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simonov
USA
3 Posts |
 Posted - 06/04/2008 : 12:10:16
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I recently underwent Mohs surgery for removal of a squamous cell carcinoma on my nose, and another cancer victim suggested I post my experience on one or two of these cancer forums. He said that many people get pretty nervous about surgeries like this on their faces, and that reading my story might help someone get over his or her anxiety and help folks feel more confident about getting treatment.
The Story
I am 45 years old and have spent a lot of time outdoors, principally hiking and backpacking in the mountains and camping in the desert. I also grew up at the beach. I never used sunscreen as an adult because though I am light-skinned I would typically tan rather than burn. This winter I tried winter mountaineering for the first time, climbing up mountain ice and snowfields. I climbed Mt Baldy, a 10,000 foot snow-capped mountain near Los Angeles, four times in Jan-Mar 2008.
In early April of this year, what appeared to be a pimple formed right at the end of my nose. I let it alone for a while, assuming it would simply go away after a while. My wife, more of a worrier about these things that I am, suggested I see a doctor about it, but I continued to let it slide until about the middle of May, when I finally called a local dermatologist to have a look at it. I was concerned that it was not going away on its own, and so was not behaving like a pimple.
I live in Costa Mesa, in Orange County, CA, right next door to Newport Beach, which has got to be one of the main plastic surgery centers of North America, if not the world. There are many dermatology clinics here. I simply looked up the closest one in the Yellow Pages, since in the beginning all I wanted was for someone to tell me what was growing on the end of my nose.
I called a dermatology clinic in Newport Beach headed by Dr Kristen Forman (949-515-4111), and was examined by Dr Vip Soni. Dr Soni has a very positive and confident bedside manner. He identified the "pimple" immediately as some kind of skin cancer, hopefully basal cell carcinoma, but decided to take a biopsy to find out for sure. Dr Soni shot my nose full of local anesthesia and essentially sliced off the growth. It was completely painless, though I guess I was a bit nervous (I am not used to doctors at all, and typically avoid them if possible). I felt woozy when the biopsy was over, probably because of an adrenaline rush or something.
Here is how I looked post-biopsy (you can click on the links below these photos and go to their Flickr photo page, where you can see larger resolution images, if desired):
Other sizes: http://www.flickr.com/photos/simonov/2479746797/
Diagnosis and decisions
After about a week, Dr Soni called to tell me it was squamous cell carcinoma, which was good news (since it wasn't melanoma), but which was also sort of bad news because squamous cell carcinoma is only really dangerous (he said) when it is in the middle of the face, where it is getting a lot of blood circulation and is more likely to metastasize.
Now while I was waiting for the biopsy results, I had done a little research and asked around about this, and had decided that Mohs surgery sounded like the best treatment. I believe in doing your own research, and getting the opinions of other doctors and patients if you are uncertain. I happened by chance to discuss this with someone who had already been down this path, and he couldn't be more helpful or enthusiastic about Mohs. But find a good doctor, he said.
So Dr Soni started outlining our options on the phone. Radiation was mentioned, and I was already dead set against that. He then started talking about "a procedure called Mohs surgery." I told him I had already decided that was what I wanted done, and all I cared about now was finding a good doctor to do it. As it happened, Dr Soni is himself something of an expert on Mohs. He works with a team in Long Beach, CA, of two dermatologists and a plastic surgeon, and they do about 20 Mohs procedures every week.
Dr Soni also gave me a referral to a Newport Beach surgeon who he considered skilled and experienced with Mohs, but since that doctor couldn't see me until the end of June, I decided to schedule an appointment for 27 May with Dr Soni and his associates. Dr Soni said he felt it was important we acted fast because of the location of the cancer.
Now, I am a rational person who does not get overtly nervous about surgery and stuff like that, so I was very calm and relaxed going to the appointment. My friend mentioned that many people get extremely worried about surgeries on their face, especially the nose, but I wasn't really concerned. I felt like I was in good hands and I just wanted the cancer gone.
Mohs surgery
Dr Soni's Long Beach clinic does all their surgeries on only one or two days a week, so this Tuesday morning was a very busy one. There were maybe fifteen or twenty other patients moving in and out of the waiting room, and I was just about the youngest of them. So many of the patients were seniors, it really made me understand better how the skin damage that causes cancer can have occurred at any time in your life, and can catch up to you much later. It made me sad because I realized that even after I dealt with my current problem, I was doubtless at great risk of continuing to see cancers growing in the years ahead.
Anyway, I was called in and the first thing they did was start shooting my nose full of local anesthesia. That stuff really works (as with the biopsy), but despite my conscious calmness going into this thing I guess I had an unconscious nervous reaction to all these dudes (two doctors and an assistant) cutting up my nose right in front of my eyes. I was nervous and tense and Dr Soni gave me a roll of gauze to squeeze in my fist. The Mohs procedure itself was short, only ten minutes or so, so I didn't have enough time to get really nervous about it. They patched up my nose and sent me out to the waiting room while they looked at the slides.
The waiting room was kind of comical. All these people sitting around with bandages on various parts of their faces.
I waited about two hours, after which they called me back in. They said according to the slides they got all the cancer. I saw a couple of Polaroids on the counter of my nose just before they had put the bandages on, and there was a hole about the size of a marble. Now they were going to fix the hole. The reconstructive surgeon was Dr Jonathan Hoenig (562-420-8333), and he said they could take tissue from elsewhere on my body, or just use what they could find in the nose. I think they were a little concerned because my nose is asymmetrical, with one nostril being much smaller than the other (though this has never given me any kind of a problem breathing). I was cautioned that one of the downsides of using tissue from another part of the body is that it might have a different texture from nose skin. I told the doctor that at this point I just wanted to do whatever was easiest for him. I was confident he wasn't about to do a botch job, and I didn't have to worry about a movie star career.
The reconstructive surgery lasted maybe 20 minutes or a half hour, and of course was much more invasive. There was no pain, but again I became irrationally nervous and tense. The doctors noticed and seemed a little irritated (it makes their job harder) and suggested I take a valium. I had to drive home later, but they offered a reduced dosage and I also decided to go have some lunch when they were done. The valium seemed to make me feel better. Soon they patched me up and sent me out.
In general, I am not one to need pain-killers (for example, after my wisdom teeth removal), but I asked about post-op pain. They said it shouldn't be a big deal, and that I should take Tylenol if necessary. As it turned out, I didn't experience very much pain at all. The nose continued to be tender (and still is, a bit), but I never experienced the throbbing you feel from most injuries. I never needed that Tylenol.
I had an overnight backpack trip scheduled for the following weekend. The doctors quickly and unanimously nixed that idea after I asked them about it. They wanted me to take it easy.
Here's what I looked like a few days after the surgery:
Other sizes: http://www.flickr.com/photos/simonov/2537985893/
Money
I have health insurance, but prefer to use it only in emergencies (like a car crash or heart attack, etc). If I can afford to, I prefer to pay cash. Making claims is messy and whenever my wife and I do so we continue to get invoices and statements in the mail for years afterwards. So I asked to pay cash for the work.
The examination, including the biopsy, was $230.
The Mohs surgery and reconstructive surgery was $1,000.
I still have not received a bill for the biopsy lab work.
There may yet be some more minor cosmetic procedures to do, but they can't cost very much.
Healing up
Yesterday, I went back to see Dr Hoenig to get my stitches removed. He seemed pleased with my progress. So am I. My nose looks quite a bit like it did before the surgery, just not as pointy (as seen from the left) as it was before. He asked that I continue keeping it moist with antibacterial ointment for a few more days, but I no longer need to put a dressing on (I stick a band-aid on to keep the ointment clean).
Here is a photo I took last night:
Other sizes: http://www.flickr.com/photos/simonov/2549143531/
This morning in the shower I found I was able to give my face a thorough scrubbing for the first time without having to worry about hurting my nose. Within a day or so I think I really will be back to normal.
All in all, this entire ordeal was a bit of a hassle, but it didn't cost much in money or discomfort. I should be cancer-free (for now).
I thought I would post all this to encourage people who were considering a similar procedure. I am not an expert, just someone who has been there, done that, but would be happy to attempt to answer any questions I can.
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thanks01
USA
170 Posts |
Posted - 06/04/2008 : 15:25:53
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| Thanks for your excellent narrative history, with pictures. Regarding "the rest of your life," you may want to read the informational material on this website in detail, which is very helpful regarding the possible fundamental health questions and solutions. It seems that although sun exposure is a factor in skin cancer, there are other causes and points of attack to keep your skin healthy in the ensuing years. Working with skin doctors is helpful and necessary, but their advice is usually concerned more with the "problem" episodes than with your underlying skin and body health. |
Edited by - thanks01 on 06/04/2008 15:26:52 |
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dan
611 Posts |
Posted - 06/07/2008 : 13:42:52
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| simonov, you may not get a lot of responses right away because you and thanks01 said it so well, but I appreciate your time and caring to post your story. I am sure others will find it very helpful. I agree with thanks01 regarding making small lifestyle changes now to avert chronic skin cancer later. My dermatologist told me to expect chronic problems with skin cancer based on what he saw 7 years ago. He was right but did not offer me any prevention advice other than to wear sunscreen and a hat. Thankfully I seem to have put enough preventative and self treatment measures together to get out of trouble, and I very rarely use sunscreen. So I am a firm believer that further skin cancers are not inevitable and can be prevented mostly through a better diet. |
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anivoc
668 Posts |
Posted - 06/07/2008 : 22:05:54
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Awesome!
Been slammed and have just not taken the time to type out my Mohs dance but will soon I promise.. Still healing |
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momi2tyler
USA
1 Posts |
Posted - 06/27/2008 : 17:53:36
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I, too, had Mohs surgery on my nose...EEEEK!! I am a 40 year old female, wife, mother of a 7 year old boy, Registered Nurse. I am exactly 1 week post-op today. Just had my stitches removed and am very pleased with my outcome. I had a biopsy done approximately 1 month ago to a small, scaling area (about the size of a pin head) that I had noticed 6-8 months ago on the tip of my nose just above my left nare, and kept hoping it would go away. My biopsy came back positive for basal cell skin cancer. I was devastated and thought that I would be disfigured for life by surgery to remove it. Luckily, I had a wonderful doctor/dermatologist who was skilled in Mohs and reconstruction. He was able to close my Mohs wound with stitches and 1 week later, I look almost the same as I did before my surgery. I have a small (1/4") scar and my left nare is slightly raised. But since, I still have a small amount of swelling on the left upper tip of my nose, I feel like my nare will return to almost normal when all swelling is gone (which could take a few weeks). I guess the main reason for my sharing my surgery is that I was sooooo stressed out after I found out that I had cancer on my nose and was terrified that I would be enduring months of plastic surgery to return to a half way normal appearance. I want to put the word out that if you catch your cancer fairly early, there is a good chance that you will be back in the swing of things and looking good in a short period of time. Don't let fear keep you from seeking treatment...I am ecstatic with my outcome and sooooo relieved. Don't put treatment off, find a good dermatologist who is skilled in Mohs and "GET 'ER DONE!!!"
KC |
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tarbabby
USA
18 Posts |
Posted - 08/23/2008 : 18:53:54
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Hi all.
I wanted to share my fun with mohs surgery.
I had gone in to see a derm. four months ago,had a spot that would not heal right on the side of my nose,the doc did a biopsy and said he would call me if I needed to do something more.
Two weeks went by and no call.
I decided to call just to make sure that it was ok.
They said it was bcc and that I needed mohs,I asked why no call and got this for an answer.
WE FORGOT TO CALL YOU.
I was upset and had some other spots on my arm that I was concerned about but the doc wasn`t I did not feel good about him treating me so I called a friend who lived three hours away who has had quite a bit scc treated.I called his doctor and he made an appointment to see him three days from the time that I called him.
That second doctor cut and burned me six times and biopsies came back with a call three days later confirming five out of six bcc`s.
He had told me to go ahead with the mohs with the first doc because I had already made the appointment,so I did,all went well and somehow he got it on the first pass,so I thought,he did do a fine job of sewing up my face and two weeks later there was hardly anything there,two months later, another problem,
almost same place and I wondered if all this had something to do with the fact that I had no insurance and had to pay bill off in several payments,eather way I did not want to see or trust him again.I could not afford to keep driving three hours to see the doc that made me comfortable,so I decided to find another doctor in my area.I had some aldara and decided to treat the spot and another and see what would happen,the new doc would not treat any of the new spots that had popped up since the last doc saw me and told me to keep up the aldara treatment and come back in two months time,again I wonder if the insurance or lack of has anything to do with the go home and come back later treatment.Since then I have found this forum and I don`t know what to do,I will if I can,try another round of mohs in the same place,I just want the job done right,as for the other spots they can burn or cut them,I just want them gone.There is one that was frose off and it is back,center of burn scar ,very small,has anyone ever treated one of these comebacks topically and had any luck,please reply to this and the black on small bcc`s treated with black salve.
thank you! |
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marsha
USA
122 Posts |
Posted - 08/30/2008 : 12:39:51
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| I had mohs surgery at 35. I didn't like my twisted lopsided nose when it was done. I didn't like it when my mother came out of surgery with 1/2 her lip gone and flaps of mismatched skin on her nose. Do not use black salve on your face for bcc. Bcc is easy to get rid of. Black salve should be saved for melanoma. |
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marsha
USA
122 Posts |
Posted - 08/31/2008 : 11:30:35
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Oh another thing that the docs don’t mention is after you have that surgery you will probable get another spot right below or above or to the side and you will need another surgery. Skin cancer is a continuing process. new spots are always popping up. By the time you are 60 70 you are shopped and patched all over.
That’s what I’ve experienced, and I have seen this with relatives and friends.
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margaret
USA
2 Posts |
Posted - 12/01/2008 : 16:03:12
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marsha,then what do you recommend for bcc besides mohs.
margaret |
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pegmih
USA
3 Posts |
Posted - 12/03/2008 : 12:45:59
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Yesterday I had Mohs surgery on my lower right leg.
The only discomfort (slight) was the first 2 shots.
The surgery only took about 5 minutes.
Within 15 minutes the results were back - All Clear!
I was stitched up and drove home.
No shower for 3 days at which time bandage will fall off.
I will surely stink.
Early this morning I woke up in pain and took Tylenol. I had been given script for tylenol/codeine but don't like the side effects of codeine. I am now taking 1 Tylenol every 3 hours rather than 2 every 6. Make sense?
I am a senior citizen and was told that Medicare does not pay for Mohs below the neck. Fortunately, I have other insurance which does pay. Nevertheless, this whole situation will end up costing me close
to $300 out of pocket.
In retrospect, I wish I had had Mohs on my nose (I'm a poet?) when I had cancer there a number of years ago. I'm sure the scar would be much less than what I have from surgery (plastic surgeon).
I would highly recommend Mohs.
Another thing. I am on my 13th day of Efudex on chest and will now quite. The area is raw but seems to be drying up. Comments? In the past, 2 weeks has been my limit with this treatment. I figued since my leg would keep me out of the pool I might as well do it now. I do not know how anyone can use it on their face & life thru it.
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simonov
USA
3 Posts |
Posted - 12/08/2008 : 09:45:48
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It's several months later and the surgery is all healed up. I've been seeing referrals from this site on my Flickr account, so I thought I'd post an update.
Here is a photo taken yesterday:
http://www.flickr.com/photos/simonov/3089912301/in/set-72157610872335360
The scar from the surgery is plainly visible. But the last time I saw my plastic surgeon, in July, he said everything was healing up just fine and he intended to use dermabrasion to eliminate the scars altogether. I was supposed to see him again the first week in September, but missed the appointment and now have been too busy and/or forgetful to schedule a new one. I really need to do that soon.
Despite the visibility of the scar, it looks pretty good to me. The nose was never that great-looking to begin with, and the surgeon preserved the natural asymmetry (in fact, he was surprised I have never had trouble breathing though the one nostril, which he says is almost closed).
If I was a young woman or teenaged girl, or even a much younger man, I'd probably go for the dermabrasion and remove the scar, but at this point I am not unhappy with it. I suspect there will be a fight with the plastic surgeon the next time I see him, because he seems pretty determined to clean up the scar with dermabrasion (professional pride, I guess). But I have read about dermabrasion and it sounds worse than the original surgery. He might talk me into it yet. We'll see. |
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kmorrow
USA
1 Posts |
Posted - 03/17/2009 : 22:48:00
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| I am a 38 year old female nurse, mother of 2 girls fighting an 8 year battle with BCC on my nasal tip. Initially seen by a plastic surgeon (recommmended by my family practitioner as this "recurrent, bleeding zit" is on my nasal tip. The first biopsy was AK (precancer) but the MD stated no worries despite my complaints of recurrence. A year and a half later saw an ENT (also specialist in plastics of head/neck/face) with biopsy which came back BCC. Four positive biopsies, three surgeries, and four years later, I ended up at dermatologist who performs Mohs. My first Mohs was in 2004. I should have known better, but I was a patient here, not in my usual critical care setting. I kept going back concerned about this non-healing crusty area on the tip of my nose. After two more positive biopsies in two years and some other "failed" treatments, I had my second Mohs in Nov 2008. The tissue loss was extensive and was in the procedure area over 10 hours. I was probably the youngest patient there by 25 years. After I "regrew" enough tissue, my plastic surgeon performed a full-thickness skin graft using skin from behind my ear to my nose. Fortunately, it went really well, and the MD feels confident I will be very pleased. To provide some insurance, I asked him to send the removed tissue (required in the grafting) to the lab for pathological analysis. UNFORTUNATELY, it came back with BCC still in most of the specimen. Therefore, I went through reconstruction for nothing. I now have a new MD and am scheduled for Mohs again the first of April. I can only hope I can retain enough tissue to not completely "gross out" all my daughters' friends. = I hate myself for having so much self-pity and concern for my appearance. I never considered myself especially attractive, but now, just don't want to appear as a freak show. It is reassuring, this probably won't kill me, but right now, that is little consolation. It is really helpful to see other successes and know you are not alone concerning the feelings and worries one has. My friends do not understand that at this point, I would rather loose my leg, than my nose. We will see what the next surgery holds... |
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susan
7 Posts |
Posted - 03/26/2009 : 01:04:58
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I am a 50ish yo female that had mohs surgery about 7 years ago. I had spots on my nose and lip area that I had been checking via dermatologists for years prior. A pimple appeared on my nose a biopsy came back as BCC. They had clear margins but unfortunately for me the scar looks like a half inch square of skin was sewn on my upper lip, my nose is indented and there is a long scar in the "natural fold" around my mouth. The surg/derm said that this was the only way to prevent my lip being unnaturally raised/asymetrical. I have since had several more BCC's on my nose other spots on my face which I have decided to treat myself with Bloodroot and more recently Sunspot ES. The cancer came back on my lip BTW and the bloodroot knocked it out. There is some great information on these treatments elsewhere on this website. I am very comfortable with myself and am only aware of my scars when I am out in public because of the way people react to me. Recently I have been reading information on ALA Laser treatments for AK and superficial BCC's and think I may benefit from this.
Susan |
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dan
611 Posts |
Posted - 03/27/2009 : 01:02:11
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kmorrow, I think there is something about having any kind of defect in the middle of one's face that makes it unbearable. When I had a skin cancer on the side of my forehead, I was not nearly as self-conscious about it compared to a later skin cancer in the center on my forehead. I suppose an off-center lesion still lets you try to project your good side whereas one in the middle means there is nowhere to hide.
Anyway, we have found several topical treatments work at least for some people. If you find one that works, then it is easy to be vigilant and catch them in their earliest stages. I also found many preventative tactics that have worked well for me over many years. The worst thing is to feel helpless while the Dr.s "practice" medicine on you. |
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abbakd
USA
1 Posts |
Posted - 03/31/2009 : 01:40:43
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Hi Simonov
Thanks for sharing, I had to grin reading about having three dudes working on your nose. Not Fun! I've had Basal Cell Carcinoma three times on my nose and I know what it is like to go through this ordeal. The last two times I had the MOHS surgery and would agree with you that this is the preferred method of treating BCC or in your case, squamous cell carcinoma.
The last time, about 2 1/2 years ago, the BCC had ran up in my nose pretty far so they had to remove almost half of my nose. It sounds a lot worse than what it turned out to be, actually I like my nose much better now than after the first MOHS surgery which had left a size-able divot on the ridge of my nose. The patch shrunk and there wasn't much I could do about it at the time.
Just from reading your account I imagine that like me, you never had planned on putting your picture out on the Internet for all to see. Especially when we weren't looking our best! I have a site where I show all too. At first it was rather weird knowing that people were looking at my pictures but I always weighed that thought against knowing that it'd probably help others faced with the same situation.
On my site about Basal Cell Carcinoma I have pictures from on the operating table to two years after. My site is here, http://www.basalcellmohs.com and I'll forewarn, the pictures are not pretty, at least not the first several sets showing the healing over the first couple months time. |
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dee2
USA
3 Posts |
Posted - 04/26/2009 : 03:24:40
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I have been reading all your stories and I have a question.
When you talk about a cancer that looked like a pimple on your nose what color was it? Was it white or flesh colored? |
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RidgebackDogs
USA
103 Posts |
Posted - 05/01/2009 : 21:20:32
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Dee,
Usually from what i've seen they're red. Mine didn't start out looking like pimples just usually a reddish crusty area. You can do a google search for pictures. Maybe Susan will post what hers looked like - kmorrow said hers started as a "bleeding zit".
If you are still unsure you could consult a dr. A couple white looking ones i have the dr said were cysts ...
but then he's sees alot more skin lesions than i do.
Good luck!
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Rose Petal
USA
33 Posts |
Posted - 05/19/2009 : 19:34:59
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simonov:
Thanks for sharing pics and your experience with skin cancer. I have the EXACT same type of cancer on the tip of my nose also.
Your scars don't look bad. YOU ARE A GUY THOUGH!
Have you had any recurrence of skin cancer in the scar tissue?
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Rose Petal
USA
33 Posts |
Posted - 05/20/2009 : 20:54:30
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simonov:
Was your squamous cell carcinoma cancer well differentiated or poorly differentiated?
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tlm
2 Posts |
Posted - 06/23/2009 : 11:52:36
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| I am having Mohs surgery soon. My well respected Dr. is doing the entire procedure, including sewing me up. Should I be requesting that a plastic surgeon sew me up? My cancer is next to my eyebrow. |
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dan
611 Posts |
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tlm
2 Posts |
Posted - 06/24/2009 : 16:46:30
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| I am having it done on the same day, but my dermo. office gave me the option of having him (My dermo) sew me up or having a plastic surgeon actually be on site to sew me up. |
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mazie
3 Posts |
Posted - 06/29/2009 : 04:25:27
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I am so glad I found this web site and more importantly, your story. My partner was visably diagnosed with skin cancer, a biopsy was done and we are to return July 7th for the diagnosis and recommended treatment.
Thank you for sharing the details and the cost. We were told by the dermatologist that any treatment would be "very expensive". We were
thrown by the cancer determination and as a result did not ask the questions we should have. Since then, I have defined Doc's statement of "very exensive" to mean many thousands of dollars.
Reading your post has taken a little fear out of this ordeal. Thanks for sharing. Hope you will continue to do well and I'll be looking for updates.
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555
USA
1 Posts |
Posted - 09/12/2009 : 13:08:54
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I had Mohs surgery for Basal Cell 3 weeks ago and my nose is still so chewed up. I am bummed. I am a 38 yr old male and I had a skin graft done to patch things up (from the upper nose). The graft only "took" for a portion of it, so I have a decent size divot still there. I am also battling acne and redness in that area. It looks so bad. The dr. have recommended Aquaphor to help the area heal, but that's clogging pours.
The dr. said that the failure rate for skin grafts is about 15-20% and I am just apparently unlucky. He set a follow-up appointment for 6 weeks and we can discuss making an incision in that area to tuck or hide the area and/or try a dermabrasion.
Simonov, what was done for reconstruction for you? A graft? Or did that do that incision and tuck?
Thanks all. I hope this gets better soon. |
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simonov
USA
3 Posts |
Posted - 10/08/2009 : 17:32:09
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I did not have a skin graft. The surgeon offered to do a skin graft, but I asked him to try to avoid that. The Mohs left a pretty big hole, so it was challenging for him to do the repair without a graft, but he did it.
I don't think he was happy that I wanted my nose back to its original, asymmetric configuration. I suspect he wanted to "fix" it.
Here is what it looked like before the surgery:
http://www.flickr.com/photos/simonov/1435969870
Here is what it looks like today:
http://www.flickr.com/photos/simonov/3971222649/
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puppybreath
USA
2 Posts |
Posted - 10/08/2010 : 17:45:16
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Thanks for sending pictures. I really researched this topic a few months ago because I had a basal cell carcinoma that had been ignored by my long-term dermatologist. I finally got to a skilled person and was told I had to have surgery.
I researched MOHs but decided to use a plastic surgeon.
It made no sense to me to let someone who has only a little plastic surgery training make a hole in my face when I could have someone with 40 years of plastic surgery experience take it out and send it to a hospital pathologist, also very experienced.
The Mohs fellowship is only a year in which a derm learns basic plastic surgery and histology.
MOHS is a cash cow for dermatologists, but your insurance will allow you to see a plastic surgeon for the procedure. A MOHS sugeon gets $1000 every time they make a scalpel cut. This could cost $1000s and you still will have to see a plastic surgeon! They don't even read your slice. A "histology tech" does it!
Ridiculous. Don't get sucked in!
I felt a lot more confident not doing MOHS. The Plasic surgeon got clean margins on his first cut and I had a beautiful scar that I am very happy with.
There is no way in Miami you can even get in with a good plastic surgeon without a month's notice. Most are not thrilled with cleaning up another guy's mess.
Plastic surgeons are trained to cut along the lines in which the face naturally falls and they are masters at disguising their cuts.
I ran into a friend of mine at my derm's office who was taking initial pictures for MOHS. I told her about my research and she ended up doing the same thing.
Good luck to all of you.
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erikpeterson
USA
1 Posts |
Posted - 12/16/2010 : 19:49:02
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I've a quick question for those of you who've been through MOHS on the nose.
I've got infiltrating BCC on my nose with MOHS scheduled at UCSF in January. I've heard that I should schedule an appt with a plastic surgeon to do the reconstruction. My surgeon is the Chief of the Derm dept with a fellowship in reconstruction and has done thousands of noses.
Any thoughts?
Thanks! |
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SShaw
Australia
1 Posts |
Posted - 02/16/2011 : 21:45:45
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Thankyou all for sharing your BCC on the nose experiences.
In over two years Ive seen 7 doctors, in Qld & NSW, re suspected BCC on the nasal tip. One "specialist" has given me in writing the statement there is no malignancy (Plastic Surgeon at Wesley in April 2010); another NSW Dermatologist has said, also in writing, I have a definite BCC malignancy - needs MOHS asap (January 2011). These two conflicting written diagnoses, both from specialists, both results of separate Biopsies leave me feeling terrified and uncertain.
My question to you all is actually this: does anyone know where one can acquire Euphorbia peplus (the plant) in sthn Qld or northern NSW?
I believe the results are very encouraging. - Samantha |
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thanks01
USA
170 Posts |
Posted - 02/18/2011 : 15:22:47
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Well, you are pretty close to Australia!
Why not just sent to the Beautanicals supplier that others have used, at http://www.beautanicals.com.au/Petty%20spurge.html . That's where I got my seeds a couple of years ago. Others on this forum have done the same, and all testify to satisfactory service. The only problem at the time I bought them was on the U.S. end, where the postal service passed some seed packets through rollers that destroyed the seeds. (This happened to another forum poster). I sent him some seeds. His grew and reproduced and then he supplied me. But the seeds from that source seem fine. Perhaps about 50% germination. |
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samdi230
Canada
24 Posts |
Posted - 02/26/2011 : 16:55:13
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quote:
Originally posted by simonov
I recently underwent Mohs surgery for removal of a squamous cell carcinoma on my nose, and another cancer victim suggested I post my experience on one or two of these cancer forums. He said that many people get pretty nervous about surgeries like this on their faces, and that reading my story might help someone get over his or her anxiety and help folks feel more confident about getting treatment.
The Story
I am 45 years old and have spent a lot of time outdoors, principally hiking and backpacking in the mountains and camping in the desert. I also grew up at the beach. I never used sunscreen as an adult because though I am light-skinned I would typically tan rather than burn. This winter I tried winter mountaineering for the first time, climbing up mountain ice and snowfields. I climbed Mt Baldy, a 10,000 foot snow-capped mountain near Los Angeles, four times in Jan-Mar 2008.
In early April of this year, what appeared to be a pimple formed right at the end of my nose. I let it alone for a while, assuming it would simply go away after a while. My wife, more of a worrier about these things that I am, suggested I see a doctor about it, but I continued to let it slide until about the middle of May, when I finally called a local dermatologist to have a look at it. I was concerned that it was not going away on its own, and so was not behaving like a pimple.
I live in Costa Mesa, in Orange County, CA, right next door to Newport Beach, which has got to be one of the main plastic surgery centers of North America, if not the world. There are many dermatology clinics here. I simply looked up the closest one in the Yellow Pages, since in the beginning all I wanted was for someone to tell me what was growing on the end of my nose.
I called a dermatology clinic in Newport Beach headed by Dr Kristen Forman (949-515-4111), and was examined by Dr Vip Soni. Dr Soni has a very positive and confident bedside manner. He identified the "pimple" immediately as some kind of skin cancer, hopefully basal cell carcinoma, but decided to take a biopsy to find out for sure. Dr Soni shot my nose full of local anesthesia and essentially sliced off the growth. It was completely painless, though I guess I was a bit nervous (I am not used to doctors at all, and typically avoid them if possible). I felt woozy when the biopsy was over, probably because of an adrenaline rush or something.
Here is how I looked post-biopsy (you can click on the links below these photos and go to their Flickr photo page, where you can see larger resolution images, if desired):
Other sizes: http://www.flickr.com/photos/simonov/2479746797/
Diagnosis and decisions
After about a week, Dr Soni called to tell me it was squamous cell carcinoma, which was good news (since it wasn't melanoma), but which was also sort of bad news because squamous cell carcinoma is only really dangerous (he said) when it is in the middle of the face, where it is getting a lot of blood circulation and is more likely to metastasize.
Now while I was waiting for the biopsy results, I had done a little research and asked around about this, and had decided that Mohs surgery sounded like the best treatment. I believe in doing your own research, and getting the opinions of other doctors and patients if you are uncertain. I happened by chance to discuss this with someone who had already been down this path, and he couldn't be more helpful or enthusiastic about Mohs. But find a good doctor, he said.
So Dr Soni started outlining our options on the phone. Radiation was mentioned, and I was already dead set against that. He then started talking about "a procedure called Mohs surgery." I told him I had already decided that was what I wanted done, and all I cared about now was finding a good doctor to do it. As it happened, Dr Soni is himself something of an expert on Mohs. He works with a team in Long Beach, CA, of two dermatologists and a plastic surgeon, and they do about 20 Mohs procedures every week.
Dr Soni also gave me a referral to a Newport Beach surgeon who he considered skilled and experienced with Mohs, but since that doctor couldn't see me until the end of June, I decided to schedule an appointment for 27 May with Dr Soni and his associates. Dr Soni said he felt it was important we acted fast because of the location of the cancer.
Now, I am a rational person who does not get overtly nervous about surgery and stuff like that, so I was very calm and relaxed going to the appointment. My friend mentioned that many people get extremely worried about surgeries on their face, especially the nose, but I wasn't really concerned. I felt like I was in good hands and I just wanted the cancer gone.
Mohs surgery
Dr Soni's Long Beach clinic does all their surgeries on only one or two days a week, so this Tuesday morning was a very busy one. There were maybe fifteen or twenty other patients moving in and out of the waiting room, and I was just about the youngest of them. So many of the patients were seniors, it really made me understand better how the skin damage that causes cancer can have occurred at any time in your life, and can catch up to you much later. It made me sad because I realized that even after I dealt with my current problem, I was doubtless at great risk of continuing to see cancers growing in the years ahead.
Anyway, I was called in and the first thing they did was start shooting my nose full of local anesthesia. That stuff really works (as with the biopsy), but despite my conscious calmness going into this thing I guess I had an unconscious nervous reaction to all these dudes (two doctors and an assistant) cutting up my nose right in front of my eyes. I was nervous and tense and Dr Soni gave me a roll of gauze to squeeze in my fist. The Mohs procedure itself was short, only ten minutes or so, so I didn't have enough time to get really nervous about it. They patched up my nose and sent me out to the waiting room while they looked at the slides.
The waiting room was kind of comical. All these people sitting around with bandages on various parts of their faces.
I waited about two hours, after which they called me back in. They said according to the slides they got all the cancer. I saw a couple of Polaroids on the counter of my nose just before they had put the bandages on, and there was a hole about the size of a marble. Now they were going to fix the hole. The reconstructive surgeon was Dr Jonathan Hoenig (562-420-8333), and he said they could take tissue from elsewhere on my body, or just use what they could find in the nose. I think they were a little concerned because my nose is asymmetrical, with one nostril being much smaller than the other (though this has never given me any kind of a problem breathing). I was cautioned that one of the downsides of using tissue from another part of the body is that it might have a different texture from nose skin. I told the doctor that at this point I just wanted to do whatever was easiest for him. I was confident he wasn't about to do a botch job, and I didn't have to worry about a movie star career.
The reconstructive surgery lasted maybe 20 minutes or a half hour, and of course was much more invasive. There was no pain, but again I became irrationally nervous and tense. The doctors noticed and seemed a little irritated (it makes their job harder) and suggested I take a valium. I had to drive home later, but they offered a reduced dosage and I also decided to go have some lunch when they were done. The valium seemed to make me feel better. Soon they patched me up and sent me out.
In general, I am not one to need pain-killers (for example, after my wisdom teeth removal), but I asked about post-op pain. They said it shouldn't be a big deal, and that I should take Tylenol if necessary. As it turned out, I didn't experience very much pain at all. The nose continued to be tender (and still is, a bit), but I never experienced the throbbing you feel from most injuries. I never needed that Tylenol.
I had an overnight backpack trip scheduled for the following weekend. The doctors quickly and unanimously nixed that idea after I asked them about it. They wanted me to take it easy.
Here's what I looked like a few days after the surgery:
Other sizes: http://www.flickr.com/photos/simonov/2537985893/
Money
I have health insurance, but prefer to use it only in emergencies (like a car crash or heart attack, etc). If I can afford to, I prefer to pay cash. Making claims is messy and whenever my wife and I do so we continue to get invoices and statements in the mail for years afterwards. So I asked to pay cash for the work.
The examination, including the biopsy, was $230.
The Mohs surgery and reconstructive surgery was $1,000.
I still have not received a bill for the biopsy lab work.
There may yet be some more minor cosmetic procedures to do, but they can't cost very much.
Healing up
Yesterday, I went back to see Dr Hoenig to get my stitches removed. He seemed pleased with my progress. So am I. My nose looks quite a bit like it did before the surgery, just not as pointy (as seen from the left) as it was before. He asked that I continue keeping it moist with antibacterial ointment for a few more days, but I no longer need to put a dressing on (I stick a band-aid on to keep the ointment clean).
Here is a photo I took last night:
Other sizes: http://www.flickr.com/photos/simonov/2549143531/
This morning in the shower I found I was able to give my face a thorough scrubbing for the first time without having to worry about hurting my nose. Within a day or so I think I really will be back to normal.
All in all, this entire ordeal was a bit of a hassle, but it didn't cost much in money or discomfort. I should be cancer-free (for now).
I thought I would post all this to encourage people who were considering a similar procedure. I am not an expert, just someone who has been there, done that, but would be happy to attempt to answer any questions I can.
hi I have good news for you get a food grad %35 h2o2 delete it with destitute water 1 part of h2o2 to 11 parts of water [ wear a robber gloves when you mix it] now sock cotton swob and play this mix only on the wound of yours now you will see a fuss on the wound that the cancer is dying apply this mix 12 to 15 time a day in mean time inhale this mix 3 time a day you be surprise how fast you well heal. When you got better spreed the world . To buy H2o2 go to farmer supply or nutrition stores .or on line good luck. |
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pingrobin
USA
1 Posts |
Posted - 11/25/2011 : 06:59:09
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Hi,
I loved reading this post. One should be prepared and avoid anxiety before going for any facial cosmetic surgery. This post really brings awareness for people with fear. http://www.hannamd.com/
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Edited by - pingrobin on 11/25/2011 07:01:43 |
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tinafey
2 Posts |
Posted - 12/02/2011 : 10:28:40
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I'm sorry to hear about the stress of these scars, and I want to offer a potential solution to help you get back to your normal life. Dermaflage is a silicone based dermal filler for recessed scars on the face and body. It makes scars completely disappear for up to36 hours, and is waterproof. I've had several post Mohs patients tell me this product was their salvation. I hope this helps!
www.dermaflage.com
quote:
Originally posted by Rose Petal
simonov:
Thanks for sharing pics and your experience with skin cancer. I have the EXACT same type of cancer on the tip of my nose also.
Your scars don't look bad. YOU ARE A GUY THOUGH!
Have you had any recurrence of skin cancer in the scar tissue?
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skyl1nev6
USA
1 Posts |
Posted - 12/23/2011 : 12:02:15
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So I had Mohs yesterday. The story that got me there was identical to this one. I seem to be more fair skinned, and spent a lot of time outdoors refereeing soccer in college and various outdoor activities. I went to a school on the beach so there was a decent amount of beach time. I did still use sun screen far more than my friends as my dad battled two melenomas and at least 8 basal cell carcinomas by the time I'd gotten to college. I am currently 36.
I knew yesterday however, when the nurses and doctor came in for the 'third' pass their jovial mood with me had dissappeared and they quit showing me the mirror. I didn't see the surgery site until this morning when changing the bandages for the first time.
I was horribly shocked to see the site which is the size of a nickel that's about 3/4 of a centimeter deep.
I really wasn't expecting to see such a bad surgery site. The doctor is going to do a grapt in Janurary because he coudln't do any of the flaps that he wanted to do. So I have a huge hole in my nose, and will have to wear a bandage for the next month. Then he will graft in some skin to help fill that hole but for next month, I'll be a little scarry looking.
Thanks for sharing your story. I know yours has been a couple of years in teh making now, but it gave me HUGE hope to see it and the outcome. |
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chapulina
USA
1 Posts |
Posted - 02/05/2012 : 15:20:26
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[font=Andale Mono][size=4][size=4][font=Century Gothic]For anyone about to have a flap repair: What they didn't tell me- First, there was absolutely no pain involved except that tiny pin prick of the first of fifteen shots to numb the nose. So, I didn't need the Tylenol 3 that made me groggy for three days. I took it fearing pain. No pain.
About Telfa: there is a Curad product that they can't call Telfa, but that works the same. The benefit is that this product comes in little wrapped packets. Once you have the design you want to cover the stitches (I had 55), trace it on the closed package. Cut it out right through the wrapper and all, and you will have a more hygenic covering ready for each of the changes you'll be making. I covered that with tan micropore tape, which makes a huge difference in the appearance and scares small children less.
BTW, this was NOT a mole. It was the tiniest scab, almost invisible, that came and went, came and went. Underneath was plenty of cancer, and on the fifth time back to the Mohs chair, it became obvious that the doc was going to do a flap repair. |
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MELaluna
USA
1 Posts |
Posted - 02/20/2012 : 10:15:48
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Simonov, thank you for your story. I just found out that I will have to undergo Moh's surgery on my face. The mark is atop of my cheek bone in the temple area. While it is not large, there is another one the same size about 5cm below the more prominent one. I was feeling somewhat okay with its removal until I began to read. Everything I read referred to reconstruction surgery, plastic surgery and many days, if not weeks of recuperation. I am now sickened by this. I do not want cancer on my face, but, I do not want my skin scarred either. Your story sheds some hope that maybe it will not be so dramatic!![]() ![]()
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shellycemt
USA
3 Posts |
Posted - 07/21/2012 : 21:58:45
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| Hi, I'm new here to this forum I'm due to havemy third surgery on my poor nose, I have had a melenoma first in like 303 and was good on my face for years but during that time I had approximatly 12-13 surgeries all over my body 3 melenomas tumers in my breast and then what they called anything from"hot spots: to baslal cell to squarmis cell well last year my nose was biopsied and then treated with mohs surgery and a plastic surgeon the next day thye truly both dr's played it down and it was horriffic! The day one the moes dr removed my baslal cell, and the following day I had to wait to get on a table in a just a big room in the hospital, for soer eason their making a big deal out of this one I truly think there is more going on then there telling me..the moes nurse said id need radiationand if i was lcky thyed get it all i am 52, but still an attractive woman and very vain as I try to keep my looks up and was fearful of the scarring the first 2 times and bouth came out great, when i herd radiation from the nurse i cried alll day with a 16 yr old son and 25 yr old daughter with 2 yr old grandchild im like im not going anywwhere then i see the plastic surgeon but notlike the last who just looked t a flap on my face this guy is on my neck behind my ear I overhear ic case its gone all the way through, and yes it is painful and uncomftable, you get black eys sometimes alot of swelling pain ugly and i have to have this done all in one day this time which im hpy waiting to the next day stunk and ths time i get the or anesthesiolagist and an hour or 2 in the OR! I guess this ne is bad but its monday putt out a prayer for me and I will write mondy lying in bed to tell u all just how bad it is or was so u can get an idea from it, the last one was the size of a ballmat the end of a neede and the wholewas the size of a dime getting it all they just dont stop and there saying this one may go all the way thru thus the extra skin to buid it up..sad mad confused shellycemt |
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cetta
USA
1 Posts |
Posted - 10/18/2012 : 13:12:41
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My birthday was August 21. I noticed a small "freckle" type dot on the right side of my nose in the fold area. Being female I look in the mirror every morning, much to my chagrin.
I watched it closely for 4 weeks. It appeared to be growing rapidly, from a small freckle to a brown "thing".
On Sept. 24 I saw a Dermatologist who suspected BCC, she took a biopsy and called me 2 weeks later to confirm her suspicions.
Her office called me and the next available appointment for Mohs surgery is Nov. 13.
I took the appointment. From the time I noticed the "freckle" to surgery it will be almost 3 months.
I do not have insurance and will be paying cash, they quoted me someplace between $1250 and $5000. They could not be sure because they said they do not know how many "layers" the doctor will have to do.
Question: Has anyone else experienced such a wide range of cost, and how many layers are "normal"
Second question I have: They mentioned to save cost they would do something called "heal by secondary intention" has anyone else had this done????
They said the doctor would probably make 2 stitches and put a band-aid on it and let it heal.
I know it is almost 4 weeks away, but the more I read the more nervous I seem to get.
Thank you all for your input, I enjoy reading your stories. |
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anivoc
668 Posts |
Posted - 10/18/2012 : 20:20:06
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Since it's your dime, you can pick any dermatologist.. I'd pick one that is also a plastic surgeon and I'd get a few more quotes...That is a crazy wide pricing...
Secondary healing is derived from the terminology used to describe the three categories of wound healing. I had never heard of it till you asked and then I looked it up...
Category 1
Primary wound healing or healing by first intention occurs within hours of repairing a full-thickness surgical incision. This surgical insult results in the mortality of a minimal number of cellular constituents.
Category 2
If the wound edges are not reapproximated immediately, delayed primary wound healing transpires. This type of healing may be desired in the case of contaminated wounds. By the fourth day, phagocytosis of contaminated tissues is well underway, and the processes of epithelization, collagen deposition, and maturation are occurring. Foreign materials are walled off by macrophages that may metamorphose into epithelioid cells, which are encircled by mononuclear leukocytes, forming granulomas. Usually the wound is closed surgically at this juncture, and if the "cleansing" of the wound is incomplete, chronic inflammation can ensue, resulting in prominent scarring.
Category 3
A third type of healing is known as secondary healing or healing by secondary intention. In this type of healing, a full-thickness wound is allowed to close and heal. Secondary healing results in an inflammatory response that is more intense than with primary wound healing. In addition, a larger quantity of granulomatous tissue is fabricated because of the need for wound closure. Secondary healing results in pronounced contraction of wounds. Fibroblastic differentiation into myofibroblasts, which resemble contractile smooth muscle, is believed to contribute to wound contraction. These myofibroblasts are maximally present in the wound from the 10th-21st days. |
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shellycemt
USA
3 Posts |
Posted - 10/19/2012 : 10:06:04
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| I am shellycemt who posted back in 7/12 on mohs surgery, and would like to say that, I am healed up nicely and wish someone could lead me to understand how to post a picture as I have the pic following the removal of the sqaumas cell on my nose. |
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dan
611 Posts |
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Topic |
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A Mohs surgery story (on the nose)
