No Scar Answer to my Skin Cancer

During my visit to the dermatologist I pointed out...

during my visit to the dermatologist I pointed out a red spot on my nose that seemed to scab over easily, but never quite heal. The derm told me it was a squamous cell carcinoma, the kind caused by sun damage. While squamous cell cancer won't usually kill you, if left untreated it does spread, and it can create big ugly areas. It could have eaten away my entire nose. I saw some photos of that. I decided it was best to have it removed when it was new and small. I went to a skin cancer specialist in Moh's surgery. Moh's surgery is a subspecialty of dermatology, and not everyone does it. But I wanted it, because the alternative was to be disfigured. My skin lesion was on my nose, so I didn't want somebody cutting a big piece off it. Mohs sounded like the perfect solution, because it's done with local anaesthesia, and the surgeon removes the skin layer by layer, or slice by slice, sending each slice to be biopsied while you are still in the office and numbed. You stay until a layer comes back clean. So they only take off exactly what's necessary to "get' the cancer. It's a cure about 98% of the time. And then you are sent to a cosmetic surgeon. In my case, because this was on the bridge of my nose, they had to do a skin graft (they can't just sew up that area, because there's hardly any extra skin.). So they took some skin from my shoulder and grafted it on to my nose. They held it in place with a cotton ball that they sewed into the nose as well. Several days later, they removed the graft. You can hardly tell it is there. There's no hole in my nose, and no real scar. This surgery is WORTH IT. I will look for some photos I took during the procedure, and if I find them, I'll post them.
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I just read your post, I have had bcc removed on right side of my nose and need more taken as not clear. They have suggested taking more skin and leaving open to heal. I could have skin graft or flap not sure what to do? Do you have pictures?
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I had my surgery June 2011. Now it is Feb and I look back to normal. Most of the skin was removed on the end of my nose and I was a scary sight for about 2 months. I had three stages of MOHS to get to clear margins.Thats why you want MOHS, so your margins are checked while your incision is still open.When you leave you know you are clear and dont have to find out later that they did not get it all. I had Dr. Galen Fisher in Richmond Va. He is highly recommended by many.
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I went to a plastic surgeon for a tiny barely more than a speck of a place that started off as what i thought was a pimple. it healed but never fully went away. Came back again about 6 months later which i thought was odd for a pimple to be in the same place (the indent on the right side of my nose) but it again healed but the skin still looked like there was a clear bump. I skipped the dermatologist (mistake) and went straight to the plastic surgeon and he said it was a sebaceous oil gland inflamed. I explained its history and he said he was 100 percent sure it was nothing. Fast forward 6 months i went for a yearly check at the dermatologist and mentioned the bump (wasnt really a bump just a slight tender clear spot. No one could really see it when i showed them. She said i needed a biopsy. sure enough came back with basal cell nodular cancer. She sent me to Morgantown wv I live in charleston wv but we dont have mohs here. Mountain state dermatology and mohs center. people come from 5 states for this surgery. I was terrified. He did the first slice being conservative and i would need no sutures if it came back clear. It did not. Second slice it would need sutures if it came back clear. It did not. Third slice, Im starting to panic thinking if this doesnt come back clear im going to be sick. Oh, im a 48 year old female. He told me that with the mapping procedure that they were doing with the mohs that the cancer had grown off to the right and that where he was moving. He said also it usually take between 1 to 2 passes on average closure to 2. But sometimes it branched of (2 to 3 years of growing) which it had done in my case. Third time was clear. He the told me that he would map out a plan on my nose and that he did this so often that he was constantly mapping a plan for the best closure procedure in his head. The numbed me for the fouth time and the cut further up my nose took out a flap and filled the hole ( i didnt want to see the hole at the time he took a pic i wish that i had seen it now he said if i ever wanted to he would email it to me) he was the nices doctor ever talking thru the whole thing about my family etc trying to put me at ease. after we were all stitched up 18 stiches. I did ask to look so when i changed the bandage at home i would not pass out. Looked swolen and weird but not as bad as i had imaged. cut from the top side of my nose down into a swirl (guessing this was the patch) and then down into the indentation on the side of your nose. Pain the first night not unbearable prescription ibuprohen took care of it because i am allergic to narcotic presc. Face swolen right eye swolen shut for several days. Today is day six back to normal phhysically had stitches out. Nose still someone what swollen but all i have to do is keep on vaseline (which clinically has the best results over vitamin e or merderma etc.) and he said when the swelling goes down and color goes back to normal you should really not be able to see anything. I am very pleased . I actually was back at ther derm for the stitches and visit today. To far to drive back to morgantown, They were ecstatic with the results they saw. I had everything checked again they found a small precancer on hairline on scalp which they froze and biopisied a mole that looked normal on my head because of my history with this one. 50 percent chance to get another one once youv had one. i go back every 4 months now. The whole point of mohs was to take as least as you can but get all the cancer. Im pretty sure the way it branched off that if i had went to the plastic surgeon i would be back for more removal. and of course although hes the most highly regarded int he area he did say it was nothing. which is always inthe back of your mind. I had Dr. John Hancox a young surgeon graduated mohs residency in 2007. Great Dr. there is something to be said for beside manner when your terrified lol
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can you please post before and after phot's. I had a BCC removed from the bridge of my nose a month ago by an experienced Mohs surgeon and am scared to death of the final results. I was informed that full recovery is 6-12 months. in advance thank you
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Had a BCC on the tip of my nose that had been frozen, scrape biopsied (inconclusive) and then punch biopsy showing the BCC by the dermatologist. She recommended the Mohs performed by an associated ENT with Mohs training. Prior to the scheduled surgery, I faxed him a half page of specific questions. Rather than answering, he required a second meeting with my hubby and me which did not go well when I challenged his "repair" skills. I asked my friend with our state medical association what was the difference in training of a plastic surgeon vs an ENT with maxofacial & Mohs training. She said a plastic has 5 years of surgical residency plus 3 years of plastic fellowship vs a couple of years (perhaps) during ENT residency. I went with the plastic surgeon who cut two facing elipses and gently pulled it together. Though the initial path report during the procedure said the margins were clear, the core was not. He clipped a few stitches and cut more, down to the cartiledge (not to worry as I have a generous nose) and stitched it back. Unfortunately, the final lab shows there is still BCC tissue and he recommended radiation. Have an appt. with a radiation oncologist next week but have MANY reservations considering the proximity to my brain! He said I couldn't have had BCC in a worse place, leaving few options other than "wait and watch" or a major excision and bi-lobed flap. Any advice??
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Hope it has worked out for you umrebel
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I had squamous cell on my forehead the size of a large
pimple..the first time I saw this doctor he froze most
of what I had I guess it was pre cancer for the most of
what was on me..but anyway I would like to know why he
himself did not do the treatment..I don't know if this
guy who did it was board certified or not..I was not a
happy camper when he got through..as I had a panic or
anxiety attack when he put some thing over my face and
blocked my airway...and when I got home this thing was
bleeding so bad I called him and he said come back and
they will put a new bandage on..as this one looked like he did a lobotomy..this was done just short of 3
weeks and seems to be indented but not to bad,as I am
a man,and old but if I was a lady I would not go back
plus the area is still numb I don't have great luck so
I am just thankful that this was not malanoma..
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I just had Mohs on my top lip for a BCC. I was told my the follow up plastic surgeon the best cosmetic result is a wedge incision taking most of my cupids bow.

The Mohs surgeon however told me on the day he would take such a minimal amount, no into the white part of my lip line, no into deep flesh. My results were no cancer at all. But then I am told on the day the plastic surgeon will still need to remove part of my lip. I ask why when there is no cancer there and I was told only a small part was taken. He said to trust him for a better cosmetic result rather than a graft. At the moment having lost all of my cupid's bow and the central part of my top lip...which wasn't even affected by the original BCC I am left pondering how this could be considered better cosmetically!!!

I get my stitches out on Thursday so will ask, how come I come away with such a perfect result but end up minus most of my top central lip? I felt like I was on a factory line and got the same treatment regardless of what my test result was!!!This just doesn't make sense to me if the BCC was going to disfigure me then the surgeons actually did a better job of it!!!!

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I have had MOHS three times now. I think a lot has to change in this profession.

Did you know that very few MOHS "Surgeons" are actually surgeons? Very few have surgical privileges at hospitals? Very few have gone through a Surgical Residency.

Through an obvious mistake in Medicare/Insurance rules, Plastic Surgeons who have trained in MOHS have a harder time getting paid for performing MOHS procedures than Dermatologists with MOHS training. We have to fight to change this.

Doesn't it make sense that you want a person who is skilled at reconstruction to also do the removal of tissue so they can keep in mind how they are going to reconstruct while they are doing the removal?

My personal experience has been horrible with MOHS. The first time I had a MOHS "Surgeon" (not really a surgeon at all) do the removal and reconstruction. The results were terrible. He cut in the wrong spot, completely missing the cancer. He left me with only part of an eyebrow and a noticeable scar.

The second time, I was not going to make that mistake again so I lined up a plastic surgeon to do the reconstruction after the removal. However, the MOHS "Surgeon" did such a terrible job of removing the tissue that the plastic surgeon did not have much to work with and I was left with a quarter sized scar.

The last time was only 2 days ago. Because the first surgeon "Missed the cancer spot", I had to go back two years later (it just reappeared as a tiny spot) and have it removed. Again a MOHS surgeon did the removal and a plastic surgeon did the reconstruction. Because the cancer had at least 2 years to grow, a lot of tissue was removed with little or no thought to how it would be reconstructed. The plastic surgeon did her best but I still can't stand to look myself in the mirror.

It is too late for me, I am permanently disfigured. But for the benefit of others, the rules have to change. Plastic surgeons have to be encouraged to do MOHS removal as well as the reconstruction of the face and hands. Additionally, dermatologists with MOHS training should be restricted to doing MOHS on less visible parts of the body when/if scarring is less important.
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I just found out today that the mole I have had on the side of my nose by its base for the past 10 years is basal cell carcinoma. I am only 25 years old, and quite frankly, scared out of my mind. I have an appt with a board certified dermatologist at a teaching clinic, so I am pretty confident he will be experienced. However, my derm mentioned that I would have the option of having him close the area or having a plastic surgeon do it. Is everyone saying definitely have the plastic surgeon? My mom has had 3 Moh's procedures and had her derm do them and to be honest, her's don't look so great. I mean, she is 60 and has serious sun damage. I don't want to seem superficial, but I am a pretty 25 year old and I am scared to death of being deformed by this. HELP!
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A;ways get a second opinion on any surgery you do AND have an appointment with the plastic surgeon BEFORE you have the MOHS. This way they can see what you looked like before they start cutting your face.
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Nicki, I had a very similar experience. I had just a 2.5 mm basal cell in the center of my left cheek. The "MOHS Surgeon," as which Dr. Peter Seline of Westerville, OH refers to himself, did two cuts and then stitched up the open wound. He said it will leave a small faint scar that will go away within a year. Well, this doctor did such a horrible job stitching up the wound that even after 4 years and 5 months through the "healing process," the scar is 6 inches long, with dark redness and puffiness completely surrounding the scar. I tried to talk this doctor a few times within the first year of the healing time after the surgery, but he never said anything more than rudely scolding me to "give it time...it may take years to completely hea!." Just recently I went to another derm who told me that such a tiny basal cell should have never been removed with MOHS surgery and that the scar is so red and visible that I will just have to learn to live with it. Skin peels and not even Fraxel lasers would have any success at making the scar less visible according to my new dermatologist who said he just wants to be frank and direct with me rather than give me hopes that it ever heal and become less visible over time and/or with laser surgery. Very upsetting and depressing, and I'll likely never feel comfortable in my own skin ever again thanks to Peter Seline's horrible stitching and suturing techniques.
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Kathy, I am terrified of needles also, so much, that I have them numb the area first with cream. It's the same thing they use on small children. Afterwards you will be swollen and bruised but the face is amazing and heals really quickly with little scarring. Happy to give you before and after pictures if you like. Good luck and be sure to take pictures of your face before and after. You will be pleasantly surprised when you look back on these in a couple of months time.
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Have Mohs scheduled for April 30 on the end of my nose. Will you share pictures?
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I was just diagnosed with a squamous cell carcinoma on the bridge of my nose. It's an extremely small spot - in fact I pointed it out to my dermatologist. Occasionally it would erupt and then heal. I am scheduled for MOHS surgery on 2/15. Needless to say I'm a bit frightened about the procedure. I hate/fear needles. Yes - I'm a big baby. And I really like my nose. Any words regarding the procedure. Thanks!

Kathy
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I am right there with you! I am scared to death of all the MOHs photos and talk of skin grafts. My nose is my best feature and poof! It's going to be ruined.
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Hi Kathy, I'm having the same procedure done on the bridge of my nose. Did you have a plastic surgeon close the area? If not are you happy with how it's healed? Thanks, Teri

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I had the MOHS right under my eye and I had a plastic surgeon do the closure. Not happy at all, one eye is smaller than the other (look like Pablo Picasso). I highly recommend seeing the plastic surgeon BEFORE you have anyone disfiguring your face, this way they can see what you looked like before the surgery.
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If you have a good plastic surgeon scarring shouldn't be a problem. The face heals extremely fast. Happy to share before and after photos of my surgery. A couple of months after surgery and you can hardly see any sign of the scars.
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Just diagnosed with BCC on my nose. Extremely scared of the mohs surgery and the scarring after. Will be having a plastic surgeon, experienced in reconstruction after mohs, fix the "hole" that will be practically on the tip of my nose. But I am very concerned about the scar. How long before you did not feel like a "monster"? What kind of recon did you have? Bilobed or forehead? I AM EXTREMELY ANXIOUS AND SCARED ABOUT THE SCARRING!!!
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Where was your surgery, nose, forehead ?? How long did it take to heal after surgery...pics would be wonderful. Having my surgery January next year and I am very scared
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Sorry for being slow to reply, just had more mohs done in October 2011. Above right eye. All is healing nicely. When I show people before and after pictures they can't believe it. Where shall I email pics for you?
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hi 9219anon,
thank you for your reply You can email pictures to: mmark5@mchsicom. I am still terrified about this surgery. Scheduled for Jan.2012
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