Remember a couple of days back when I told you guys about my declining vision and about how important it is to be able to see so you can, you know, SEE? And how in the process of seeing I’d found this weird blemish on the right side of my nose that clearly needed to be checked out by a dermatologist? Well, the weird blemish that wouldn’t go away was finally bobopsied and they didn’t find my twin, but they did find skin cancer. That’s the funky news. The good news is that it’s a basal cell carcinoma, the most common type of skin cancer and the least risky kind. The good kind.
Still, it’s cancer and it has to go.
Let us pause for some comic relief, shall we? Yes, we shall…
I wasn’t at all surprised by the diagnosis, I expected it. Still, I admit I felt a little unnerved by it, but after I had a chance to fully process the information and talk with Husband about it, I got a grip. I just want it gone.
Unlike melanoma, basal cell carcinoma doesn’t metastasize or spread from the skin to other organs. It’s not going to kill me, but left untreated it can cause all sorts of problems because it keeps growing, and it can move into nearby tissue, nerves and bone, doing some pretty gross damage.
My dermatologist discussed treatment options with me and strongly suggested I have Mohs Micrographic Surgery because it provides the highest cure rate ( > 98%) and because of the cancer’s location on my face. And so, I had my consult with the Mohs surgeon today. He thoroughly reviewed the pathology report with me and gave me a head to toe check, just to make sure there are no other cancers. He knew I’d been a lifeguard for years just by seeing the pattern of freckles on my shoulders, chest and upper back. Isn’t that funny? Anyway, thankfully, it’s just that damn thing on my nose. The result of the sun worshipping idiocy of my youth. Scorching, blistering burns on my way to getting as tan as I could. It doesn’t matter how careful I’ve been the last 20 years, I’m paying for the burns I got in my teens and twenties. WEAR YOUR DAMN SUNSCREEN, KIDS.
My BCC is about 5mm x 6mm on the surface, still superficial, meaning it’s roots – if there are any – are not too deep. It’s irregularly shaped on the surface, margins are involved, meaning we don’t really know how far or wide it reaches under the top layer of skin yet and we won’t until the surgeon gets in there. It’s probably bigger than what’s on the surface, we know that. If the tumor was on my trunk or one of my limbs, the dermatologist could just cut a big hole, dig it out and sew me back up, with no real concern about the scar it would leave or how it would look. Things change when you start talking about cutting open someone’s face. That’s where the Mohs surgeon comes in, with the focus on both treatment and cosmesis.
During Mohs surgery, the visible portion of the tumor is excised, then layers of cancer-containing skin are progressively removed, mapped, processed and examined under a microscope. The entire process is repeated until no tumor is found. Because of this complete systematic microscopic search for the “tentacles” of the skin cancer, Mohs offers the highest chance for complete removal of the cancer while sparing as much normal tissue as possible to promote a good cosmetic outcome.
Because my BCC is on the side of my nose, bordering the bony bridge area where there is no excess tissue to work with, the surgeon told me he’s going to plan to do some reconstruction after the removal of the cancer. If it was elsewhere on my face, he could let the wound fill in and heal on its own or simply pull it together and sew it up. But no, unless I want to be left with a big crater in the middle of my nose or have my nostril pulled up towards my forehead, so he’ll do this flap reconstruction thing by borrowing some excess tissue from under my eye, kind of pulling it down and over a little to fill in the hole he’s going to make when he cuts the cancer out. He showed me the likely path of stitches, talked with me a little about what to expect like black eye, swelling, slightly longer healing time because of the reconstruction, wound and scar care, stuff like that. And yeah, at that point I kind of lost it because I did not sign up for this. I thought I’d be having a friendly little scrape or freeze or something, maybe a superficial stitch or two. Not THIS. But the surgeon and the nurse were very reassuring, it’s going to be fine, you caught it so early, it’s really important to treat this now while it’s still relatively small, we’re highly trained blahblahblah, I got it together, booked the surgery for July 16 and left.
Then I did what any rational person in my situation would have done. I sat in my car, Googled Mohs surgery and flap reconstruction and after I did some reading, I clicked on images. Because I have this completely fucked up need to KNOW. Trust me, don’t do it, DON’T GO THERE. Unless you think it’ll scare you straight into religiously applying your sunscreen and immediately getting any weird growths you find on your skin checked out by a doctor, and if that’s the case, then DO. And then I drove home, told Husband I’m going to be a hideous, disgusting beast but hey, I’ll be cancer free and that’s all that matters and then I poured myself a glass of wine +.