Hello Doctor, I am 60 year old healthy female with medically controlled hypertension. I have Behcet’s disease, though mostly under control. I have had various tropical diseases. I also had hepatitis A at childhood, and TB meningitis. I also have scoliosis. I have been diagnosed BCC (Basal Cell Carcinoma) half way down and in the middle of my back. It is about 2cm in diameter and raised about 1cm high. Having had many skin cancers removed previously I expected the same procedure i.e, administration of local anesthesia and excision. However, the general surgeon at the local hospital wants me to have general anesthesia for the surgical removal of BCC. I cannot understand the necessity for a general anesthesia for removal of a BCC (I have had many removed previously without any problem). As I have had adverse reactions to anesthesia before,I am very nervous about this. Once I had respiratory depression during moderate sedation. Of five previous surgeries, I have had blood transfusions with two. My recent blood work showed low PTT. Is it necessary that I should undergo surgery under general anesthesia?
Hi,  Welcome to icliniq.com. You should ask your surgeon the reason behind giving general anaesthesia in your case. Basal cell carcinoma is a locally invasive tumour with very rare chances of malignancy. The need for general anesthesia can arise when on clinical examination it was found that the tumour also involves underlying subcutaneous tissue, nerves and surrounding structures. In such cases we cannot rely upon the local anesthesia as we may have to extend the surgery. During surgery we have to remove one extra centimetre of the healthy margin to prevent recurrence of the tumour.  This margin will be sent for histopathological examination later, to determine whether margins are free from tumour. If margins are involved resurgery has to be done. The size of your tumour is 2cm and may be your surgeon on examination found it to be a deep tumour. Hence to prevent resurgery, he might have advised surgery under general anesthesia. As in case of local anesthesia, sometimes it is difficult to extend the surgery especially when underlying nerves are involved. Do not worry about the general anesthesia as there are few anesthetic compounds which do not cause respiratory depression. So, inform your surgeon regarding the previous respiratory depression and get treated accordingly. For further follow up, consult a surgical oncologist online -->