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Waiting for Mohs Surgery After Unexpected Discovery of Bcc on Skin Fold Upper Right Lip - Melbourne, Australia

Wnt to doctor for routine filler/botox and was...

Wnt to doctor for routine filler/botox and was asked about a sore I had on my upper lip . I informed the nurse it was ecsma . She told me that she didnt think that was correct and sent me straight away for biopsy which came back the next day positive to infiltrating ulcerating bcc. With a depth of atleast mid dermis possibly more.

Have seen dermatologist who then referred me to a Mohs surgeon who booked me in for urgent surgery 16th May. The only skin cancer I ever new about was melenoma. I have had this sore for at least 4 years of being sore and bleeding. Who knows how long I had it before then.

I suppose now I am surfing the net trying to find out as much information as possible. It is scary not knowing how much they will need to cut out until the day. Is my bcc a normal easy one or is it going to be a more difficult deep procedure.?? Is the mid dermis deep far down and how far in 5 years could it spread under my skin.?? So many questions??

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I had a bcc on my upper lip, rt side...I had Mohs surgery. It is about 5 years since my surgery and I have to tell you it can hardly be seen, especially if I don't tell anyone. I just came in from purchasing my sunblock by Clinique... and the service rep. was amazed that I said I had surgery... and I had to show her where it was. Having said the good result, let me tell you that on the day of the surgery I was shocked at the extent of the cut... and for several days after I was swollen and not looking my best... however, in short order (considering) I was healed and looking much better and like my old self. My surgery required something called a "flap"... which helps covering the area cut out. My doctor used the natural crease that is on your cheek... along the nose down beside your mouth and into the chin to "hide" the stitches... Moh's surgeons make very, very fine stitches that heal almost invisibly. My advice to you is to not surf the web and look at the horrific pics of the "process"... it is the end result that you need to think about and that you will be cancer free! I get checked 3 or 4 times a year... and have had 2 other se surgeries requiring Moh's... one on my scalp and one on my front neckbone area... very little scaring for each of those too. I wish you every good thing... and hope that all went well.. I just noted the date of your surgery. So it is done and you know the worst is over... Hope you are on the mend and keep yourself checked for skin ca frequently.
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I'm going in for a biopsy on a sore that has left a crater and not healed for 18mnth that the plastic surgeon is sure is a cancer possibly a bcc its right on top of my top lip in the middle of the cupids bow it goes slightly into my lip and extends out both sides of bow i also have had lumps in my neck for 2yrs and were ultrasound 2yrs ago and showed slightly reactive lymph nodes and was told not to worry however the plastic surgeon has said there are a couple of cancers that can spread into the neck apart from being totally freaked out I'm seriously worried about the mess this is going to leave on my face being in a difficult spot has anyone else experienced this

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I was just stitched.Flaps are often needed on noses.
Once the circle was cut out and the all cells were removed, the surgeon immediately repaired it in a straight line .As our skin is so flexible he slid it together in a straight line and just stitched it with 9 stitches.I did have a look in a mirror before this was done.
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Thanks Wookie, just a few more questions...how was the corrective surgery done, did they do a flap, or were you just stiched? How many days went by between the MOHS procedure and your surgeon repairing the incision?
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Hi Jillydog,

Sorry I havent posted earlier , I have been overseas. Have you had your surgery yet? My BCC was an infiltrative deep BCC. My Moh's surgeon was recommended by my dermotologist and particularly because he was also a plastic surgeon. Not all Moh's surgeons are plastic surgeons as well. As my BCC was quite aggressive we estimated that there was a chance it would be quite large. I had flap surgery, stitched and corrective. I had around 50 stitches. It all sounds very scary but now you wouldnt tell. Without make up you can just see the white line where the stitches were but only if you are aware of the site. Finding a good surgeon is essential ask around . If you are in Melbourne I can recommend my surgeon. Also the after care is very important in the healing process for the best result. Feel free to email any time if you have any other questions. Good luck. :)
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please tell me the name of your surgeon in melbourne - I am planning to go there for mohs surgery (bcc on nose) .

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Hi Melbourne Gal. I'm pretty sure the non healing sore on my nose is some form of cancer, but have been dreading the inevitable. Could you let me know the name of the Moh's surgeon/plastic surgeon you went to. If Moh's is recommended, I would like to have some idea of who I would like to go to! It's scary. Thanks so much...:( WendyJ
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Correction !

My incision was approx the size of a 20 cent piece.
9mm x 11 mm sounds too big .
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I had my surgery late October at one side of my face, near my mouth.The suture line is barely visible now. I had a rounded excision approx 9mm x 11mm which has shrunk to a 4.5 mm long scar since the sweling has gone down.The surgeon has repaired my incision vertically along the natural fold on my cheek.My surgeon was a MOHs surgeon/ dermatologist.You may need more than one "layer" removed if the lesion is deep.With private insurance I only paid $500 extra to the surgeon.All other costs were covered for a day surgery facility and also for removal of stitches.
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Dear Jillydog,

If it is on your upper lip the Moh's surgeon will take thin slices within the margin of the BCC until he has taken out all the cancer. If there is more left after the initial cut he then has to go deeper. You do need to be aware and ask the surgeon how much might be taken and you need to have organised a reconstructive lip surgeon for the best results and also talk to him about the outcome before you proceed and how you will look. I had a wedge taken out of my upper lip and they took most of my cupids bow (which no one at this stage can reconstruct) I wish I had of asked more questions and had more information. Also when signing the medical procedure contract be specific. It is just like any other contract. I was told they would stay within the margins but on the day he went out of them because he thought he should. However, as I previously said no cancer was found and I ended up with disfigurement anyway. I am sorry if I scare you but you need to have all the information and I don't believe as in my case things turn out always terrific!!!!So be educated and ask lots of questions before you go ahead,

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Hi All, I was just diagnosed with have a BCC on my upper lip and am scheduled to see a MOHS surgeon on the 3rd of Jan. My dermo said it was roughly 5mm across, its quite raised and feels like an eraser size ball inside. I'm just wondering what to expect, is the MOHs surgeon always the reconstructive surgeon? I read your post Melbourne Girl and would be grateful for any further info regarding location, size of your BCC. Thanks!
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Jillydog,

You need to get as much information as you can so you know what to expect. Mohs surgery is just that surgery and you can end up with a result that you were not expecting or not totally informed about. For example, I was told that they would stay within the margin and on the medical consent form it just read Moh's surgery to upper lip. However, on the day the surgeon went outside the margin and took a large amount. No cancer was found but I end up with the same result as if I had. Also when I asked him why he went outside the margin he said as the surgeon it was his call!!!!

So I am sorry if I scare you but you need to be well informed as I thought it would all be fine and for some it is but for some of us it isn't!! It can be disfiguring and you need to know all that is involved so you can make an educated and informed decision. You should also consult with a reconstructive plastic surgeon who specialises in lip surgery.

All the best

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I had my surgery yesterday and fortunately for me I only needed one layer removed.I have very little discomfort.The suture line is quite long but in line with my natural creases on my cheek so I expect in time it will barely be noticible.
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Thank you ! You are reassuring. I am a registered nurse and I still don't like the look of this ! I am in Sydney in good hands (and will be back in Melb next year.) So if I end up with an excision the size of 50 cents I will not be alarmed. Thanks for the offer of the photos which I will ask for if I get concerened.
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Just to correct my earlier comment. A BCC was diagnosed on my lip through a biopsy. I was then recommended to go for Mohs surgery as I was told it was a way of saving my lip especially if, by chance there was no further cancer found. On the first cut no cancer was found however, because too much was taken on the first cut I then had to have the large area of my lip cut to correct what was taken. I fully appreciate that it is great not to have found any cancer but for someone like me, it seems upsetting to then still have such drastic surgery!!! As I put to the Doctor they certainly need to come up with a better way of detecting the spread of a BCC rather than just slicing away at one's body or face. I will also give credit where credit is due and the plastic surgeon did do a good job from what was taken. My lip is healing well and I guess I am coming to terms with my new look!!! Just remember everyone though they can do everything in plastic surgery but replace your cupid's bow. Perhaps it seems insignificant but when its gone it sure is missed!!!!!

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My surgery was very close to the right side of my mouth with some of my lip being cut out. My surgeon was very particular when closing the site to ensure the best result later. I had a little swelling but nothing really major. From my experience I had quite alot taken out about the size of a 50c piece and now you wouldnt even tell anything was there. I can tell a little because I know where it was but do alot of after care and make sure you stick to what they tell you. Most of the graphic things you see on the internet are not the greater percentage of what happens. I wish you all the best try not to stress to much and if you need email me any time afterwards . I have some before and after pics that will hopefully make you feel better. cheers :)
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Your post was encouraging. I just had my surgery yesterday and have two incisions on my upper lip on either side of the bow...i am scared I will not be able to smile normally.....the scars will be vertical and at a horizontal slant above my lip...hopefully following the normal age lines ( I am 56) gosh it was way more than I expected. I didn't think they would have to go into my lip. Sigh...anyhow if you have any other advice let me know..Thanks. Minnesota Mom
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Hi,
My only advice now would be make sure you do all the after care the doctor advises. It really does help recovery and I was very surprised at how quickly everything healed. You can see the scar ever so slightly when I am looking into the mirror. But no one notices it at all. My photo on this site was posted after operation. I know exactly how you feel it was such an ordeal to go through and when you have no idea what to expect it can freak you out. Good luck , keep healthy xxx
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I am having MOHs surgery soon for a BCC (morphied type). It is very close to one side of my mouth. I have no idea how much swelling to expect. has anyone had surgery there?
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Great to find this page with comments. I have just undergone surgery for bcc tip of nose (9 days ago) Had full thickness skin graft from neck to nose. Depth 5mm (sorry we aren't imperial measure anymore in Oz) and covered an area of a man's thumb print on my nose removed. All under GA with surgery from plastic surgeon. Wonderful bed side care at private day surgery - (all worth the expense). I woke up and it was all over.
Given excellent verbal debriefing with husband before leaving clinic and written instructions with Surgeon's direct mobile if t any issues (infection, bleeding etc). All care was taken that I did not feel any stress or physical pain before during and as much as possible, after. I had a large area removed and would take at least 12 months till end result.
I'm not 100% sure that the graft has completely taken, I'm just going by the fact that he took the stitches out and dressed the area again, but I know grafts this size can take time. Next visit he said that generally his nurse takes off final dressing, but to make an appointment so that he would do that. Physically, I know when I look down to my nose, after the nasal bone the last half of flesh is not there (the divot is that large) but at this stage I am very glad cancer is gone. I might add, that this all began as a small lesion less than grain of rice. I noticed for a year it would come go bleed. While it appeared the skin was healing above, the bcc was spreading larger below. If anyone is reading has this type of lesion, please please have it checked out by specialists.
All up costs consult f/ups, surgery,anaesthetist, $A2,700 after medical rebates.
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Hello to all. To Mitra333, I am sorry to hear about your experience. I too am very surprised they did what they did, not right IMHO. As far as my recovery I have gained new insight to this "Gold Standard" treatment. Let me share my thoughts...prior to my "procedure" I informed the staff that I had Fibromyalgia and told them stress is hard for me. At first the nurse offered a possible solution, Versed which is something that they had on hand. However when I met with the Dr. that was off the table. So I endured hours, slice by slice, of the MOHs procedure. It was horrific to got through 8 hours of their slicing and analyzing. Four levels later I had what they themselves described a wound looking like I had been shot in the head (upper forehead). The closure was awful, 2 people shoving and pushing on my forehead so the Dr. could then stitch it up. I know this I will never go through it again without proper education and the right medication. If this does not put your body and mind into shock then what would? Here we are so far ahead with medical technology and yet MOHs is done most of the time WITHOUT any thought to the COMFORT of the patient! I talked to a friend afterwards, she is a surgical nurse, and upon telling her what happened and the name of the Dr. she stated "He does things old school". Ya think?! Anyway I am healing alright but my level of trust is in the basement.
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I am sorry to hear about your Mohs surgery. I am very surprised that they did Mohs when biopsy result indicated no cancer. If you have just had it done then maybe wait a little for it all to subside. Mine looks amazing now. My doctor was so good and took extra time and care at closing to ensure a good result . Maybe it is just like anything you need to look around for a good Moh's surgeon to get the best results. My Moh's surgeon was also a plastic surgeon so maybe that is what the difference was. I hope that they can fix it because I know how it feels to have something like that done on such a vital spot.

Keep me updated on how you progress. If you are in Melbourne I can recommend Dr Alan Sheridan from the Victorian Dermotology Clinic.

Cheers
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Hi just had Mohs surgery on my upper lip on left side of cupids bow. They found no cancer at all but to repair the incision I have had all of my cupids bow taken and most of the central part of my lip.

I am totally disillusioned with the whole procedure. I was told a good Mohs result meant no drastic surgery but here I am feeling like there was absolutely no need to take what has been taken. I feel I look stupid so will probably have to have further corrective surgery. I hope yours is healing well.
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Dear Mitra: As I write this, I will get my stitches out tomorrow, March 14, 2012. The Moh's surgeon had to do two passes and I believe I have lost the bow of my lip as well. The Plastic Surgeon did a great job stitching me up. He took longer with that than the actual surgery. He did have to take more on either end so as there would not be puckering. The "columns" under my nose will now be closer with a fine scar between. I'm very nervous about getting the stitches out. Did you have further corrective surgery? I don't want to go through this again, but I'm still swollen and my top lip looks like a blob - very Daffy Duck. I hope you are well and thank you for sharing your story!
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It will be one year on March 23, 2012 since my surgery. I lost the right side of my cupid's bow. I have recently been to a renowned plastic surgeon and he advised no further surgery because it would just mean more scaring. Disappointing, but I am grateful for lip liner and lipstick to correct artificially the best I can.
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