Skin Cancer and Mohs Surgery Surprise-Not
Needing a Mohs surgery for basal cell carcinoma skin cancer didn’t exactly come as a surprise to me. Although basal cell carcinoma (BCC) is the most common type of cancer, it accounts for less than 1 in 1,000 deaths caused by cancer. BCC is a form of skin cancer and affects the deepest layer of the epidermis and rarely spreads beyond this level of tissue. 75% off all BCC involves the skin of the head or neck as these are the areas of the body most exposed to the damaging rays of the sun. Of these 75%, the majority of BCC affects the dermis of the nose. BCC can affect all people but is much more common in people with lighter skin and lighter or red hair. So since we can’t choose our parents, it will tend to run in families. With this knowledge, I knew I was eventually facing the perfect storm as I fit the mold perfectly.
There are a handful of treatment options for BCC. The most effective and least invasive treatment for BCC is Mohs Surgery, named after Dr. Mohs that invented the surgery. Mohs Surgery is nearly 100% effective while minimizing scarring as the technique only removes thin layers of cancerous tissue in increments until no further BCC is present under the microscope. This is my personal account of my first hand experience with BCC that was treated with Mohs Surgery.
It all started out as a tiny spot on my nose, less than the size of pin head. There was slight discoloration at first followed by a scaly surface a few months later. The spot was still very small but the scaly surface would fall off and replaced by more dry skin. The spot grew over time which caused some slight suspicion. I tried applying a very small amount of a popular antibiotic ointment on the area which helped and seemed to almost clear up the suspicious area. But the borders of the lesion continued to slowly creep outward little by little. Over time, the worsening scaly area would slough off after towel drying my face which left the area red, raw, and with a small amount of drainage. Within an hour or two, the open area would dry and heal and this process continued 3-4 days per week as the borders continued to drift outward. By now the spot had grown to half the diameter of a pencil eraser and was at a point where I knew that putting off my recommended annual dermatologist appointment for another year was not a good idea. Unfortunately, getting an appointment was not all that easy as my doctor books herself out 4 months in advance. By the time I was able to see my dermatologist, the lesion had grown to the size of the diameter of a whole pencil eraser.
At the dermatologist appointment, the doctor interviewed me while she was examining the lesion. Her medical assistant prepped the surgical tray and lidocaine during the interview and exam. The doctor injected the lidocaine and in a moment had removed the entire surface of the lesion and was applying pressure to stop the bleeding. The assistant applied a small thick bandage while my doctor handed me a pamphlet explaining the Mohs Surgery procedure. In 3-4 days, her office called me to tell me that the biopsy was a malignant cancerous lesion and Mohs surgery was necessary. I had skin cancer.
One week after my appointment, I arrived 8:00 AM at the Mohs Surgery Center with the lesion looking like it was half the original size. My doctor had removed a considerable amount of the small tumor during the biopsy. I didn’t think the Mohs surgery was going to be any bid deal. I was a bit surprised at the depth of the cancer. The surgery prep routine was almost identical to the biopsy appointment except the surgeon drew lines along my nose similar to a grid and her assistant took digital photos of my nose from all angles possible. Soon my nose, forehead, and left side of my face were numb and the first surgical layer was removed and off to the lab to be froze, mounted on a slide, and examined under a microscope.
This was followed by more pictures and then a nice rest in a leather recliner with a warm blanket, hot coffee, cookies, and a chance to finish my book that had sat undisturbed for 2 months. 90 minutes later the results were in and another layer needed to be removed. This procedure was completed three times before the last of the cancer had been removed. In the mean time, I enjoyed multiple refills of hot coffee, more snacks, and finished my book all by noon. What does a guy have to do to get a break and relax in a recliner?
Now that the good news arrived that all the cancer removal and the Mohs surgery were effective, the surgeon carefully placed 6 sutures vertically along the left bridge of my nose after cauterizing multiple blood vessels that did not want to cooperate. The odor was exactly the same as hair being burnt. Her assistant followed up with a swapping of skin glue, application of steristrips, and then a tightly folded 4×4 dressing as a wound covering. By 1:00 PM, I was off to Home Depot and then home to see if I could extend my mini vacation before the kids would get off the bus!