Ready…set…complain (Mohs surgery, Part II)

I wish I had this one memorably lovely photo of myself as a tot but it’s packed away until we get to the mountain house next year. You would love it. It’s one of those early color photos, somewhat faded, of me at the beach. Diminutive, with reddish blond hair, big green eyes and a sweet green print bathing dress, I’m just standing there looking waif-like and fair.  I was really very cute. At three I was already wearing big Coke-bottle lensed glasses everywhere but the beach; there, I stumbled around blindly most Sundays as my family escaped the ticky-tacky postwar suburbs of Royal Oak to Detroit’s Metropolitan Beach. Five decades later, sitting on an exam table in University of Michigan’s cancer care center, I would see an almost identical poster size 1950s photo of a pretty little girl on a beach and the title, “This is when it all started.”

I met Rich when I was 51. I had one child in college and one in high school. a fulltime psychotherapy practice, a little weekend cottage on a small headwater lake. a blessedly wonderful posse of friends and very nice skin. We were married the next year in June and, although it is not visible in any of our wedding pictures I remember that I had noticed the tiniest pinprick of a spot on my forehead- a spot that bled slightly when I rubbed hard with a towel but never seemed to hurt, was never inflamed or irritated. I just noticed it a couple times a week.MVC-113F(Me and my face-in the sun-a few months before the first bout of basal cell cancer. Can’t see a thing.)

September has always been the month when I’ve gotten an annual physical and that year I mentioned it, almost as an afterthought, to my internist. She referred me to a dermatologist. In her office, I was more alarmed about getting a shot in the forehead so she could take a small biopsy than I was that anything was wrong.

So that was the first round of basal cell cancer and, typical of this type of skin cancer, it has recurred. Again and again. It’s as though a time bomb went off in my body and all of the things that collude to make a person prone to BCC came together at once. (Basal Cell, along with Squamous Cell are called NMSC or non-melanoma skin cancers. They rarely metastasize, frequently recur and are usually not life threatening, as opposed to melanoma, which is the very best reason for you to get checked regularly by a dermatologist.) These days, it seems as though everybody can put themselves and their children at risk for skin cancer through over exposure to the sun but here are the factors that are most likely to put you at risk:
-Early unprotected exposure to the sun or severe sunburns, often at a young age. My parents didn’t know about sunscreen. In fact, in the fifties people were busy trying to tan skin with oils that attracted damaging rays. In high school I had friends who would coat themselves with baby oil and bask on tin foil. Even today, the tanning booth business is a big industry with the rays from tanning booths being twice as damaging as the sun outdoors. I never did any of that but I did burn severely several times in my young life and during later trips to Central America I still didn’t know enough to BLOCK sun exposure as opposed to applying 15-30 spf sun screens. Today, I try to avoid much sun exposure and cover myself with hat, high level sunblock, protective clothing. Today, I sometimes have to be physically restrained from smearing glop all over random small children. It makes me sad that, when I’m focused on this BCC, the sun seems like my enemy, especially since I am a passionate gardener, love the ocean’s shore, crave the light. But I cope. My Tilley hat is my constant companion.
-Very fair skin. That includes most people of Irish descent, with the white skin, blue or green eyes, freckles, reddish hair. That’s because a high percentage of Irish people have a Skin Phototype of I or II. In our family I am definitely the one with the ‘always burns, never tans’ phototype skin. It seems as though skin pigmentation provides some screen from UV rays.
  • SPT I – Always burns, never tans
  • SPT II – Burns easily, tans minimally
  • SPT III – Burns moderately, tans gradually to light brown
  • SPT IV – Burns minimally, always tans well to moderately brown
  • SPT V – Rarely burns, tans profusely to dark
  • SPT VI – Never burns, deeply pigmented

-Certain medications make you more prone to burning.

a. Diuretics, Antibiotics, (Tetracycline drugs) skin care products
b. Microdermabrasion products and Retin A
c. Heart medications containing Amiodarone
d. Diabetes medicines containing Glipizide
e. Herbal ingredients Balsam of Peru used in after shaves and perfumes
f. Nonsteroidal anti-inflammatory pain drugs such as Advil, Aleve, Motrin and Celebrex

Certain medical conditions, particularly immune disorders.

Okay. Back to my specifics, complaint and whining. My dermatologist sent me over to the Mohs Clinic at U of M. Oh, wait, another digression from me. Mohs surgery is named after Frederick Mohs who started systematically whacking small chunks out of people as far back as the 1930s and today it’s a specialty area with many highly skilled surgeons and, if this stuff shows up on your face it’s most likely the best treatment option. Here is a brief video clip explaining the procedure, the benefits and it’s not at all gory. I’ll wait while you watch it.

Rich went with me that first time (and most every time since) and I want to go on record as saying I didn’t find any humor in his musing, “Why this is just like the waiting area at the airport, except for all these lepers.” They had taken a first piece out of my forehead, I was lightly bandaged and sent to wait with all the other diced up patients. Just like at the airport, you try to find a seat where you can be as far from the next person as possible and stare mindlessly up at the television screens running CNN (and old Mayberry RFD reruns. I liked that touch.) About 45 minutes later they called me back and said they found more in the margins of what they had removed and needed to take more. Back to wait, back for a THIRD pass, back to wait and then they said they were ready to close the wound. U of M is a teaching hospital so I had a full cadre of residents and interns and students-I didn’t like that so much. On the other hand, everybody has to learn their trade and the Mohs Clinic at U of M is state of the art. I wasn’t thrilled when the surgeon let the resident in plastic surgery do the close, either, but in fact, the resident did a very nice job and no one really sees that scar today unless I show them. At the time, you could have fooled me about this outcome, given my first look 2 days after I got home.  They offered, incidentally, to let me look at the open incision but I declined because Rich had looked and was turning green and retreating to the corner as he choked out, “Well. That’s not too bad. I guess.”IMG_6264(No, I was not a happy camper. No, that was not my hair color at age 52. It turned bright silver at 32 years of age, as though all the pigment decided to leave my hair as well as my skin…they had also taken a small biopsy beneath my left eye, which I KNEW wasn’t the same thing because I’d had funky backed up tear ducts there since childhood. An intern did this despite my protest. Today I would ask for a higher power before letting someone nick me, because that also left a mark that I still see today. Be a good patient and advocate for yourself.)

Here are the worst things about that first experience:
This is all done under local anesthesia. Shots in the face kind of hurt, although my current dermatologist is smooth, very smooth.
I didn’t have anything to relax me before hand. This is a mistake for most people, I think. I mean, they drape your face, which is pretty claustrophobic, turn on really bright lights, clank scalpels and sometimes you can feel warm liquid running down into your ears if they don’t wipe it up fast enough. Today, I wouldn’t have this procedure without some kind of sedative or anti-anxiety medication beforehand- Valium, Xanax, etc. I have to say I don’t remember great pain afterwards- but that could be one of those things I’ve sort of blocked out. We’ll see this time. I DO remember itching as it healed. Serious, annoying, want-to-scratch-my-eyes-out-itching. You have no idea how many times you touch your face in the course of a day, let alone an hour. So itching and keeping my hands off was hard for me.

They did another small one on my upper lip, too- that one I never could see before the fact. Because I was short on extra skin to pull together (lots of blotches, not so many wrinkles yet) they decided to let this one heal from the inside out. Much smaller, it was far more irritating over the next couple months and today leaves a more noticeable scar.
Since those first two on my face, it’s been fairly steadily showing up on other parts of my body. Usually, every 6 month check up results in 3-4 “burns” where they freeze off spots and I’ve had 4 additional surgical bouts with it. By far the largest was one on my upper back that I never would have found on my own. That one was a little rough because (as FC knows) it’s hard to keep still and every movement of my arm and shoulder pulled on it for a while. Having the stitches removed was a relief.
I’m not a BIG complainer but I tend to complain out loud when I do. Next week’s procedure (sounds better than surgery) will be back on my face and I’m dreading it. I have leftover twitchiness from multiple eye surgeries as a child- anybody but a loved one gets too close in my personal space and I want to swat at them. Not rational, but I can’t seem to help it. However, this BCC is not the end of the world and probably not even the end of my nose so I’m going to try and keep this in perspective. Lots of people, including some of you, have gone through this or will go through it. Each year more than 1 million cases of skin cancer are diagnosed in the United States, one in five adults over 50 will have it and WHO says it’s on the rise. (Jeez! What’s it going to take for us to protect the ozone layer?) I’ll probably post about every day life between now and then but I’m going to ask if Dr. Spencer minds if Rich takes photos so you can picture the before, during and after-if you care too. Maybe if you go through it with me you won’t be quite so freaked at the possibility if you need to do it. Because, you know, it’s probably a really good idea to get that annoying sore on your face looked at…

Oh. Here are the results, photo from 2006 taken two years after surgery. Not so bad, really.after(What the hell? I’m out in the sun again…)

20 responses to “Ready…set…complain (Mohs surgery, Part II)

  1. Been there, done that…over and over. This is very good. I hope someone reads and heeds.

  2. I really am glad I saw that video. That surgical technique post-dates my training in cytotechnology (well, maybe not post-dates, but they never mentioned it in school).
    I’m going to find out who does it around here, so that when I have a problem again, I’ll know where to go. I’ve had 3 actinic keratoses removed – all precancerous, according to my dermatologist (2 just below my eyebrows and one on my chest). I have something now, in the upper left corner of my forehead, that I keep picking at and it is now to the point of bleeding. I was told it was a seborrheic keratosis (I’m prone to them), but I want it gone!!

    Take care, Vicki. The after-photo is lovely and even if you have a visible scar or two, having you around with scars is much better than the alternative.

  3. You look great!! My dad was a forest ranger in the 50s way before sunblock and is fair skinned, so he’s dealing with the same stuff as you. The constant vigilance and worry would wear me down, that’s for sure!! Keep us posted on the “procedure.”

  4. I think you look great too! Really clear-eyed, soft-skinned and lovely. I am amazed by how good you look after that 2006 surgery. Quite impressive, really. I hope the next one is even easier than the first. I agree that a little relaxation intervention before hand is a good thing.

    When I was young I was always a little bummed out that I didn’t have fair skin, and was often mistaken for being from India. It wasn’t easy growing up brown in our culture in the 50s. But I learned to love my brown skin and see that it has served me quite well.

  5. You look fabulous. I am having my girls read this as I have to constantly remind them about sun exposure with out pool. Thank you for doing this.

  6. Been there as well. What do you expect I grew up in Florida with baby oil my suntan lotion. I have the scar on my upper back to show for it and two hunks out of my nose. I wish that young people would listen to the knowledge that is known now. My boys are too big for me to slather on the sunscreen anymore though I still shove it at them as often as possible

  7. I hope this “event” will go well and that all the pre-event medication will have you dreaming of cool gardens and zoo animals… or other favorite things. And I hope others will learn from this post and coat those tots and stand your ground with those teenagers that want to tan for prom. The sun does come back to bite you.

  8. My experiences with Mohs were less traumatic. I took along my I-Pod and listened to Bach’s Goldberg variations–pretty calming. I am not wild about warm liquid running down my face–I assume it is blood.
    I agree– you look great.

  9. I’m always wide awake when my perky cute dermatologist Mohs me.

  10. My dermatologist is perky and cute, too, but it doesn’t do as much for me as it does for FC.

    YOU, my darling friend, are beautiful inside and out. I would never in a bazillion years allow anyone to take a close-up picture like that of me. You look FAB. Yes, yes, I know it was taken years ago but I’ve seen you in real life only a year ago and you look exactly the same except for the hair color, which is a graceful silver and totally works.

    So, you’ll get yourself a little Valium, Rich will take pictures, and WE get an education. Good deal.

  11. I wouldn’t call this complaining. I feel like I’ve been educated. Thanks…and good luck with your “procedure”.

  12. thanks for great information, just bookmark and waiting your next posting 😉

  13. I have an annual next month and I’m going to be sure to ask my doctor about my skin. Given the amount of burning I had as a child (living on the beaches during summers) and skiing. I’m really glad that we’ve learned the sun lesson though — we’ve kept the kids from being sunburned.

  14. Really, I keep coming back to the picture with the stitches. I really dig it. AND I love you for posting that pic. And writing this post. xo

  15. I have found this so helpful; thanks for your honesty and for sharing this.
    I am 43 and am going for Mohs surgery for an infiltrative BCC on my face in two weeks. Needless to say I am quite terrified. I really appreciate your suggestions; I have some Ativan to help with the day. I am very athletic and have spent a lot of time out in the sun , but likely this came about due to all the burns I endured in childhood. I share your concerns about sun protection and for understanding what we have done to our planet to so destroy our relationship to the sun. You look beautiful and I so hope I can make it through as you did. I am also a psychologist/psychotherapist…and am using every technique I know to cope with this.
    Thanks again, looking forward to reading more of your posts.

  16. Wow, what can I say after reading this?
    I’m off to be tortured in a week or so, maybe a shot of rum might be just the thing before I leave for Moh’s surgery by a new doc in Ann Arbor.
    Let’s hope he’s more competent than those boys at the U of M!

  17. Robert Karasiewicz

    My Mohs surgery went fine. It was when I got the bill that the trauma happened.
    $900 for the surgery and $500 to close the incision.
    I have had many small surgerys and a few major ones–NEVER did a surgeon charge extra for closing! There is another extra charge when the patient needs additional slices taken.
    None of this was talked about before hand.

  18. Thank you so much for your honesty and openness in sharing your experiences! I just had my 5th and 6th BCCs removed this week. One was on my back- no big deal. The other was a much more extensive Moh’s procedure on my face, ultimately removing a section (the size of a penny) between my nose and mouth including part of my upper lip. I had a plastic surgeon do the repair- he did a skin flap graft with lovely blue stitches… I’m only a few days out from the surgery and of course, looking Frankenstein-ish. My emotions are all over the place, but I found your words comforting and I feel more hopeful when I look at your photos. You look great!

  19. I liked your column on this topic. I underwent the same surgery. 9 hours in the chair. 25 injections. Skin forehead flap. Last week was phase 2. More injections and hours. My face is butchered and the pain is unreal. I have a high tolerance for it as a parole agent and having worked in corrections. This is week 6. All surgery is done but the damage is done. My face looks asymmetrical. I can’t move my eyebrows. I used to be a good looking guy. They said it would disappear. I can see it won’t. The took a huge amount of tissue for the basal cell removal. They were in a hurry. It was Friday. I couldn’t stop throwing up on the way home. I was awake the whole time. No pain meds. It was like being back in combat and taking shrapnel to my face. I won’t be going back because my employer, the state makes it horrible to get the time I need to heal without filing a grievance. So suffice to say in retrospect I should have done more research and not have trusted recommendations from their constituents. I am depressed and feel defeated.

  20. OH Mark! That sounds horrible. Got a call this morning, mole on forehead is BBC. Mohs in a month. I wish they could give IV’s with meds while you wait. I have a fear I will be wearing bangs from then on. This article was great and prayers out to everyone that understands this. I find most people think its no big deal.

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