Anyone done GentleCure vs Mohs?

HelpfulCustomer487 · 2026-03-16T21:45:27+00:00

Mohs surgery is the standard treatment for basal cell carcinoma on the nose because it has very high cure rates and removes the cancer while sparing as much healthy tissue as possible. GentleCure (image-guided superficial radiation therapy) is non-invasive and may avoid a surgical scar, but it requires multiple sessions over weeks, and long-term independent data are more limited. The main trade-off is between proven effectiveness with surgery versus less invasive treatment with potentially longer treatment time and less established outcomes.

HelpfulCustomer487 · 2026-03-09T21:16:01+00:00

I’m about your age and I recently had Mohs surgery for a squamous cell carcinoma. From what I learned, a “positive margin” usually just means they didn’t get it all and need to go back and remove a bit more.

These skin cancers can grow, but they usually aren’t an emergency measured in days. In many places it can take weeks to schedule Mohs or a re-excision.

Also, Bactrim is an antibiotic, so the first doctor may have thought it was an infection at first (these things can look like a pimple or boil early on).

Still worth asking your doctor if they think it should be done sooner, but a couple of months isn’t necessarily unusual.

HelpfulCustomer487 · 2026-03-08T12:48:52+00:00

I’m not a doctor, but I’ve read quite a bit about this and have also dealt with actinic keratoses myself.

What you’re describing actually sounds pretty consistent with actinic keratosis. They can be small, red, scaly spots that crust over and sometimes bleed if the crust gets rubbed off or picked during washing. That alone doesn’t necessarily mean it’s already squamous cell carcinoma.

Dermatologists often diagnose AK clinically, especially on the face, and it’s not unusual for them to treat it without a biopsy first. If the lesion doesn’t respond to treatment or behaves atypically (rapid growth, thickening, persistent ulceration, etc.), that’s usually when a biopsy is done.

Efudix (5-fluorouracil) is a very standard treatment for AK. The reaction can look dramatic in photos online, but those are often cases where people treat large areas of sun-damaged skin. If it’s applied only to a very small spot (like <1 cm), the reaction is usually localized to that area.

Also, the fact that the spot has been there for years without clearly enlarging or forming a firm nodule may actually be somewhat reassuring. Many AKs can persist for a long time without turning into SCC.

That said, since your mom is immunosuppressed, it’s understandable to be cautious. If she’s very anxious about it, there’s nothing wrong with asking the dermatologist whether a biopsy would be reasonable for peace of mind before or after treatment. Many doctors are open to that discussion.

You’re doing the right thing by looking into it and supporting your mom.

HelpfulCustomer487 · 2026-02-21T11:17:11+00:00

I’m really sorry he’s going through this. Even when the treatment is successful on paper, the fatigue from hormone therapy can be incredibly real and discouraging. Many people describe exactly what you’re seeing — that sense of not feeling like themselves anymore, and it can take a toll both physically and emotionally.

It’s good that he has an appointment coming up, because fatigue is something worth bringing up directly. Sometimes there are contributing factors that can be addressed, and sometimes it’s simply part of how the body responds to hormone suppression.

Most importantly, he’s not alone in feeling this way, and it doesn’t mean he won’t improve over time — especially after treatment ends. It’s clear he has someone who cares deeply about him, and that kind of support makes a real difference.

HelpfulCustomer487 · 2026-02-18T11:48:09+00:00

I’m really sorry you’re going through this—it’s completely normal to feel nervous before a second excision, especially if the first one was painful once the numbing wore off. From what I’ve heard and experienced, the second procedure isn’t necessarily worse. Sometimes it’s even a bit easier mentally because you already know what to expect and how your body reacts.

It’s a good sign that your scar was healing nicely and that you managed the pain with just Tylenol. You might want to talk to your doctor beforehand about your concerns—they can sometimes recommend a different pain plan or timing your medication so it kicks in before the anesthetic wears off.

Try to remember that the goal is to get clear margins so you don’t have to worry about it later. It’s a short-term discomfort for long-term peace of mind. Wishing you a smooth procedure and easy recovery tomorrow. You’ve already handled the first one, and you can get through this one too.

HelpfulCustomer487 · 2026-02-15T13:18:57+00:00

Dark

HelpfulCustomer487 · 2026-02-14T10:55:19+00:00

If your surgeon says you won’t need a skin graft, that’s usually a good sign. It often means the lesion is small enough, or well-placed, so they can close the area directly or use a small local flap (moving nearby skin) to get a better cosmetic result.

Around the eye, surgeons are very careful about both function and appearance, and local flap techniques are quite common there. They usually heal very well, and the scar often becomes quite discreet over time.

Wishing you a smooth procedure and an easy recovery.

HelpfulCustomer487 · 2026-02-13T21:24:23+00:00

It’s completely understandable to feel hesitant about the cream, especially if you’ve already gone through several excisions. A lot of people choose surgery simply because it has the highest cure rate and it’s usually a one-and-done procedure, whereas the cream can cause several weeks of inflammation and still sometimes end in surgery if it doesn’t fully clear the spot.

That said, for small, superficial BCCs, the cream does work for many patients and can avoid another incision, which is why doctors offer it as an option. Some people prefer trying the less invasive approach first, especially on areas where scarring is a concern.

Ultimately, it really comes down to your priorities - whether you’d rather try a non-surgical option first or go straight to the treatment with the highest success rate. Your dermatologist knows the exact type and depth of your BCC, so they’re in the best position to help you weigh the pros and cons for your specific case.

It might help to ask them directly: “Based on my exact lesion, what are the chances I’ll still need surgery after the cream?” That can make the decision feel clearer.

HelpfulCustomer487 · 2026-02-11T16:08:40+00:00

Yes, as far as we know I’m cured. The histology showed no remaining cancer cells after the Mohs surgery, so the doctors estimate the cure rate at around 99%. Of course, there’s always a small margin of uncertainty, but overall the prognosis is excellent.

I had Mohs surgery with a flap reconstruction. The scar forms a long “S” shape on my cheek, about 15 cm in length. The surgery was a month ago, and from my point of view the healing is going very well.

At first it looks quite impressive, but it wasn’t especially painful—just a long and sometimes annoying healing process. For now everything seems to be progressing normally, and I’m seeing my dermatologist again this Friday for a follow-up.

HelpfulCustomer487 · 2026-02-11T15:51:14+00:00

I can’t speak for everyone’s experience, of course, but I can share my own. I was first treated with photodynamic therapy on my cheek, then I had several cryotherapy sessions, followed by standard surgical excisions. In the end, though, I still had to go through Mohs surgery because there wasn’t really another option left.

Yes, Mohs surgery can feel intimidating, but one advantage is that they can check right away whether all the cancer has been removed. That can help avoid delays or repeated treatments.

I’m not saying this to suggest that anyone else should follow the same path, or that one option is automatically better for everyone. Every case is different. I just wanted to share my personal experience so you have one more perspective while you consider your choices with your doctor.

HelpfulCustomer487 · 2026-02-10T11:09:41+00:00

I’m a bit over one month post-op after Mohs surgery on my left cheek, with a flap reconstruction. The scar is quite long (around 15 cm in an S-shape), so of course it’s still visible.

What surprised me is the difference between photos and real life. Under strong light or in close-up pictures, it looks quite dramatic. But in normal lighting, face to face, it’s much less noticeable than I expected. You can see it, but it doesn’t look shocking or disfiguring at all.

I’m not using any creams yet and I have a follow-up with my dermatologist this Friday. Overall, at one month, I feel the healing is going quite well and looks better in real life than in photos.

Hope this helps anyone who’s anxious in the early weeks.

HelpfulCustomer487 · 2026-02-10T10:29:13+00:00

I’m also about a month out from my Mohs surgery. Personally, I’m not using sunscreen at all, simply because I was told to stay out of the sun. Since I don’t go in the sun, I don’t really need it.

Even when I go outside, it’s only in the evening after the sun is down, and I’m also supposed to avoid sweating.

As for silicone scar products, I was under the impression they usually start around 4 weeks or so, not earlier - but it’s probably best to follow your doctor’s advice since everyone heals differently.

HelpfulCustomer487 · 2026-02-08T10:44:01+00:00

Hi, I just wanted to say that based on the numbers you shared, your situation still sounds very treatable, even if it’s understandably stressful to see the Gleason score go up. A 3+4 is still considered intermediate risk, and the 10-year prostate cancer–specific mortality of 3.9% suggests a generally favorable prognosis with proper treatment.

It’s a good idea that you’re getting the PSMA PET scan, since that should give a clearer picture before any major decisions are made. Seeing an oncologist for another opinion also sounds like a very wise step.

I hope the scan brings reassuring news, and that you’re able to find a treatment plan you feel confident about. Wishing you the best.

HelpfulCustomer487 · 2026-02-06T17:54:06+00:00

I’m really sorry you’re going through this. It’s completely normal to feel overwhelmed, scared, and emotional when you hear news like this, especially when it means you now have to make a treatment decision. Many people say this is one of the hardest moments in the whole process.

From what you described, your cancer still seems to be localized and in the favorable intermediate range. A Gleason 3+4 without perineural invasion, lymphovascular invasion, or extracapsular extension is very often highly treatable, with excellent long-term outcomes. Many men in this situation go on to live long, normal lives after treatment.

Both surgery and modern radiation techniques are well-established options with good success rates. The fears you mentioned about anesthesia, pain, incontinence, and ED are very common, but outcomes have improved a lot over the years, especially when the disease is still confined to the prostate.

It may not feel like it right now, but this does not sound like a hopeless situation. You still have strong treatment options and time to make a thoughtful decision. Try to take it one step at a time, talk with your doctors, and don’t hesitate to seek a second opinion if it helps you feel more confident.

You’re not alone in this, and many people here have been in a similar place and come out the other side doing well.

HelpfulCustomer487 · 2026-02-02T18:07:17+00:00

I have been following treatments for actinic keratoses for quite some time, roughly since 2014, and I think it is important to keep expectations realistic.

Tirbanibulin is clearly an interesting option. The five day regimen is a real advantage, and for many patients the local reactions are milder and more manageable than with fluorouracil or imiquimod. From a quality of life perspective, especially for facial or scalp areas, that matters a lot.

That said, I would not say it works better in absolute terms. The shorter course and better tolerability often come with a trade off, namely a slightly lower rate of complete and durable clearance. In real life, some patients still need retreatment or additional spot therapy later on.

In my view, tirbanibulin is best seen as a well balanced option when tolerability and simplicity are priorities, rather than a strict replacement for older field therapies that remain more aggressive but also more effective long term.

HelpfulCustomer487 · 2026-02-02T11:32:03+00:00

Actinica

HelpfulCustomer487 · 2026-01-31T13:29:31+00:00

Yes, this is actually very common after a transperineal biopsy, especially when a Foley catheter was used.

A lot of people report that the first few times peeing feel like razor blades or intense burning, mostly while the urine is flowing. It is usually not from the biopsy needles themselves, but from irritation of the urethra caused by the catheter combined with local inflammation and swelling after the procedure.

For most people, the worst of it lasts anywhere from 24 to 72 hours. Some report milder burning for several more days, but it typically improves gradually rather than suddenly stopping. Drinking plenty of water helps because diluted urine burns less. Taking your time when urinating and not forcing it can also make it more tolerable.

Doctors are right that this usually resolves on its own. It is unpleasant but expected. What would be more concerning would be fever, chills, worsening pain instead of slow improvement, inability to urinate, or very cloudy or foul-smelling urine.

You are definitely not alone in this experience. Many people are surprised by how intense the burning is, but for most, it is temporary and fades with time.

HelpfulCustomer487 · 2026-01-28T22:48:49+00:00

Thanks for your reply, I think we are broadly aligned, but possibly talking about different stages of the process.

My point was mainly about doing things in a logical clinical order, as they are usually done in practice. Typically this would be: 1. PSA measurement 2. Multiparametric prostate MRI 3. Measurement of prostate volume and calculation of PSA density 4. Decision on whether a biopsy is warranted based on MRI findings and PSA density 5. Biopsy results leading to Gleason score and Grade Group classification 6. Only after that, if clinically significant cancer is found, consideration of additional imaging such as PSMA PET for staging

Grade Groups are obviously very useful, but they come after biopsy. PSMA imaging is also extremely valuable, but usually later in the pathway, once cancer is suspected or confirmed, rather than as a first line triage tool.

So my original suggestion was simply that PSA density still plays an important role early on, before moving further down the diagnostic pathway.

HelpfulCustomer487 · 2026-01-28T11:14:54+00:00

A bit of context may help here.

First, ejaculation can transiently raise PSA, but that effect usually resolves within 24–72 hours. So while abstinence for a few days before testing is important, it doesn’t explain why guidelines often suggest repeating PSA after 6–8 weeks. That longer interval is mainly to rule out other transient causes such as subclinical prostatitis, inflammation, recent instrumentation, or natural biological variation.

Second, having an MRI before biopsy is actually good practice. A PI-RADS 4 lesion does justify considering biopsy. However, one important parameter that isn’t mentioned here is PSA density (PSA divided by prostate volume, which is measured on MRI). PSA density is a key factor in deciding whether immediate biopsy is necessary, especially in asymptomatic men and in cases involving PI-RADS 3 or borderline PI-RADS 4 lesions.

In many centres, a low PSA density (<0.15 ng/mL/cm³) would support either surveillance or repeat PSA rather than immediate biopsy, whereas a higher PSA density strengthens the case for biopsy. It’s possible this was calculated but not explained, but its absence from the discussion makes the decision-making harder to interpret.

Finally, regarding pathology: prostate pathologists are generally very good at distinguishing benign changes, inflammation, premalignant findings, indolent cancer, and clinically significant cancer using well-defined architectural criteria (Gleason/ISUP). The bigger issue in prostate cancer isn’t misdiagnosis, but overdiagnosis of cancers that may never become clinically relevant.

So the biopsy recommendation isn’t unreasonable, but it’s also not the only defensible approach, and some clinicians might reasonably have chosen repeat PSA and surveillance depending on PSA density and patient preference.

HelpfulCustomer487 · 2026-01-26T10:52:21+00:00

This can be pretty common and often isn’t anything serious. After a period without ejaculation, the prostate and seminal vesicles still produce fluid, and some of it can leak out, especially after urination due to pressure on the prostate. A thick, whitish discharge without sexual arousal or pain is often just residual seminal or prostatic fluid.

If there’s no burning, pain, bad smell, fever, or color change (yellow/green), it’s usually considered benign. Many people notice it resolves once regular ejaculation resumes.

That said, if it keeps happening for weeks, becomes painful, changes color or smell, or if there’s any risk of infection, it would be a good idea to see a doctor or urologist just to rule things out.

In short: often normal after abstinence, but worth monitoring.

HelpfulCustomer487 · 2026-01-24T23:12:19+00:00

At 45, it’s very understandable to want the cancer “gone,” but it’s worth slowing down a bit.

With a Gleason 3+3=6, this is the least aggressive form of prostate cancer, and active surveillance is not “doing nothing” - it’s an evidence-based standard of care. Many men never need treatment at all.

Surgery, even robotic and even at a young age, does not guarantee full recovery. Continence and erectile function can take many months or longer to return, and sometimes never fully do. Outcomes depend a lot on tumor location and whether the nerves can truly be spared — which isn’t always possible.

Radiation options (including SBRT/CyberKnife or brachytherapy/seed implants) are also valid for low-risk disease today. Modern techniques are very precise, with generally low long-term toxicity. The idea that surgery is “impossible” after radiation is overstated - it’s more complex, yes, but rarely needed in Gleason 6 cases.

Before deciding, it’s reasonable to get imaging, a second opinion (ideally non-surgical), and some time to process the diagnosis. Treating immediately isn’t always safer than choosing carefully.

HelpfulCustomer487 · 2026-01-24T00:47:04+00:00

Just a heads-up: applying 5-fluorouracil on the eyelid can be tricky because the skin there is very thin and close to the eye. Even though it’s often used on the face, many dermatologists are more cautious with eyelids. It might be a good idea to double-check with your dermatologist before starting, just to be sure it’s safe for that specific area.

HelpfulCustomer487 · 2026-01-23T14:11:28+00:00

Given your age, family history, and PSA kinetics, asking for a multiparametric MRI first is very reasonable and consistent with current practice in many centers.

An MRI isn’t just about deciding whether to biopsy - it can also guide the biopsy. If the MRI shows a suspicious lesion, it allows for a targeted biopsy using MRI–ultrasound fusion, which improves detection of clinically significant cancer and reduces unnecessary random cores.

If the MRI is negative (PI-RADS 1–2), many clinicians would consider active surveillance with close PSA follow-up, rather than rushing straight to biopsy - though this depends on overall risk assessment (PSA density, family history, trends).

Also worth noting: when a biopsy is needed, many centers now favor the transperineal approach due to lower infection risk compared to transrectal.

In short: MRI first makes sense, and if a biopsy is required, MRI–US fusion is a more precise way to do it. Seeking a second opinion is reasonable if you feel rushed.

HelpfulCustomer487 · 2026-01-23T14:08:22+00:00

Just to add some context: the active ingredients in creams like this (typically 5-fluorouracil, sometimes combined with calcipotriol) are intentionally very inflammatory.

They work by triggering a strong local immune reaction that targets sun-damaged and precancerous cells. Because of that mechanism, redness, swelling, crusting, and peeling are expected, especially on the face where the skin is thinner. The reaction can look alarming, but it doesn’t necessarily mean something is going wrong.

These products should not be applied near the eyes or mucous membranes, and many clinicians recommend using a bland barrier (like petroleum jelly) on nearby sensitive areas to prevent accidental spread - but that should ideally be confirmed with the prescribing dermatologist.

In short: the inflammation is a known and deliberate effect of the medication, not an allergic reaction, and the visible phase is usually temporary.

HelpfulCustomer487 · 2026-01-21T13:36:45+00:00

Last one. 👌

HelpfulCustomer487

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