerned about scarring because the cell was rather large and had to be extracted as opposed to other methods. My dermatologist made arrangements with a plastic surgeon who would close the wound after the cell was extracted. Both took their time to make sure the entire cell was removed and the scarring was minimal. The scar basically follows the line on my chin below my lip and is hardly noticeable and I am very happy with the results even thoughI know the scar is there. Talk to the doctor who will do the procedure and express your concerns about the scarring issue but in the final analysis, be more concerned about making sure the cell was totally removed even if a small scar will be noticeable. Good luck.

[Guest]

So I had my annual skin exam on Thursday, and my derm found something on my upper back that may be a small basal cell. He took a biopsy, and I'll get the results back on Tuesday.

 

Basal cells are not malignant but do need to be removed. So my main concern, if it's a basal cell, is avoiding or minimizing scarring from the removal process. After doing some reading, I'm confused about the different extraction methods and which are less likely to leave a scar. The only thing that's clear is that superficial BCs can be removed in less invasive ways than deep ones.

 

If you've had a basal cell removed, was it extracted, frozen off, or burned off? Or did you use the Effudex cream? How was the scarring as a result?

 

Your dermatologist may have used a euphemism in order not to scare you. "Basal cell" is really short for "basal cell carcinoma," which is indeed a cancer, although not the killing kind. It's incredibly common--almost one in three Caucasians gets one during his lifetime. Although it is a cancer, it doesn't metastasize, or spread to other parts of the body. It will continue to grow locally, though, until it's cut out. It almost never kills, though, except in severely psychotic or profoundly mentally retarded people, who might completely ignore it or even wear a scarf to cover it up. I did once see the picture of a crazy person who literally let it eat through his skull and eye socket.

Although cryosurgery (freezing) or 5FU (Efudex) can theoretically be used, they definitely don't work 100% of the time, and, in practice, I rarely have seen them used. Mohs surgery is the most cosmetically efficient way of taking it out and being 100% sure you have it out, but insurance companies most often will only pay for this in cosmetically sensitive areas, i.e. the face. Usually in a less cosmetically sensitive area, traditional surgery is used, perhaps with a plastic surgeon. You could use 5FU to shrink the tumor prior to surgery, but it's nice to have a pathologist actually look at a tissue sample and say "Yes, you have it all out."

[seeker630]

My father had a basal cell carcinoma removed from his forehead about 5 years ago with the Mohs procedure and it did leave a half-inch scar, although it's not that visibleunder most conditions.

 

But this thread is good reminder to everyone to have anything suspicious checked out. Last year, my father's dermatologist found a melanoma on his face, on his right cheek below the eye. We scheduled Mohs surgery immediately and they made 4 ever-larger excisions before stopping because they were in the edge of the eye. Because of the size of the wound, the doctor sent us to the head of plastic surgery at Wake Forest University Baptist Hospital the next day. They grafted on a layer of artificial skin to fill the wound and then later a skin graft from his thigh. We had a third surgery to correct some eyelid problems caused by the pulling of the skin graft.

 

I think this melanoma was at the site of a small excision performed some years previously; I think they didn't get it all the first time!

[+ FreshFluff]

Thanks, everyone. I really appreciate all the responses. DoIt, it's great to know that your wife managed to avoid scarring. Ron, MscleLover, and Charlie I know that the nose is an especially tricky area to remove it.

 

The description my doctor gave me ("It could also be sebhorroic dermatitis") is apparently how superficial basal cells on the back often look.

 

Unicorn, thanks for the information. My mom's derm, who specializes in skin cancer work, has exclusively done cryosurgery on her. Let's say the cryosurgery doesn't get it all, and you catch it again in an exam 2 years later. Would that be problematic?

 

Also, Harvard Medical School's site mentioned electro-cauterization as one way to remove BCs. Has that been effective in your experience?

 

I'd be happy to pay for Mohs if it means less scaring. Re my derm, his work is probably at least 50% cosmetic and he did a great job with electro-cauterization of a sebbhoroic dermatitis bump on my face, so I trust him in that regard. But I don't know how much Mohs work he's done.

[Guest]

Thanks, everyone. I really appreciate all the responses. DoIt, it's great to know that your wife managed to avoid scarring. Ron, MscleLover, and Charlie I know that the nose is an especially tricky area to remove it.

 

The description my doctor gave me ("It could also be sebhorroic dermatitis") is apparently how superficial basal cells on the back often look.

 

Unicorn, thanks for the information. My mom's derm, who specializes in skin cancer work, has exclusively done cryosurgery on her. Let's say the cryosurgery doesn't get it all, and you catch it again in an exam 2 years later. Would that be problematic?

 

Also, Harvard Medical School's site mentioned electro-cauterization as one way to remove BCs. Has that been effective in your experience?

 

I'd be happy to pay for Mohs if it means less scaring. Re my derm, his work is probably at least 50% cosmetic and he did a great job with electro-cauterization of a sebbhoroic dermatitis bump on my face, so I trust him in that regard. But I don't know how much Mohs work he's done.

 

One has to have special training to do Mohs. Seb derm is easily removed by any method. It would take talent to leave a scar. The last seb derm I had, I just ripped off in the shower. It bled, of course, but I just put a band-aid on it. There is no chance a seb derm can become cancerous. If money is of no object, by all means get the Mohs. I'm not quite sure what your concern might be for a scar on your back, but, hey, it's your body and your money. I'm not familiar with electro-cauterization for BCC, but that doesn't mean it's not effective. I just don't happen to know anyone who's had it.

According to Wikipedia:

Electrodesiccation (EDC) is accomplished by using a round knife, or curette, to scrape away the soft cancer. The skin is then burned with an electric current. This further softens the skin, allowing for the knife to cut more deeply with the next layer of curettage. The cycle is repeated, with a safety margin of curettage of normal skin around the visible tumor. This cycle is repeated 3 to 5 times, and the free skin margin treated is usually 4 to 6 mm. Cure rate is very much user-dependent and depends also on the size and type of tumor. Infiltrative or morpheaform BCCs can be difficult to eradicate with EDC. Generally, this method is used on cosmetically unimportant areas like the trunk (torso). Some physicians believe that it is acceptable to utilize EDC on the face of elderly patients over the age of 70. However, with increasing life expectancy, such an objective criterion cannot be supported. The cure rate can be low or high, depending on the aggressiveness of the EDC and the free margin treated. Some advocate curettage alone without electrodesiccation, and with the same cure rate.[41]

In other words, this method doesn't seem to have either the sure-fire cure rate of surgery, or a cosmetically superior result. So I'm not quite sure what the advantage is. If the best cosmetic result is your goal, and money is of no object, go for the Mohs. You might use the 5FU first if the lesion is big, in order to shrink the tumor.

[traveler1954]

Basal Cell Carcinoma are malignant skin cancers which metastasize rarely but do invad

 

So I had my annual skin exam on Thursday, and my derm found something on my upper back that may be a small basal cell. He took a biopsy, and I'll get the results back on Tuesday.

 

Basal cells are not malignant but do need to be removed. So my main concern, if it's a basal cell, is avoiding or minimizing scarring from the removal process. After doing some reading, I'm confused about the different extraction methods and which are less likely to leave a scar. The only thing that's clear is that superficial BCs can be removed in less invasive ways than deep ones.

 

If you've had a basal cell removed, was it extracted, frozen off, or burned off? Or did you use the Effudex cream? How was the scarring as a result?

 

I am a surgeon who treats this pests. Most are caused by chronic sun exposure. The can be nasty on nasal tip, ears and central face, eyelids, lips; areas where you want full removal without losing too much normal tissue, which can cause a deformity, yet wanting to avoid recurrences. Rarely large, invasive basal cell carcinomas, including recurrent ones, can be fatal, burrowing into the brain or other critical area. That's where one should chose Mohs technique which allows precise removal. On extremities and the trunk, a small area of normal tissue around the lesion can be included with the tumor, submitted for simple frozen section to ascertain that the lesion is gone. Then any larger open defects on the back or extremities extremities are best left open to allow them to heal on their own. They are not sutured but cared for with cleanliness and dressing changes. They leave remarkably little scarring. Those treated by a dermatologist using electrodessication and curettage, leave depressed, white, unsightly scars. Some with complex defects left by Mohs technique, like the superficial nasal tip, may also be also left open to heal spontaneously or closed with a small flap. Those that are very large or expose deep, critical structures are closed on the spot by plastic techniques, that including grafts and flaps. Electro dessication, 5FU (topical chemo) and other topical agents and cryosurgery just do not have the accuracy in eradicating all types of BCC with near 100% efficiency.

[+ FreshFluff]

Thanks, I appreciate the input. I'm sure this guy does plenty of Mohs work. Who, in your opinion, is the best doctor for Mohs removal in NYC?? Feel free to PM me. (I'll also look online once the results come back.)

 

There is no chance a seb derm can become cancerous. If money is of no object, by all mans get the Mohs. I'm not quite sure what your concern might be for a scar on your back, but, hey, it's your body and your money. I'm not familiar with electro-cauterization for BCC, but that doesn't mean it's not effective. I just don't happen to know anyone who's had it.

 

I'd be less concerned if I were a man. As a female, my shoulders and upper back are on display every time I wear a dress or a camisole top, which is nearly every time I have an evening out. Money is certainly an object:), but it's an object I'll spend to minimize scarring in such a visible area.

 

As for seb derm: I had it removed by electrocauterization, which is the popular method of removing it. In any case, I'd say that this doctor is skilled overall, but like you say, I'd prefer to have someone who does a lot of Mohs.

[+ FreshFluff]

I am a surgeon who treats this pests. Most are caused by chronic sun exposure. The can be nasty on nasal tip, ears and central face, eyelids, lips; areas where you want full removal without losing too much normal tissue, which can cause a deformity, yet wanting to avoid recurrences. Rarely large, invasive basal cell carcinomas, including recurrent ones, can be fatal, burrowing into the brain or other critical area. That's where one should chose Mohs technique which allows precise removal. On extremities and the trunk, a small area of normal tissue around the lesion can be included with the tumor, submitted for simple frozen section to ascertain that the lesion is gone. Then any larger open defects on the back or extremities extremities are best left open to allow them to heal on their own. They are not sutured but cared for with cleanliness and dressing changes. They leave remarkably little scarring. Those treated by a dermatologist using electrodessication and curettage, leave depressed, white, unsightly scars. Some with complex defects left by Mohs technique, like the superficial nasal tip, may also be also left open to heal spontaneously or closed with a small flap. Those that are very large or expose deep, critical structures are closed on the spot by plastic techniques, that including grafts and flaps. Electro dessication, 5FU (topical chemo) and other topical agents and cryosurgery just do not have the accuracy in eradicating all types of BCC with near 100% efficiency.

 

Thanks for this detailed account, traveler. I haven't had chronic sun exposure in that area, but I did have a bad sunburn when I was 18 and spent several summers on the swim team as a child. Since then, that area has been covered by hair plus sunscreen most of the time, so it's gotten no color.

 

When you say "They leave remarkably little scarring," are you talking about the Mohs technique or simple extraction?

[Professor Mitch]

I had a MOHs procedure done by a plastic surgeon last June on a small spot near my left ear. I went immediately when it appeared , but it was quite deep, and the procedure left a 3/4 inch scar which has faded over time. She offered post-op plastic surgery on the scar, but it is so close to my hair line I declined. However, be prepared. This small spot resulted in a wound that took 20 stitches to close. Basal Cell is nothing to fool around with.

[Diverdan]

I too have had MOHs surgery to remove a basal cell on my face very near the nose. The dermatologist was a specialist in MOHs surgery, and I have no scar, in fact sometimes I have a hard time remembering exactly where it was. Others have described the surgery already, so I won't repeat anything. It is really the only way to know that all the cancerous cells have been removed, as they keep going until there are no cancerous cells remaining. I asked my surgeon why she took what seemed to me to be a relatively long time, and she replied, I never want a patient of mine to have a scar or have it return on the site where it was removed! It can return, but not in the same place if the surgery is done properly. Basal cell is very frequent and most insurance companies discount it when they ask if you have ever had "cancer" because it does not indicate any long term issues, as other cancers may.