Yes, you absolutely can. If IG-SRT for some reason doesn’t completely eliminate a particular skin cancer (or if you develop a new skin cancer in the future), Mohs surgery (or a standard excision) is still available as a treatment option. There is no contraindication to doing surgery after radiation, aside from the slight considerations that radiated skin can be a bit less elastic or slower to heal. But skilled surgeons deal with that scenario often (for example, some patients have Mohs, then radiation, then Mohs again for a recurrence – it can be done).
So, if a new skin cancer pops up on the same patient, they have the full menu of choices again: they could do Mohs, or IG-SRT again, depending on circumstances. One treatment doesn’t rule out the other for future lesions.
If IG-SRT was not successful on a lesion (rare as it is), as discussed, Mohs would be the logical next step, and it’s typically very effective then. Surgeons might note that tissue that has been radiated can sometimes bleed a bit less (vessels are a bit scarred) and might take a bit longer to heal, but these are manageable issues. If needed, a flap or graft could be used if wound healing is a concern, but often the area can still heal on its own.
So, you haven’t “burned bridges” by choosing IG-SRT now. We keep all tools at our disposal. It’s analogous to how if surgery fails (i.e., tumor recurs), we then consider radiation; likewise, if radiation fails, we consider surgery. And if an entirely new spot arises, we again decide which method is best for that new spot – maybe Mohs, maybe IG-SRT – totally independent decision.
Patients sometimes worry, “If I don’t do Mohs now, and I need it later, can they still do it?” – and the answer is yes. It might be a little trickier if the area is scarred from radiation, but Mohs can cut through scar tissue just fine and track cancer cells as usual. The cure rate of Mohs isn’t really compromised by the fact that area was radiated; the main difference is just tissue quality (which the surgeon deals with by possibly going a bit wider or doing a repair differently).
Similarly, if you get a different skin cancer on another part of your body in the future, you might choose Mohs for that one if appropriate, even if you did IG-SRT this time (or vice versa).
The overarching principle is that we always have Mohs as a backup plan. It’s one of the reasons we can be confident offering IG-SRT: we know that if the unlikely recurrence happens, Mohs can then be done with a high chance of cure.
And for new lesions, both options remain on the table. Many patients do a mix: maybe they had Mohs on one lesion and IG-SRT on another, depending on location or preference for each. That’s perfectly fine.
So, yes – Mohs or other surgery is still fully viable later, whether for a recurrence or a new cancer. Your future dermatologic care is not hindered by having done IG-SRT now; you maintain access to all treatments as needed.
