Basal Cell Carcinoma: Should I get Mohs Surgery or Radiation Therapy?

Posted on: February 15th, 2023 by Our Team

As a fellowship-trained Mohs surgeon at Phoenix Surgical Dermatology Group, I frequently am asked about radiation therapy instead of Mohs surgery for my basal cell carcinoma. I hope this blog article can help delve into the differences between these two treatment modalities.

Mohs micrographic surgery is a specialized surgical technique used to treat skin cancer, particularly basal cell carcinoma (BCC). It is considered the standard gold treatment for BCC due to its high cure rates and ability to preserve healthy tissue. In contrast, radiation therapy has been traditionally used to treat BCC. Still, it is less effective and carries a higher risk of complications. Here, we will delve into the details of these two treatments and explain why Mohs micrographic surgery is superior to radiation therapy for BCC.

What is Mohs micrographic surgery?

Mohs micrographic surgery is an exact and specialized surgical technique to remove skin cancer. It was developed by Dr. Frederic Mohs in the 1930s and has since become the most effective treatment for BCC and other types of skin cancer.

During Mohs surgery, the surgeon removes the cancerous tissue layer by layer and examines each layer under a microscope to ensure that all cancerous cells have been removed. This allows the surgeon to precisely target and remove cancerous tissue while sparing as much healthy tissue as possible.

What is radiation therapy?

Radiation therapy is a treatment that uses high-energy beams, such as X-rays, to destroy cancer cells. It can be administered externally, using a machine that directs the beams at the cancerous tissue, or internally, using a device that delivers radiation directly to the cancerous area.

Radiation therapy is traditionally used to treat various types of cancer, including BCC. In addition, it is often used in cases where the tumor is unsuitable for surgery or when the patient is not a candidate for surgery due to underlying health conditions.

Why is Mohs micrographic surgery better than radiation therapy for BCC?

1. Higher cure rates: Mohs micrographic surgery has consistently shown higher cure rates for BCC than radiation therapy. One study found that Mohs surgery had a cure rate of 99% for BCC, while radiation therapy had a cure rate of 80-90%. Mohs surgery is much more effective at removing cancerous tissue and preventing recurrence.
2. Spares healthy tissue: Mohs micrographic surgery is known for preserving healthy tissue. During the procedure, the surgeon removes the cancerous tissue layer by layer and examines each layer under a microscope to ensure that all cancerous cells have been removed. This allows the surgeon to precisely target and remove cancerous tissue while sparing as much healthy tissue as possible.

In contrast, radiation therapy can damage healthy tissue surrounding the cancerous area, leading to side effects such as skin irritation, scarring, and loss of function in the treated area.

1. Shorter treatment time: Mohs surgery is typically a one-day procedure, while radiation therapy can take several weeks or even months. Mohs surgery is a more convenient and efficient treatment option for patients.
2. Lower risk of complications: Mohs micrographic surgery has a lower risk of complications than radiation therapy. Complications from radiation therapy can include skin irritation, scarring, and loss of function in the treated area. In rare cases, radiation therapy can also lead to more severe complications, such as secondary cancers.
3. More cost-effective: Mohs micrographic surgery is often more cost-effective than radiation therapy, particularly in the long term. This is because Mohs surgery has a higher cure rate, which means there is a lower risk of cancer recurring and requiring additional treatment.

As with any medical treatment, the decision to undergo radiation therapy or Mohs micrographic surgery for basal cell carcinoma (BCC) should be based on individual factors and be made in consultation with a qualified healthcare provider. Mohs micrographic surgery is generally considered the gold-standard treatment for BCC due to its high cure rates and ability to preserve healthy tissue. However, there may be certain situations where radiation therapy is the more appropriate treatment option. Here are a few reasons why someone might choose radiation therapy over Mohs surgery for BCC:

1. The cancer is unsuitable for surgery: In some cases, the location or size of the tumor may make it problematic. In these situations, radiation therapy may be the preferred treatment option.
2. The patient is not a candidate for surgery: Certain medical conditions or other factors may make a patient unsuitable for surgery. In these cases, radiation therapy may be the safest and most effective treatment option.
3. The patient prefers radiation therapy: Some patients may choose radiation therapy over surgery due to factors such as the shorter individual treatment time.
4. The patient prefers non-invasive treatment: For some patients, the thought of undergoing surgery may be anxiety-provoking or undesirable. In these cases, radiation therapy may be a more appealing treatment option due to its non-invasive nature.

It is important to note that radiation therapy is generally less effective and carries a higher risk of complications than Mohs micrographic surgery for BCC. However, it may be the most appropriate treatment option in certain situations based on the individual patient’s circumstances.

As with any medical decision, it is essential to carefully consider each treatment option’s pros and cons and consult with a qualified healthcare provider before making a decision. At Phoenix Surgical Dermatology Group, we specialize in skin cancer. Schedule a consultation today.