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'm sorry to hear you are dealing with this. I too let a sore on my lip go for 3-4 years and when I finally had the courage to deal with it a biopsy revealed both bcc and squamous cells. I had MOHs surgery in February this year. The procedure with the reconstructive surgery took about 3 1/2 hours. All the cancer was removed and I am healing fine. Obviously, if you are on this sight , you want to know what you might be dealing with during this difficult time. My tumor was deep and they had to go in twice to remove all of it. The reconstruction entailed the removal of 1/3 of my upper lip. This procedure was done by cutting away a v-shaped area from just under my nose and then closing with removable stitches outside and dissolvable inside. I was under local anesthesia so I was completely aware of all that was happening but I felt nothing. I was also shown in a mirror what my lip looked like after the MOHs and then again after the reconstruction. (I had looked online at photos of the surgery, so I wasn't surprised at what I saw.) it was a little unnerving going through it, but I felt prepared. The healing was uncomfortable but I only used prescription pain meds for the first 24 hours and then Tylenol was sufficient. The discomfort after surgery was mostly irritation from the stitches until they were removed at day 6. Swelling went on for about 3 weeks. I was saddest and most concerned that I couldn't smile for that period. But, eventually I did. Once swelling was gone, the sight remained red and tight but compression on the sight a few times each day does help with the fluid build up and inflammation. Be sure to ask the best way to do this. I was only applying pressure on the outside of my lip and was shown that I need to squeeze from under the lip up to under my nose as well. This has helped reduce the hard tissue internally even more. As far as how others see me...most people don't notice and those that know about my surgery tell me it is really hard to see. It is amazing how much upper lip we have. I am not unhappy with the results at all. I am most grateful that the cancer is gone.
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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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Thank you! I wish I would not have looked at pictures on the internet. My MOHS surgery is scheduled for June 30th, and I am VERY nervous. I wish it wasn't on my face. Your post made me feel better.
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I will be thinking of you on the 30th ... sending you every good karma... remember... in very little time considering... you will look like yourself again!
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Thank you so very much! I know the Lord has me in His hands.
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One thing that helped me during the procedure was the connection with my breath to relieve my anxiety. I have learned how much this very accessible tool has helped me in so many areas of my life while on my path as a yoga student and eventually a teacher. I'll keep you in my thoughts and prayers.
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Hi , Thank you for your comments. Since my post in 2011 , I did receive Mohs and although it was all very scary had an amazing result. Other people can't even tell I have had any surgery done. I am now an old hand at dealing with this. Have had a melanoma on my back removed and now a second BCC from just under my nose only a few days ago. Luckily with this one I picked it up straight away so even though I still had 2 cuts to get all the cancer at least I know in a few months all will be ok. I am also going to have laser treatment for the scaring which will flatten the area even further. So in the scheme of things even though it is a scary thing to go through. I am still happy and healthy and here on earth. xxx
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It's funny you mention breathing. I didn't do well with the anesthesia to get my biopsy spot numb. They kept telling me to breath. Thank you for the advice! I appreciate you thoughts and prayers. One week to go!
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God bless you! I'm thankful you are well & it sounds like a real brave trooper.
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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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