Adventures in Running with Maurine

Skin Cancer Surgery

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This post is not running related – but I thought I would write down my experience with Mohs surgery to remove Basal Cell Carcinoma in case anyone else that follows me has to have surgery and wonders what to experience. 

I don’t know when I noticed I had a growth under my right nostril.  Probably somewhere between 1-2 years ago.  It started pretty small and I thought at first it was a pimple, then a mole, then a wart.  Somewhere in there I probably figured it might be something I needed to have looked at, but between job travelling, job stress, and then switching insurance countless times earlier this year, I put it off. 

Back in August I finally went in to see my primary care physician. She took one look at it and brought in a book and showed me sample of basal cell carcinoma and said I needed to see a dermatologist. The clue – in case you need to know – was a cratered appearance where the center portion occasionally breaks off and bleeds. 

This first image shows the growth.  Many people never even noticed it. 

   
One week later I had my first visit to a dermatologist.  She also agreed, but the pumped me full of lidocaine and did a biopsy.  While she was at it, she burned off two small precancerous growths on my nose with liquid nitrogen and a scaly patch that I asked her about near my left ear that was also precancerous.  After about a week those scabbed over and then cleared up. 

That afternoon she called to verify the diagnosis of basal cell carconima and then I was contacted by the surgeon’s office to schedule the surgery. 

Mohs surgery is done in a doctor’s office.  It is all local anesthetic.  They warned me to allow 1-5 hours for the process.  But I was allowed to eat before the appointment and drive myself home. 

Day of surgery – the doctor came in and explained the process.  They would numb my face and remove as much visible cancer tissue as needed. Then I would be left alone while they biopsied the tissue. If any edges were not clean, they would repeat as many times as needed until all edges were cancer free.  He did warn me that because there is no spare tissue under the nose that I would be thinking for several weeks and months that he didn’t know what he was doing – but he does. 

Draw a circle around the edges.  Take a photo.  Pump me full of lidocaine and start the cutting process.  Since I could see a lot of what was going on with my peripheral vision I don’t know if that was good or bad. 

First cuts were done.  Crater at that point was 10mm x 10mm. 45 minutes later they come in to tell my the upper left edge needed to be cut more.  Crater after that was 13mm x 10mm and I told him I was starting to feel things so he poked me about 20 times since he knew he would be either removing more or repairing. 

Another hour passed by and this time I got a clean bill.  More pictures (I am not posting that one since it is not very pretty). More lidocaine.  

The repair work took a while. He had to make some good incisions and then cut the upper skin away from the lower skin so he could make a flap.  It felt like the stitching went on forever.  When I asked him how many stitches he said he lost track but between 30-40. 

More pictures (I didn’t take a copy of this one) and then they put on a heavy pressure dressing to keep bleeding and swelling down as much as they could. Off I trundled to Target to get my antibiotics and another ice pack and headed home. 

The next day I took off the pressure bandage.  Not a pretty sight.  The face was really swollen and my lip was huge with pooled blood. But – you can see that the outer incision is along the crease in the cheek and should fade into that crease.  The inner incision should look similar to repair for cleft lip.  I’ve seen how fantastic those look post surgery – so am not worried. 

I’m really glad I am not self conscious about how I look most the time – because it is not great yet. And my daughter says the wild hair makes this picture all the better. 

 Today is 15 days post surgery.  As you can see in the final picture, there is still some swelling and inflammation – but it is down a lot.  The lip is normal sized, just still black.  There is a good portion of my face and mouth that is numb.  Feels like novocaine that won’t go away.  If I talk too much or try to smile I can feel the incision pull – but considering a week ago it was uncomfortable to talk for more than a few minutes, things have improved a lot in a short period of time. I love the bruising that goes down to my neck.  It makes my old lady jowls stand out.  
At this point I keep  Vaseline on the incisions at all times for another week.  I need to be careful about sunburn on the scars for a year.  Of course – it was probably sunburns back in my teenage years that contributed to this. 

There hasn’t been a lot of pain and the discomfort has been either from swelling or from the incision being stretched. I guess that is the good thing about a quarter numb face. 

I hope this helps anyone that has to consider Mohs surgery. I’ve seen other Mohs patients where they were able to close the edges and had smaller scars.  This one is larger because of being under the nose and the size of the growth. 

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