Mohs micrographic surgery is the most appropriate treatment for this patient's basal cell carcinoma (BCC). Many modalities are available for the treatment of BCCs. Selection of the most appropriate technique depends on a number of factors, including the size of the lesion, the location, the patient's age and comorbidities, the histologic subtype of the tumor, and the cost of the procedure. Although standard surgical therapy is appropriate treatment with high cure rates (>95%) for tumors and a low risk of recurrence, micrographic surgery (Mohs) is preferred for tumors with high-risk pathology (micronodular, infiltrative, or sclerosing) or lesions in sites where a cosmetic outcome is important. For this patient, the size of the lesion and location on the temple indicate that a tissue-sparing procedure would be desirable because of cosmetic considerations. The histologic subtype indicates that this lesion has a relatively high risk of recurrence, and given the patient's age, she will presumably live long enough for recurrence to be likely. Mohs micrographic surgery offers a very high cure rate (>98%) coupled with the likelihood of a good cosmetic result. It is also a cost-effective choice in this setting. The fact that the patient is on anticoagulation therapy is not a contraindication to surgery.

Cryotherapy may be used to treat superficial BCCs and some nodular BCCs, but it is not generally used for other histologic subtypes because of an unacceptably high risk of recurrence. It also has an unpredictable cosmetic result and is not generally used for tumors on the head and neck.

Electrodesiccation and curettage is a reasonable treatment for nodular and superficial BCCs that occur on the trunk and extremities. It is not appropriate for more infiltrative subtypes since the recurrence rate is quite high. It is rarely used for tumors on the face because of a relatively high recurrence rate and an unpredictable cosmetic result.

Radiation therapy is a reasonable choice for BCCs in patients who are either not surgical candidates or who refuse surgery. It carries the risk of chronic radiation skin changes in subsequent years, and given the patient's age, this makes it a less desirable option. Radiation therapy is also less cost-effective and less convenient for the patient, since it requires multiple treatments over the course of several weeks.

Topical imiquimod treatment is often used for superficial BCCs and sometimes used off-label for nodular BCCs, but it is generally not used for other subtypes of BCC because of an unacceptably high risk of recurrence. This is particularly true for lesions on the head and neck.