...... The answer is very complicated and stems from the same answers a patient might have regarding the requested thoroughness of examination. (See Doctor & Patient Examination). Here are some hypothetical answers. One must consider just how long the patient wants to live and what quality of life is desired. Clearly, a 90-year-old man who has severe heart disease and is not expected to live more than a year does not need Mohs Surgery for a basal-cell cancer smaller than the size of a dime on the neck. But a bleeding, infected BCC on his nose might become a painful, non-healing, ulcer in six weeks if treated with liquid nitrogen (cryosurgery) or C&D (scraping and burning). In this special case, Mohs Surgery may be best because it would leave a smaller hole to be sewn. However, if an inoperable (surgery too difficult) squamous-cell cancer is occurring in this 90-year-old's ear, radiation is likely the best treatment. A drawback to radiation is that it will require multiple (20+) treatments at a very high cost. Every case is special and must be weighed by both the patient and the doctor, if possible.

......Nowadays, since President Reagan's bout with skin cancer, younger and/or better-informed patients tend to request Mohs Surgery. The author has noticed a plethora of recurring (failed treatment and returned) skin cancers in younger patients in South Florida whose cancers have been treated with liquid nitrogen or scraping and burning. Is it possible that doctors are being too gentle, treating younger patients with freezing or scraping in order to reduce the size of inevitable scar that results from textbook-exact treatment?

......To answer the question of how much surgery is necessary is not easy and the argument can be debated from several points of view, but here are some guidelines. If you think you are going to live more than five years, you should consider having treatments that are more exact and have higher cure rates, if the cancer occurs on an area of the body that is important to you. When a cancer returns the results can be devastating, deforming and require much greater surgery just to remove the cancer. Just how easy or difficult is the surgery in your chosen doctor's hands?

......When considering what type of treatment you need, don't forget that the average life span of men and women today exceeds 70-80 years and will likely far exceed it for today's 40 and 50 year olds. The problem with avoided or ineffective treatment is that you could end up in a nursing home, 90 years old, with a large infected hole from an even larger tumor. It may not be the tumor itself that hurts you if it becomes long-standing and large; it could be the accompanying infection.

......Government and insurance officials should be careful not to set age limits on types of treatments, forcing patients to have one treatment or another. The author has seen many patients older than 85 who swim, play tennis and conduct complex business. Alternatively, the author has seen many people in their 60's who look, feel and act like what many people would expect from a person older than ninety. Every case is different and we should adapt to this variability. There are many treatments described in this website; knowing them well will help patients protect their own health interests, even if the government and insurance companies won't.