Welcome to Mohs!
When my family physician told me in February I had skin cancer, I was stunned. I asked her to biopsy a spot during my yearly physical because I wanted to have it removed by laser. It was red, sometimes itchy and flaky, and perched over my right eyebrow. Vanity finally drove me to do something about it. Three months later, a surgical dermatologist removed a basal cell carcinoma, the most common form of skin cancer, from my forehead.
I really do not remember when the spot first appeared, but I know it was after the birth of my second child, who will be eight in July. Feasibly, it existed on my face for seven years. Prior to surgery, I tried to explain to my dermatologist why I ignored it for so long.
"Women are prone to blemishes," I began. Then I moved on to another female excuse.
"I thought it was my hormones. It did come up after my last pregnancy."
When he asked me why I didn't have it checked out any earlier, I weakly responded, "Well, I thought I was just getting older, and it may have been an age spot."
I should really give myself a reality check. I was only 32 years old when it appeared. Age spot? I wouldn't accept that excuse either.
After reviewing my pathology report, my doctor decided to do Mohs surgery, a procedure first used in the 1930s by Dr. Frederic Mohs at the University of Wisconsin. The surgery removes skin cancer with minimal damage to the body because the surgical team can pinpoint exactly where the cancer cells are microscopically to retain as much normal tissue as possible. Mohs also has the highest reported cure rate (95-97%) of any other skin cancer treatment (50-60%).
The dermatologist’s staff mailed me a packet of information two months before the surgery explaining my type of skin cancer, how it was treated, side effects of surgery, and how cold it would be in the waiting room. Three of the four pieces of information I took seriously. I really should have carried my sweater.
My information packet explained that Mohs surgery could involve more than one trip to the cutting chair on the same day. After the first round, the surgeon would look at the excised skin to see if all edges were clear of cancer cells. If not, then the patient returns for a precise removal of the cancer and its roots. The removed area is again checked to make sure the edges were clear. Then the surgeon repairs the damage. If too severe, the patient could be referred to a plastic surgeon. My best case scenario was one round of surgery and then reconstruction by the dermatologist; worst case, multiple rounds of surgery and reconstruction by a plastic surgeon.
The one thing I was not prepared for on my first trip to the surgical chair was the sizzle of my skin as a member of the surgical team cauterized my wound. The nurse placed pads over my eyes to block the bright lights, so all I could do was listen to what happened around me. When the doctor was working above my head, I heard a snipping noise and felt a tug as he cut the affected skin from my face. The snip was followed by a short buzz and sizzle. My head was totally numb from the shots they gave me in my face, so by that point, there was no pain.
What’s that burning smell? Is that my skin?
Carly Simon sang “You’re So Vain” over the radio. The surgical team spent most of the time during the procedure aggravating a twenty-something year old nurse by making her guess the band or singer who came on the radio while they worked. She was the youngest in the crowd, and they assumed she was ill-versed in 70s classic rock.
I soon realized no blood dripped down my face. I heard repeated short buzzes—Are those electrical currents?—and knew they were related to the smell. Someone on the surgical team was systematically cauterizing the wound as the doctor cut the skin cancer away. Very little blood seeped into the bandage they applied before sending me back to the waiting room while my lab work was completed.
When I returned to the surgical room for the second round (there was a small area which needed further removal), I asked my doctor how many of these surgeries he performed on average each week. "38-45," he replied. That was reassuring.
Before stitching me back together that morning, he asked me if I wanted to see what he had done. He handed me a mirror, and I looked at the hole on my face, noticing the discolored flesh. I expected my body beneath my skin would be a healthy, pink color; instead, the burnt flesh was stippled in dark brown.
Are the cells dead or alive? Can he really close that hole? I cannot have this on my face. Breathe, Jules. No bone is showing. He didn’t cut deep. There is really a hole on my forehead almost the size of a quarter. Breathe. Thank goodness my husband loves me. I don’t want to cut bangs in my hair. Get rid of this mirror! Breathe.
"It would be probably be more interesting if it weren't on my face," I mumbled.
“I’m sure it would,” he replied.
The team left after he finished stitching, and one nurse began washing the orange Betadine from my face. Twelve stitches under the bandage on my face, instructions on wound management in hand, and I went home.
I was one of the one million Americans affected this year by basal cell carcinoma caused by sun exposure. I do not lie in tanning beds or stay in the sun for any length of time, but I do have fair skin and spent countless hours as a teenager on the softball field in 100 degree heat during South Georgia summers. From now on, I will use my sun sense, wear hats and sunscreen when outdoors, and visit my doctor yearly. I want to prevent another trip to Mohs.