resconstruction of nose after mohs

My daughter has noduloinfiltrative basal cell carcinoma on her nose.  We visited two plastic surgeons for the reconstruction after seeing two mohs surgeons.  They talked about a "flap".  I need the name of someone in south florida that specializes in reconstruction with a good reputation.  She is only 31 and will be getting married in a year and would like to have the least visible scar possible.  One mohs surgeon suggested that it would be best to heal by itself if not too much needs to be removed versus plastic surgery.  I tend to agree.  He said that in the future she can have the plastic surgery but she doesn't agree with that.  The name of the top guy down here would be helpful and if anyone's had experience and can share some information, it would be grreatly appreciated.

[Winikor]

We have now seen the Chief of Plastic Surgery at UM.  I had done some research and found that radiation may be a good option for the type of cancer she has (see my post on March 13).  After examining her and looking at the biopsy, he said that radiation may be the better way to go, being that her leision is infiltrative/nodular (although he did say he wanted to see the slides of the biopsy, which we are waiting for).  He discussed with us the different surgery options, none of which will have great results if that's what ultimately has to be done being where the leision is located.  We went back to the dermatologist who originally took the biopsy and he agreed that radiation may very well be a good option.  None of the other doctors we saw discussed radiation, only Aldara chemo, which is not an option for the type of basal cell my daughter has.  I would liket to know if you have seen radiation work on this type of basal cell and what, if any, have the results been and have there been any scarring and/or adverse effects.
Thank you.

[Bhupinder Kaur, MD]

Hello,
Infilterative basal cell carcinoma is the most aggressive of basal cell carcinoma but they are radiosensitive. It can be used for advanced and extended lesions and in patients for whom surgery is not suitable (e. g, because of allergy to anesthetics, current anticoagulant therapy, a tendency to form keloids or facial tumors). For cosmetic results, radiotherapy is better but this depdns on the staging of the malignancy and biopsy cell reports. I agree with your daughter’s oncologist that a look at the biopsy slides will give a better idea.

It is very difficult to precisely confirm a diagnosis without examination and investigations and the answer is based on the medical information provided. For exact diagnosis, you are requested to consult your doctor. I sincerely hope that helps. Take care and please do keep me posted on how you are doing.

[Winikor]

I'm sorry it took me so long to see your response to my post and I thank you so much for it.  We went to see the Chief of Dermatology at UM and he said that he wanted to try interferon before doing radiation.  He had reviewed the slides and agreed that she needed treatment to shrink the cells.  As it happens, interferon was recalled and now my daughter cannot fill the prescription (we don't know why it was recalled).  Therefore, now he suggested we go see the radiologist oncologist to discuss radiation.  The biopsy was taken at the beginning of January and here we are in May.  I am afraid that this has spread and needs immediate treatment.  In the news this past week, the new "vaccine" for prostate cancer (provenge?) is said to help with skin cancer.  I would like your opinion on this.  The problem is that this will probably not be available anytime soon.
The information you provided was very helpful and I truly appreciate your response.
Thank you again.

[Bhupinder Kaur, MD]

Hello,
Thanks for the update. The vaccine for prostate cancer has got FDA approval but it is still to be marketed. It is not used for basal cell carcinoma. However there is a proposal for a vaccine for skin malignancies but it is still in the research phase.
I hope it helps. Take care and regards.

[Winikor]

Dear Dr. Kaur:

We have now seen the Chief of Dermatology at UM who looked at the slides and determined that what my daughter has is morpheaform bcc.  We went to see the Radiologisit/Oncologist at UM (Dr. Wolfson) who told us that he would use external beam radiation for 4 to 5 weeks and that she would have excellent results with minimum risk.
My daughter's fiancee took her to a top dr. in NYC who is against radiation.  This dr. said that radiation could miss one of the cells and she would have a problem later on that would be much worse than what she has now and suggested mohs surgery.  My daughter is still very apprehensive because she has seen pictures of the flaps they would have to do in order to repair the nostril.  What is your opinion on radiation for morpheaform on the nostril?  My daughter says that this had been bleeding for over a year and she just neglected it.  Thank you in advance for any help you can give us.

[Winikor]

My daughter had the mohs surgery.  We were very fortunate, they only had to go in twice.  She has had the reconstruction but that hasn't gone so well.  She had a skin graft from behind the ear.  She had the stitches taken out two days ago and the dr. said that parts of the skin graft did not "take".  What exactly does that mean?  How will this affect the outcome?  Will this have to be done again?

Thanking you in advance for your reply.

[Winikor]

Just wanted to post an update on my daughter.  She had quite a bit of trouble with the skin graft but eventually it all healed.  She developed a keyloid and has been treated for it several times.  Aestethically she's not happy, but I think she looks great.  However, she was just diagnosed with Infiltrative basal cell carcinoma on the top of her nose (on bone between the eyes).  I don't really understand what that is and when I google it, the info I get goes to malenoma?
She was told by her dermatologist that this is an aggressive form of BCC but I know that "infiltrative" means deep.  How common is this?  Right now she's being greated with Aldara for 2 weeks to bring the bcc to the surface and then a biopsy will be done.  Just wanted to know where I can get some good info in this type of bcc.  Any light you can shed on the subject, or anyone for that matter, will be greatly appreciated.