Accutane is hit or miss and as a person who has taken 3 full courses over several years, it is NOT a guarantee. You really have to weigh the risks yourself. I would definitely work myself up to it so i would try dietary changes first for 3-4 months. I would also try topicals (surprising enough, the acne.org regimen has helped so much than my last course of accutane did). There is no coming back from doing accutane and you may have success or long term side effects from it - it'll be a roll of the die.
Good Luck in your decision