Between You and Me: ‘No skin off my nose,’ but there was.
By Leah S. Dunaief
Just to add some excitement to my life, I had Mohs surgery this past week. Of course, it was not my idea. The dermatologist identified a spot on the side of my nose as possibly the beginning of a basal cell carcinoma, scraped it off and sent it for a biopsy. The report came back positive.
The next step in this situation was a visit to a Mohs surgeon, who specializes in removing the unwelcome cells.
So off I went.
Now typically there are three types of skin cancers: basal cell, squamous cell and melanoma. Mine was a basal, the least of the three and slowest growing. Nonetheless, it had to come off.
An appointment was made for the deed to be done. Now Mohs surgery, used first by Frederic E. Mohs in 1936, is intended for areas totally visible, like the cheek or nose, where scars would be most undesirable. The skin with the troubled spot is cut away one layer at a time and then studied under a microscope. When a layer is found free of the cancer, the surgeon can stop removal. In that way, no more skin is cut away than is affected, minimizing the healing process and the scarring.
At the initial consult, I was told to come back at 8:30 a.m. last Monday and bring lunch and a book because there was no way to know in advance how deep the basal cells have penetrated and hence, how many layers may have to be removed.
“Plan to spend the whole day here,” the nurse instructed. “Of course you can leave as soon as the skin is cancer free.”
So I dutifully appeared at the appointed time, heart pounding, not knowing exactly what I was in for. For those facing Mohs surgery or will undergo the procedure in the future, here is what’s involved. And by the way, more and more people are developing various skin cancers because the skin is damaged by the sun, older people have had more time to be affected, and there are now more older residents in America than ever before. Thousands of baby boomers turn 65 every day.
Mohs surgery can be done in a hospital or a physician’s office. I was in an office. First, the nurse carefully and thoroughly wiped my face with antiseptic to prevent an infection. Pictures were taken to record the exact location of the spot. Then my upper body was draped, and the nurse injected pain killer in several locations on the nose and cheek, which each felt like a sharp but quick pinch.
When I was anesthetized, the physician entered, put on his surgical gloves, and the procedure began as Christmas music played softly in the background. It took less than five minutes to get the specimen for the lab. It takes about an hour for the slide to be inspected, using a special diagnostic machine.
I was then bandaged and sent out to wait. While I was waiting, I studied the others in the waiting room. Some had bandages on their ear or their cheek. One lady had a dressing on her scalp. A man had one on his neck. All were reading.
I also enjoyed the company of my son, who accompanied me throughout this experience, for it gave us an opportunity to chat and catch up on the latest. That was the silver lining.
In less than an hour, the nurse waved me back into the procedure room, and I swooped up my untouched lunch, my book and my coat and anxiously followed her.
“It’s all clear,” she said smiling. “No further cancer.”
“Hot dog!” I exclaimed, thereby giving both the young nurse and youngish doctor a laugh. Apparently, they were not familiar with that enthusiastic expression. I guess the current phrase would have been,
“Cool!”
Then the surgeon took a thin slice of skin from elsewhere on my nose, and using this plastic surgery technique, covered the surgical site. The wound was next stitched up and covered with a pressure bandage that was to remain until the next day.
Happily we could leave. The task now is to keep the area clean and manage the ensuing pain until the healing is complete.
Until then, should we cross paths, I hope you won’t confuse me with your neighborhood raccoons. Or think that I was in a bar fight and got punched in the eye.
