Saturday, December 11, 2010

Basal Cell Carcinoma Cancer on My Nose / Mohs Surgery




On August 31, 2010 I was diagnosed with Basal Cell Carcinoma (BCC) on the left side of my nose.  I thought I would write this blog to provide others with information on BCC and Mohs surgery.  Skin cancer and Mohs surgery can be very scary, but Mohs surgery has a very high success rate.

If you're reading this because you are considering Mohs surgery, let me start by saying I believe the best option for treating cancer on your face, scalp and ears is Mohs surgery.  Mohs has the highest success rate and removes the least amount of healthy tissue  But I also think you need to do as much research as possible, so you know what to expect when you go for surgery.  There is no way to know, before the surgery, how far the cancer has spread.  The cancer you see could be just the tip of the iceberg. Here is a link for more info on Mohs Surgery:  http://www.mohscollege.org/

It's also very important to understand how extensive the hole could be after surgery and how it will be closed.  Who will be closing the hole, the Mohs surgeon or a plastic surgeon?  What methods do they use to close the hole? 


My Story:
It was probably March or April of this year when I first noticed a small sore (about as round as a pencil eraser) on the left side of my nose that would never completely heal.  It was light red and had a light scab on it all the time.  After a few months my wife convinced me to make an appointment to see a dermatologist.  I got in to see the dermatologist on August 23rd.  He checked several spots on my body but was only concerned about the spot on my nose.  He recommended a biopsy be done to determine what it was.  I asked a few questions about the biopsy procedure and then he went ahead and did the biopsy that same day.  The biopsy cut the top of the sore completely off.  The worst part of the biopsy was the shots to numb my nose.  But it only burned for a few seconds and then I never had any more pain.  It took about about 14 day for the biopsy to completely heal.  I wish I would have thought to take some pictures before the biopsy, but I didn't. 

Here is a picture of my nose after the biopsy had fully healed.  It healed up so nice that you can't really even tell where the biopsy was.
It was August 31st when the dermatologist called and let me know the biopsy results showed that it was Basal Cell Carcinoma Cancer.  He told me it was the best kind of skin cancer to have (if you have to have skin cancer). My first thought was no big deal it looks like the biopsy got it all.  The dermatologist explained that Basal Cell Carcinoma Cancer could be like an iceberg in that what you see is just the tip of the iceberg and you don't know how much is under the surface.  He also explained that after the biopsy new skin had just healed over the cancer.  He explained that because of the cancer was on my nose he felt the only option to treat it was to have Mohs surgery to remove the cancer.  That's when it started to get a bit scary.  I was thinking...Surgery? and What's Mohs? The dermatologist told me Mohs was the name for a precision surgical procedure to identify and remove the entire tumor layer by layer while leaving the surrounding healthy tissue intact and unharmed.  Since there is so little tissue on the nose it is critical to leave all the healthy tissue intact and only remove the cancer cells.  Here is a link for more info on Mohs Surgery:  http://www.mohscollege.org/

The dermatologist recommended I go to a surgeon trained in the Mohs  procedure.  He gave me the name of a Mohs surgeon and off I went.  As soon as I got home I got on Google and start searching for more info.  The pictures and stories were shocking to say the least.  I was starting to realize that the surgery could be more that just simply cutting a small piece of tissue out of my nose.  The dermatologist had told me I would more than likely have stitches, he just wasn't sure how many.

I scheduled a consultation with the Mohs surgeon that my dermatologist had recommended.  The consultation when very well.  He examined my nose and explained in great detail how the entire procedure would go.  I asked him if he could estimate how much tissue he would have to remove and what he would have to do to close the hole.  He explained that there isn't any way to tell how much cancer there is until they are doing the cutting and checking the pathology.  As for closing the hole, he said he wouldn't know until he was done removing the cancer.  He did explain some of the options, like skin grafts and flaps.   I asked him how often he had to refer patients to a plastic surgeon to close the hole.  He explained that he closes the hole most of the time.  But he said he wouldn't hesitate to refer someone to a plastic surgeon if the hole was extensive and a plastic surgeon would be better suited to close it. The Mohs surgeon i chose performs eight surgeries a day, four days a week and has been doing Mohs surgeries for almost 30 years (that's over 29,000 Mohs surgeries, I was his 29,113 patient).  I felt very comfortable and went ahead and scheduled surgery for October 20th, 2010.

Surgery Day: Surgery was scheduled for 8:30am.  But the doctors office was 120 miles away so the wife and I had to hit the road by 6:00am.  I felt the drive would be more than worth it to go to one of the top Mohs surgeons in the country.  Here are some pictures of my nose before surgery. The new skin had healed so well after the biopsy that you can barely see the the cancer spot.



Once I arrived at the surgeons office he examined my nose and marked the spot he would remove with the first cut.

Here is nose marked for surgery:


The next step was for the nurse to numb my nose.  This was the worst part of the surgery.  She gave me about 10 shots to make sure my nose was completely numb. The shots were the most painful part of the entire surgery. I forgot to mention that you are awake for the entire procedure.  After my nose was good and numb the surgeon came in and cut out the first piece of tissue.  It only took him a few minutes to remove it.  The tissue was sent immediately to pathology to check it for cancer on the margins.  The nurse then put a large bandage on my nose and told me the results would be back in about an hour.  So my wife and I went out for lunch.

Here is a picture of the first piece of tissue removed (7mm in diameter and ~2 mm deep):


After about two hours the nurse came to let me know the results showed that there was still some cancer on the bottom edge and that I would need to have more tissue removed.  She then gave me another round of shots to numb my nose.  They didn't hurt as bad this time, but I think she gave me about 12-14 shots.  Once my nose was good and numb the surgeon came in and removed a second piece of tissue.

Here is a picture of the second piece of tissue removed ( hole now 10mm x 9mm and ~2 mm deep):


Again it took about two hours to get the results from pathology.  The nurse explained that the results were taking longer than normal because a couple of the patients (there were 9 of us that day) had very large chunks of tissue removed.  The results were all clear this time and I was now ready to be closed.  I had to wait about four more hours before they took me back to close the hole.  The wait was again due to size of the holes that needed to be closed on a couple of patients ahead of me.  Once the surgeon came back in he explained the options to close the hole.  He felt the two best options were either a skin graft from the inner ear or to just let it heal on its own.  A third option would be a skin flap, but he felt the scare from a skin flap would be much worse that the scar from the first two options.  His recommendation was to leave it alone and just let it heal.  I really liked this option, especially since I would not have to have any more shots.  The nurse then bandaged me up and gave me instructions on how to care for the hole.  The surgeon gave me a prescription from pain, but I never had any pain, so I never even had it filled.

Picture of Nose One day after surgery:


Picture of Nose Three days after surgery:


Picture of Nose Eight days after surgery:


Picture of Nose 20 Days after surgery:


Picture of Nose 52 Days after surgery:


Picture of Nose 4 Months After Mohs Surgery






Day 1 and 4 Months next to each other.  Still can't believe how well it healed.

After a few months of stressing and worrying everything has worked out just fine.  

If you have questions about the procedure feel free to email me.  Also, you can email me if you would like a recommendation on one of the best Mohs surgeons in the country.

Bert


Updated 8/17/2013

Here is a current picture of my nose.  It's been almost three years since the Mohs surgery and the scar is barely visible.



100 comments:

  1. Thank you for sharing your experience, it was very helpful.

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  2. Thank you for sharing. My BCC is in the same spot but a bit bigger. My spot hasn't healed since the biopsy either. Your experience seemed quite positive.

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  3. Hi

    Thnaks for sharing

    I wanted to ask what instructions the nurse gave you to care for the hole - your results are amazing

    All the

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  4. i meant all the best!

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  5. Since they left the hole open and didn't put any stitches in it, they told me to keep it covered and moist for the first three weeks. To keep it moist I used a Double Antibiotic Ointment and small round band-aid over that. For the last 2 months I have been using Mederma on the scar. I've been truly amazed at how well the hole filled in.

    Thanks

    Bert

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  6. Thanks so much - your results are truly astonishing!

    all the best

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  7. I really appreciate you sharing your experience and especially the photos. I just found out today that I have a bcc on the side of my nose, sort of where it meets your face....All day, I've been worried about the hole the surgery will leave behind, but I feel more positive after reading your blog and seeing your photos! Thanks again.

    Bonnie

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  8. Dear Bert,
    My mom rec'd the call today that her biopsy was bcc also. I plan to be by her side, (she's 84)during the procedure. It's on the tip of her nose, and tho' I'm glad I read all you wrote, I'm afraid once the doctor tells her how many needles she will have to endure - for the biopsy she only had one - she might leave! Did they tell you what to expect? Do you wish you did/didn't know? Thank you,
    Gail

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  9. Gail,

    I did a lot of reading and then asked a lot of questions during the consultation with the Mohs surgeon. He told me exactly what to expect every step along the way. I got several shots before each surgery, but the nurse took her time and the pain(burning sensation) wasn't as bad as the one shot for the biopsy. When the doctor gave me the shot before the biopsy he injected it very fast and is really hurt. Best of luck to you mom.

    Bert

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  10. Thank you for sharing your story. I too had a BCC. Mine was on the tip of my nose,and was removed under local. Yes - the injections are by far the worst part of the procedure. I had a full thickness skin graft taken from my neck. This sadly failed, and I had a miserable few weeks wondering what would happen next time. Since then, the hole in my nose has miraculously filled in. by itself. 2 months later, it looks a little lumpy, but very presentable, and I will not need another skin graft as originally planned. My message to people out there going through the same thing is - try not to panic,even if you have complications. The surgeons are great, and the body is a wonderful thing!

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  11. Dear Bert,

    Thanks for sharing your experience. It's great that your nose healed so beautifully. I went through the same surgery last May and wrote about it here:

    http://www.mohssurgery-mystory.blogspot.com/

    My scar is also minimal. I agree that Mohs is the best way to go. I think that by sharing the details of our experience, we can help others who are going through the same thing.

    Best wishes,
    Camille

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  12. Hi,

    I just had Mohs surgery last week on not one, but two places - one on my nose and one directly under my nose. My doctor also recommended letting them heal on their own. As the holes heal, they look like they are filling with yellow pussy stuff, but the doctor said it is just the new skin forming. The hole under my nose is already filled and looks like a skin is formed over it. The one on the side of my nose is quite a bit bigger, but it looks like it is already starting to heal. The doctor said that letting them heal on their own is a lot less invasive and the end result will be just as good. Overall, the experience was not at all as bad as thought it would be. Thanks for sharing your story.

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  13. Hi Bert, Thanks for sharing. My cancer is on my nose also, but on the right side at almost the same place as yours. I had the same thing done to mine, but they had to go back into mine four times. All the shots were bad. I ended up going to a plastic surgeon to have mine stitched up. It was done yesterday and I am in pain and bruised. Hope it will get better soon. Dot

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  14. Thanks, Bert. I was just diagnosed with BCC in the same spot as yours on my nose. I have been very upset because of many stories on the web detailing MOHS surgeries in which very large amounts of tissue were removed. So, it was nice to see how contained your surgery was-especially since, like you I waited several months before being seen. I would definitely let it heal on its own, given the beautiful result you achieved, if my surgery leaves a similarly sized hole.
    Heidi

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  15. Hi, thank you for the information. I was just informed that I have the same thing. My operation is in November. It is just hitting me that I have cancer. It is so hard to believe. I hope this surgery goes well. I wonder if this means that we will have cancer again?!!!

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  16. Thanks a lot for sharing such great information. I had seen the photos you have posted here are that looks great , it was such nice result you get.

    nose surgery

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  17. Thanks Bert. That was a great story.

    Here's my story about a nasty BCC right on the tip of my nose.
    http://billolearyphuket.com/ArticleView.asp?ArticleID=33

    Both of us had similar results so we're both blessed.
    Every good wish,
    Bill O'Leary

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  18. Hi Bert, Thanks a lot for posting about your experience with Basal Cell Carcinoma/Moh's suregry (complete with photos). I am having Moh's surgery on Monday 11/28/11 and my BCC is also on the left side of my nose. Your description of your experience and the pictures were of great help to me and eased my nerves a bit. Again, thanks.
    P.S. Hope you and your family have a Blessed Thanksgiving!

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  19. My brother's doctor took the same approach and he healed near perfect as you did. You can't tell that he had surgery. I had a basal cell removed in August and my highly respected surgeon used the flap approach. I had sutures, major swelling and am not scarring nicely. I will need cortisone shots to soften the scar tissue to help the puffy spots and laser or dermabrasion. It will probably take me a year to look pretty good. I discussed letting it heal on it's own with my doctor and he said it could leave a divet (pock mark) or pull on the nose and that he never does this approach. I'd love to know if anybody else has heard this from their surgeons.

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    Replies
    1. Hi a few years down the line but I too have been told of options by my plastic surgeon here in the UK - go on Monday for appointment, not sure if having actual surgery then :0....... he said about a hole? but not sure yet and stiches may pull skin on nose and possibility of skin graft eeeeeeek ......and I believe wherever they take skin sample can be as sore as hell!!!! he is not a Mohs surgeon as far as I know but a senior consultant in his field. I have been mortified at some of the surgery stories and photo's and even though I am 67 am panicking incase I look like the elephant man lol! as i do take care of my appearance. I am ceetainly going to chat about the self healing process with my surgeon even though i am on strong arthritis medication. I know it has to be done but am so so scared of ending up hideous.. :( Watch this space hope my guardian angels are looking out for me xx

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    2. I just had BCC exactly where Bert had his on 7/23/13, today is 7/25/13. My hole is just a tad bigger than Bert's, but I was given 3 options, (1) stitches but it would pull my nose up from the bottom (like a pig nose-only way I can explain it & he said it would not be attractive at all & he showed me & it was not pretty. I have to clean my everyday & swap Q-tips in it w/warm water then dry it w/Q-tip & then put Vaseline or this new stuff called Aquaphor,just like Vasline they said, I chose to use Aquaphor. My nose hurts, my cheek hurts & I have to tape it from right under my eye to above my lip to completely cover hole. However, I find that brushing my teeth, yawning, things that open my mouth hurt my nose & I can feel it bleeding under there, but we're on day 2. I was told the BEST option 4 me, was to return in 3 wks cleaning as abv-mentioned and then they would graft skin in 2 places from my nose & ear to fill hole & stitch it. However, I could not smoke 7 days b4, have to take antibiotics MORN. of, & cannot smoke 14 dys afterwards. I said I would take that option, but I'm thinking I might show them Bert's photos & ask about that, if it takes 4 months & looks good as new, I like those odds; however, this is just a surgeon who performed many MOHS surgeries & he never mentioned see what it looks like healing by itself, so I have to assume i'll need the skin grafts as my hole as I call it is just a tap deeper than Bert's, & I do not have a plastic surgeon,but they did suggest that they might have to send me out to one, so that was comforting. I was also told that if I smoked, I would FOREVER have permanently "black" on the top of my nose where 2 skins grafts R 2 B performed & on the side, although I know it's not good 2 smoke, I quit for 40 days & wish this procedure was done during that period. So hopefully, God-willing w/many prayers, it'll work out well. I am so thankful to Bert for sharing this & sorry that these posts are over a year ago. Grateful to everyone who posted! God Bless

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  20. Hi Bert,

    I would like the name & location of your surgeon. I don't see your email address on the page??

    Thanks,
    RB

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  21. RB

    Below is my surgeons info. He and his entire staff were outstanding.

    Dr. Michael McCall
    Associates in Dermatology
    310 E. Broadway
    Louisville, KY 40202
    502-583-1749

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  22. Thanks for the info.

    Best,
    RB

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  23. Thanks for all the pics and info on your journey......How long was it between when u first noticed the bump to when u had it checked out?

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  24. It was around 6 months from the time I first noticed the bump until I had it checked. I kept thing it was a sore that would just heal on it's own.

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  25. I was just curious bc I've had this bump on the tip of my nose for about a year now. Thought it was a pimple at first.......Finally went to the derm bc it would bleed every now and then. Found out it is BCC. I have an appt with a Surgeon that specializes in Mohs surgery next week. I'm really nervous......Not so much bc it's BCC but bc of where it's at. Hopefully they won't have to do too much cutting.

    Thanks again for all your info.

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  26. Dear Bert,
    I had a spot on my cheek that the dermo just diagnosed as BCC. SHe did the biopsy and said I'll be going for the MOHS once the pathology comes back. I'm a bit freaked out (although trying not to show it) as she said it was 'pretty advanced" and that it had to be there for at least a year (now that I think back, probably closer to two years). I had been covering it up with makeup and not thinking much about it until over the past couple of months when I washed my face at night it would bleed for no apparent reason. I was pretty sure what it was and didn't think too much about it. SO many things came up that I just didn't "have the time" to call the dermo. Boy as I sorry now that I waited! THe biopsy segment is about as big as a dime, maybe a little smaller? but just a little. I'm just wondering how big the hole in my cheek is going to end up being... now I'm really worried! It looked like nothing really. Just a pink to red bumpy spot, kind of kidney shapped - irregular borders that developed these little bumps (pimple like) that would break open and bleed (more frequently the longer it went on)... Please folks - if you are reading this and have a spot that just "doesn't look right", don't wait. Really, go to the dermo .. FIND THE TIME. It won't kill you if it is basal cell (it will just give you some scars and nasty looking spots if left untreated), but other forms of skin cancer WILL kill you.. please don't wait. A tiny little spot is sooo much easier to treat. Now I'm going to have this huge chunk taken out of my cheek. I wonder how deep they will have to go. I'll let you know how it works out... THanks for all your information!

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    Replies
    1. Good luck to you on the surgery . I did go in at first concern and not a bit sorry. You gave good advice. My two surgeries are being done within days of each other . one on my cheek had stitches, but with the proper surgeon you'll not have a huge scar. now my nose I am concerned about, but knowing I went in as soon as possible helps me feel less worried. But, I try not worry about something I can't do anything about now. life goes on....again good luck !

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  27. I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading. Nice blog. I will keep visiting this blog very often.


    Susan

    Tonsil Stones Removal Guide

    ReplyDelete
  28. Good Day,

    I had Moh's surgery for almost identical case (basal cell carcinoma/pencil eraser sized on left side of nose) as your's two weeks ago today. I do keep it moistened with vaseline, but it seems that the surface scab wants to slide off, good thing is that the hole has filled in. Was wondering if you had a hard time with surface scab, did you ever have it come off? Thanks

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  29. The Dr recommended that I keep it moist and covered for the first few weeks. To keep it moist I used a Double Antibiotic Ointment and small round band-aid over that.

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    Replies
    1. Because I kept it moist and covered I didn't every really have a scab.

      Delete
  30. I had a sizable BCC just over my left temple on my forehead. I had Mohs surgery on Wednesday, 22 Feb. 2012. The pain after surgery was sever, but I am now on day 2 and pain is easing. I have about 12 stitches and hope the scaring will be minimal.
    GR.

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  31. Greg: My story is almost as similiar as yours, as far as the date and BCC location on my nose. My BCC was discovered in June, 2010 and removed by my local DERMO using a scalpel. The BCC is on the right side of my nose, closer to the cheek. No Mohs procedure was ever offered to me by this surgeon. After some thought, I contacted my Primary Physician and asked for a referral to seek a second opinion. I crossed the bridge from NJ over to the Fox Chase Cancer Center in Phila, PA and finally got the answer I was looking for. The BCC was not totally removed the first time and now was still present on my nose. After another positive biopsy was completed, I was offered the Mohs Surgery Procedure as the best alternative. Greg, thanks to your posting here on this website I now know what I will be facing on my surgery date which is: March 9, 2012.

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  32. I am very grateful for this site. I had basal cell carcinoma on the right side of my nose and had never heard of it or the mohs surgery before. I had my surgery 2 days ago and they got it all the first time which I am so glad of. The surgery went great, but in my case when the feeling came back, I had the most excruciating, pulsating, burning pain for about 24 hours. I did have stitches, so maybe that was the difference. I don't know, I thought I tolerated pain well in the past. Anyway, 2 days later and I'm fine, no pain meds today. In 5 days I go to get my stitches out, but tomorrow I go to have a squamos cell carcinoma cut off my leg. I won't be having the mohs surgery tomorrow, so I don't know exactly what to expect. Thanks again Bert for your stories and everyone's comments.

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  33. Hello-how long (months wise) did it take before your nose divot started to fill in? I am going on day 21 and the divot is still very indented. Thank you.

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    Replies
    1. It was pretty much filled in after six weeks.

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  34. Thanks. Did you do anything special to help it fill in? Was it still pretty indented at 3 and a half weeks?

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  35. This is a great post. I was looking for something like this and you gave me what i wanted to know.

    Skin Cancer Treatment

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  36. This comment has been removed by the author.

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  37. Bert,
    Thanks for the post. I'm having a BCC removed tomorrow, from pretty much the same place.
    The photos and your explanation have helped me understand what's going to happen and how big th edivot will be (hopefully)
    Cheers
    Tony

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  38. Hi Bert, Thanks a lot for posting about your experience with Basal Cell Carcinoma/Moh's suregry (complete with photos). I am having Moh's surgery on Monday 11/28/11 and my BCC is also on the left side of my nose. Your description of your experience and the pictures were of great help to me and eased my nerves a bit. Again, thanks.
    http://www.npclinic.org

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  39. Hi Bert, I enjoyed your blog due to my own surgeries
    ( ongoing yet ). one is near my nose on the crease of my cheek. the other on the right side of my nose ( looks much like yours only never a sore). both are BCC. I had to have the cheek done yesterday and while the biopsy was small, the cancer was actually a bit deep and longer down my cheek. Stitches required to close. but it will be well hidden in my crease with a small pink scar. I can live with that. Now the nose is another matter. in two days I have to have the moh's surgery performed. I am praying it's not too deep and I can let it close up on it's own. encouraged by your story I think that it might be an option now. Hope so !
    I have excellent DRS. and all work in the same center together. I could not have been sent to anyone that I like better. It's been a fairly pain free experience so far and I am confident in the outcome for my surgeries.
    The one Dr. is a specialist on Moh's and that gave me such joy. I had researched online all about BCC and learned I was right where I should be ! how lucky is that ?
    I was un-nerved at first, but soon lost my fears...what will be will be, and I did catch it early as I could. Mine did not display any of the so called signs you look for . I just felt uneasy with the little white round spot on my nose and the cluster of pimples in the crease of my face near the nose. My Dr. praised me for just following my feeling that I should at the very least check it out. Well, this is too long , but your blog had caught my attention and led me on to further exploration on the BCC. Thanks Bert !

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  40. I had my second surgery for BCC. This one on the side of my nose. my Dr. that does the Moh's procedure was wonderful and after having put me at ease began the surgery without delay. He gave me (one shot) and my nose was completely numb. He had the lab results in 15 minutes, then had to go in once more for a bit on the side . No further numbing was needed.
    Then I had a dressing put on my nose and instructions on how to deal with the wound at home. He did not have to close as it turned out to be smaller than thought. what joy ! After reading Bert's blog I now know pretty much what to expect as far as healing time etc ! Thanks ever so much Bert !

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    Replies
    1. Darcy

      I'm glad to hear that both of your surgery's went good.

      Thanks for commenting and letting others know how your surgery went. I'm sure it will help others.

      Thanks

      Bert

      Delete
  41. Hi great informative site! Just had Mohs done 3 days ago on my lower cheek area. I just happened to mention to my Dermatologist about the tiny pink lesion that not even she noticed on my face. This tiny thing was basal cell ca and took 3 times back to get it all. I had a hole the size of a marble and now have sutures from my lip to lower chin. I look awful and can only hope for good healing. The good news is that the cancer is gone! Never would have thought the pinpoint size lesion was the tip of the iceberg. Scary stuff this skin cancer.

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  42. I had my surgery yesterday morning - right side of my nose, a bit bigger and deeper than your pictures. I had a very similar experience as yours, however my nose is swollen about twice it's normal size, one nostril is almost completely swollen shut, my right eye socket is swollen almost shut, and the inside of my mouth is swollen and numb. Did anyone else have this happen after your surgery? I had 10-12 shots the first time, followed by another 8-10 before the second round of cuts - maybe it's just taking me a little longer to absorb the lidocaine injections?

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  43. Bert, Thank you so much for sharing your story and pictures. I had BCC on nose and had MOHS surgery five days ago. The MOHS doctor decided to let the hole heal on its own. I was having second thoughts on this until I came across your story and saw your results. Since I am a female I was feeling self concious and was thinking that I didn't make the right choice by not having a plastic surgeon do the closure, but your nose looks great. I'm a little impatient and hate walking around with a bandage on my nose, but if my results are like yours it will be worth it. Again, thanks for sharing your story.

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  44. Hi Bert, Another follower...my surgery is scheduled for the 30th. Right side of my nose slightly closer to the top. Your article certainly answered many questions. We are lucky enough to have a local dermatologist who has been doing the MOHS surgery for 20 years. In fact, the last few days I've been wondering if I should even bother having it removed. It's been there for sure for a couple of years and I was a procrastinator as I questioned what it was. Sounds like and certainly looks like your turned out with 100% positive results. Still not sure what I want to do but thanks for your post!
    Judy

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  45. I had a biopsy yesterday and I'm pretty sure its basil cell. My question is.... does the "hole" fill in? This is on my nose so I'm worried.

    Jackie

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    Replies
    1. My biopsy hole completely filled in.

      The Mohs surgery left a small scare.

      Delete
    2. Hi Bert,

      I had my Mohs surgery on the left side of nose a couple weeks ago. My dermatologist left a defect very close to the the one in your picture. Mine is slightly higher on the side and back a bit from your site. I am encouraged with the final healing picture you show. I see a big difference at the 20 day post surgery mark. Although mine is continuing to heal it is still read in the defect area - so I was told I can keep up the routine of covering the wound with Polysporin and keep it bandaged. I don't think this can be over emphasized - the best results are when it is not allowed to scab and the wound heals itself inside and repairs the edges. I have another Mohs surgery site on the right side of my face just below my sideburn area in front of my ear. I did not continue to cover and keep the area wet with Polysporin past the two weeks. The site has a depression but the coloring is very good. I use a scar reducing ointment now but it is too soon to see results. Thanks for taking the time to post your experience for others who have had Mohs surgery or will soon. It agree - always use sunscreen and wear a broad rimmed what outside!

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  46. Hi Bert,

    I received my biospy results today and will be have Mohs surgery in November. I had thee other dermatologists look at my nose at my request and all said it was nothing. When I was at a new dermatolgist last week and when I questioned her she immediately told me it looked like skin cancer. Go figure, another doctor in the same practice told me a month ago it was nothing. Knowing I've had this for a few years is very, very scary and I pray it won't be too deep. Tomorrow I have another biospy on the other side of the nose for a similar smaller spot.

    When they did the biospy I said "aren't you going to numb the spot first" and she said that what she was doing when she gave me the shot, ouch. That's the part I'm not looking forward too, seems like there should be a better way of numbing the area. Heck, I'm a type 1 diabetic and no stranger to needles but those darn needles in the nose really smart. But thank you so much for sharing your positive experience, it has helped to calm me down a little. I hope my experience will be as positive yours too. Also, thanks to all the others that have shared their experiences.

    Cheryll

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  47. Just wanted to thank you so much for posting your experience. I'm a nervous wreck about getting mine done and this was extremely helpful. I like to know every step of things like this and your details and pix were just what I needed. Thanks again!

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  48. Thanks so much for sharing-

    I had the same thing done but closer to where nostril joins cheek, in the depression there. It has been 3 almost 4 weeks, saw MD last week for followup and he said he could do some cauterizing to try and smooth out the divot some-but it has has filled in even more the last several days. After seeing your results, I think I am going to wait 2 more weeks and see how it looks instead of letting him re-injure the site again next week as I am not eager to prolong wearing a bandaid on my face. Actually I became allergic to the adhesive on any brand of band aid-so am now cutting tiny pieces of vaseline gauuze and putting it over the hole and covering w a skin toned steri-strip when I am at work. During the evening and sleep I just wash my face and put some aloe from a plant on it. Your result was very encouraging-thanks!

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  49. Hi,it's great to see your well. Could you please send me the details of your surgeon. I am really concerned about my nose. My spot is right on the boney part of the nose and has been there for some time. The last two days I feel like it is starting to burn and feel a headache around my eyes and whole top section of my nose. I had a squamous cell carcinoma cut out of my right hand a few years ago that appeared very quickly and it was removed quickly. I feel something very wrong and am scared I left it too late. I live in Cairns and can fly down there. Thankyou so much for sharing your story. My email is mariah.is.awsome@hotmail.com

    Kind regards,
    Vicki

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  50. Vicki, My Dermatologist/Surgeons information is listed in the comments above (look around Dec 21st). Best of luck with everything, hope everything turns out ok.

    Bert

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  51. Over two years later and your post is STILL a blessing! Thanks Bert for helping me see what's about to take place next Thursday. I am having a pencil eraser sized BCC removed from my nose but a little higher the lateral side than yours. Thank you for taking the time to journal and post your journey!

    David Sexton

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  52. I just found out my mother has to have this surgery. She's been through so much with COPD and now this. The sore on her nose is much larger, so I can't imagine how deep it goes. I hope that after the surgery is over she can get most of the hole covered.

    Thanks so much for having this blog. I am still freaked out but your story helped a lot.

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  53. I found this site today while trying to figure out how to explain the surgery to my husband and what he might expect. Thank you! And you look great!

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  54. I too had Mohs surgery. The same spot as you, but on the other side. They got all the cancer the 2nd time too but did the flab. They had to shoot half of me face to numb it. He made 2 incisions above it pulled the skin down and pushed it in the hole. Yes I was there all day and was the last patient bc of what they had to do. I too was 2 1/2 hrs from home. About 10 miles away the shots wore off...oh boy the pain was awful. I called him and he sent a script to my drug store. My eyes were black and blue and all swollen up. I looked like the beast from Beauty and the beast. It took a few months to heal on the outside and 2 yrs to fully heal from inside. It still is itchy at and my surgery was 2007. I am fair skinned also.

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  55. Thank you so much for posting your information!!! I am a 64 yr. old, white, female. A very small spot came up on the top of my nose (much the size of a pimple), after two months it bled, crusted over and I realized that it was not going to heal. Biopsy was done and it was a Basal Cell Carcinoma. Last Friday I had the MOHS proceedure done. HAD I NOT READ YOUR POST and saw your photos, I think I would have not been able to handle the sight of my nose when the doc finished!!! Thank you for your blog! I feel confident that it will heal and that all will be well. The amazing thing is that this all happened in a 3 month time frame. I went to the doctor about two weeks after it bled for the first time. We need to urge folks that have these spots to have them checked out RIGHT AWAY! You cannot ignore it and hope it goes away. Your efforts are SO appreciated. You sure helped me!!

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  56. Thank you so much for this post. My Basal Cell Carcinoma was removed five days ago in almost the exact same spot. Luckily all the cancer was removed the first time, however, my spot looks larger in diameter and deeper than yours, but very similar. I was concerned about scabbing and had to remove some scabbing this morning, but mine today looks very similar to yours on day eight. I will continue on treating as I have been and can only hope it ends up looking as good as yours. Thank you so much for posting, this was a great recap.

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  57. After reading and seeing pictures of various MOHS patients I was a bit relieved to read your post. I am 37 and had MOHS done on my forehead near my hairline last year. They had to go in 4 times and I have quite the indentation still. I'm very conscience of it. I just got results back on a biopsy for a similar spot to yours....small sore, scabbed all the time, but mine is right in the middle of my nostril. I am very worried (especially after seeing some pictures of various cases) about the after appearance. I am scared that I will have a noticeable indentation, but I have been really trying to be prepared to ask questions beforehand this time and know what approach they will take on closing it up...or not. I'm nervous, but thank you for showing me a success story compared to some of what I have viewed. :)

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  58. I had mohs surgery today on the right side of my nose near the bridge. It was for basal cell carcinoma. They only had to do one scraping. It is about 3 inches long and my eye is very swollen and edemous. It hurts really bad and they said I only needed Tylenol. I am glad to have the cancer removed but I do also worry the scarring will look terrible. I'm 48 and I teach so I need to look presentable for my students. I'm lucky I have the summer off.

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  59. Bert, thanks for sharing. I had my first BCC in my twenties.In part, I totally believe the excessive sun exposure I received as a young child is to blame. My foolish mother was adamant about me having 'color' in my face and subjected me to hours of needless sun exposure without the benefit of sunscreen. Thanks to Mohs surgery and a great surgeon, the scar under my left eye is virtually undetectable.

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  60. I've had half a dozen Mohs surgery's in the last 5 years and about that same amount of simple excisions in the previous 10 years. Got a big bandage on my forehead as I type this comment. 70 years of sun on the beach and golf course will do that for you. Now I visit a dermatologist every 3 months to freeze off every suspicious looking patch on my body. Still, some spots grow too quickly and must be cut out. As far as letting the wound grow in by itself or having it closed with stitches, it really depends on the size and location of the wound. My skin doesn't heal very fast so I lean toward stitches if the hole is of any size. I've had a few on my face that took months to fill in on their own. Another factor however, is probably my age. I'm not that concerned about looking beautiful any more, I care more about getting the hole healed up as quickly as possible. You'd best just take your doctors advice on whether to use stitches or let it heal on it's own.

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  61. Tx Bert, I have the same has you only closer to my crease by the nostril. It was pretty deep, they did everything you said, cauterized it partially, waited a couple of hours, breakfast lunch & dinner b4 I went back in for them to remove some more cancer re: the BCC, he was a great surgeon, not sure if he's a plastic surgeon, but he mentioned they would send me somewhere if needed re: stitches/plastic surgeon; however, I'm loving your idea of waiting 4 months, just was wondering how long U had 2 clean yr wound? I have to go back in 3 wks. my options were (1) stitches now which would pull up my nose (pig-like) (2) skin grafts taking 2 pieces off my nose & some out of my ear & putting one back on top of my nose & the other w/ear graft in hole in my nose. My hole as I call it is a little bigger that yours Bert, I put Aquaphor which is just a diff. type of Vaseline in the hole after Q-tipping it clean & dry & then BIG GLOB of Aquaphor to prevent scabbing. Doc recommends sking grafting; however I smoke, & if I don't quit 7 days prior & take antibiotic DAY OF graphs in 3 wks & no smoking for at least 2 wks, ALL areas grafted will B permanently BLACK -4 life. Although I know I should not smoke, I've been quitting back & forth. I was also told NEVER EVER to go out w/o skin block on hole when healed as it will leave a dark mark for life as well, smoking or not. My sister is very concerned as she does not like this hole opened up & there's no getting water in it. How do I wash my hair? they said that's too much soap & water. (hairdresser so I can lean my head back., but cleaning it is disgusting & it does hurt even 2 days out. Surgery performed 7/23/13, today is 7/25/13 my nose is sore, esp sleeping & I have trouble eating, yawning & brushing my teeth, but i'm liking the idea of waiting 4 months to heal itself bandage or not

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    1. Evelyn, I kept my wound clean and moist for 3 weeks. To keep it moist I used a Double Antibiotic Ointment and small round band-aids over that. I didn't have pain after the first couple days. I hope everything heals well for you. Bert

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  62. I had MOHS surgery yesterday, it was pretty brutal, I had a large section of my nose removed, dorsum and tip. The local anasthetic kept wearing off,so he said he wouldnt do a flap,as I metabolised lidocaine too quickly. He took skin from my collar bone area which is now aching like crazy. I am so scared of having this dressing taken off and seeing what the graft looks like. He's already told me it was a big area for a graft. Today my nose feels like it's on fire....and is throbbing. It was quite brutal.

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  63. I go in next Thursday for this (BCC infiltrating) on the side of my nose...just slightly off the edge of the nostril. The dermatologist/surgeon has told me that I will probably have to have the flap procedure done because of the location. My concern is that my husband and I have a 5 week European vacation planned for later in September (21st). I don't mind being scarred....I don't think!.....I just want to go! Can anyone tell me if a 6 week recovery will suffice?

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    1. Additional information...the surgeon said he does the flip from an incision he makes in the crease that runs from the nose to the outer lip. Anyone have this?

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  64. Bert, I just had Mohs surgery on my nose. It ended up looking similar to yours, but was more on the tip of my nose. I went with the natural healing too and now what had started out as an indent has suddenly become a raised bump as in your picture '52 days after surgery'. Your '4 months after' picture looks like the area ended up healing fairly flat. Guess I just want some reassurance that the red bump will end up flattening out. And has the scar returned to a natural color or is it still whiter than normal skin?

    Slightly Worried

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    1. Slightly Worried, I just added a picture of my nose taken today (almost 3 three years since my Mohs surgery). My spot was raised at first but flattened out pretty good after a few months. Now there is only a very small scar this is really close to the same color as my skin.

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  65. Hi Bert...Fine job. I am in post-op care.
    I was told to wash with antibiotic soap, clean w vaseline and Q-tip, top with xeroform and telfa and bandage w brown paper tape. When cleaning with Q-tip and vaseline, I am to remove any scabs that form. I have no scabs except for some yellow blobs. Are these yellow blobs to be removed? Are they pre-scabs. Some doctor friends say they are new skin forming and people in the doctor's office say they are scabs to be removed.I am confused.
    I think messing around and removing causes major headaches...not sure.

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    1. Let me add...this is a nose Mohs similar to yours but just a bit bigger.

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  66. Hi Bert your results are simply fantastic! Congratulations you heal really good! I wish I read this blog before my surgery so I would ask my doctos to do not have a flap like I did unfortunately.. I definitely hated my results. Well It's been a month and a week now from my Mo'h surgery. I also had to remove until my second layer I thought it would be something looking just like yours since the doctor told me it was not deep and not big. But 2 days after my repair wish I had with a plastic surgeon when I looked myself on the mirror I've got so sad becaus I had this line from a cut from between my eyes to my nose tip. He said he flap my cheek skin to cover the hole.
    Now I still have this brown line and this redness on my nose that makes me feel so horrible. My dermatologist prescribed me Locoid Lipoderm for redness and I just don't see any improvements..I wish I could exchange some pictures with you from my nose. I keep thinking that I should not have had a repair and let it heal as you did I am sure it would look much better!! I'd rather have even a little hole that this big line on my nose! Feel free to emaikl me at cv2009@gulftel.com Thank you for sharing his nice blog with us! Claudia

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  67. Thank you so much for posting this. My dermatologist thought that my "spot" (on the side of my nose) was an actinic keratosis and "froze" it. Unfortunately, a few months later the area returned and was larger so I returned today and he is quite certain that it is a bcc. He did a biopsy, results should be in about 2 weeks, and said that if it IS bcc, he would recommend Mohs surgery. Cancer and surgery freaked me out, more than a little, so I really appreciate your writing abut your experience. My surface area of the spot is about twice the size of yours.

    Again, your info was very, very helpful to me. Thanks.

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    1. Mine was much larger and required a facial incision to get a skin flap to 'patch' the hole with..My nasal passage is still not as open as i wish it was (He used cartlidge out of my ear to put in the hole.) This week I had a chemical peel to help remove other pre-cancerous blemishes from my face..this will be followed by Light treatment after a week of Carac cream applications..to hopefully get rid of all surface blemishes...then in January I am going to have Mohs again on my left temple area.....All this because of sunburn damage years ago!...What a year!!!

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  68. Bert,
    Thanks for posting your story. Your photos are a lot less scary than most Mohs photos on the Internet, and the location on your nose is roughly the same as mine. I have my consult with my Mohs surgeon on Friday. Even though you didn't take any photos before your original biopsy was done, do you know the size of the tissue they took in your original biopsy? I'm just trying to get an idea of how big a hole I'm going to have in my nose. My original biopsy tissue removed was .2 cm x .3 cm x .1 cm.

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    1. The original biopsy was only a couple cm in diameter and very thin.

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  69. Bert,

    Thank you so much for your great information. do you know of good Moh's surgeons in st Louis?

    diane

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  70. Good to share experiences, thanks to all of you for weighing in on this serious topic.
    I had my first BCC when I was 26 yrs. old. I'm now 55. I am quite knowledgeable about Mohs! In 2001 I had a BCC, on right side of my nose, had Mohs and mohs surgeon recommended plastic surgery to repair the whole. Like Bert I took before and after pics. The hole defect was quite alarming! And wondered how in the *&^% could they fix that. I was sent to a plastic surgeon who did a skin flap, took my cheek skin and stretched it to "flap" over the whole and the incision followed the curvature outline of my nose. He did a great job, you have strain to see the scar. Fast forward to today. My left side of nose recently biopsied and positive for BCC, in reading the patho report, the cancer is infiltrated, and aggressive and extends to the deep margins. I was told I would most likely need reconstructive surgery. It is upsetting, I know they do wonderful things today w/ plastic surgery, but it is the time that is involved in the before, during and aftermath of this experience. One never know how vane we can be. I am a young looking 55 yr. old female. I have had many Mohs on my face, including, lip, eye lid, brow area and forehead by hair line. But even still, over the course of these 25years, I have had enough already. And yes, I endured severe sun burns when I was in the military. I try to educate young people today, don't burn. Anyway, guess I'm just venting as I embark on this latest BCC event.

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  71. Thanks for sharing Bert. I've got my biopsy coming up this week and i am scared from all the negative things I've been reading. Your post is the first one that frighten me. If you have time, can you email me directly rivercactus@gmail.com and send me a note of encouragement? Mine is on the right side of my nose and i am hoping that they will let i heal on it's own. Thanks again, Amber

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  72. I meant "didn't frighten me" and let me add that i am Very afraid.

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  73. Thank you for sharing your story. I have a lesion inside my right nostril that my dermatologist wants removed for biopsy, saying 60% chance it's basal cell. I'm getting the run around with various Dr.'s - the ones I can choose from on my insurance are few in the area where I live. I had been hoping to get the biopsy, mohs and reconstructive surgery done by the same person to not have to deal with new Doctors, but they tell me it doesn't work that way. I'm rattled - have to admit. Not much tissue inside the nostril :-(

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  74. Thanks very much Bert for a very informative blog, I am 15 days post BCC removed from the side of my nose.i had a graft placed on the site ( a little bigger than yours ) and it bled severely 3 days following surgery and now there is a large dark scab there which I am covering with a thin smear of antibiotic cream. Saw my plastic surgeon at 7 days and he was happy with it, but I have been worried about there being a defect ( concavity ) once the scab is lost . Your photos are reassuring , I know I had a graft from the pre- auricular area ( just in front of the ear ) but I think as it is now it should hopefully heal similarly to your healing result,again thank you.

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  75. Thanks for sharing. I think I am heading down the same path soon and it is great to hear from someone who has been there. It is more than a little scary to have cancer and just as scary to have surgeons mucking about in as visible a place as my face. Just out of curiosity, how did your life change after the process? Sunscreen? Regular derm appointments?

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  76. Thanks for sharing. My husband has surgery 7-24-14. His surgeon uses the Mohs method. His cancer is in almost the same spot as yours and about the same size. The surgeon and the plastic surgeon will work together. The Mohs surgeon removes the cancer and then the plastic surgeon decides how to proceed depending on the size. The three options are to let it heal on its own, skin graft, or flap. Hopefully it will be small enough to heal on its own.. Thank you so much for the pictures they really helped. Wish we still lived in Ky. so we could use your doctors.

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  77. I had MOHS a few years ago. I waited far too long to have a biopsy and surgery. The basil cell was a smal spot on my nose. It was rather inconspicuous so I never thought much about it except it continuously drained. Yuck! I was shamed into seeing a dermatologist and eventually did. After the biopsy and the surgery I found out how lucky I had been. They cut all the way down from the bottom of my eye to the bottom of may nostril. They went all the way to my bone and scrapped It over and over to remove the cancer. The surgeon said had I waited much longer the cancer would have entered my optical lobe and eye. That would have been a totally different issue and surgery. After the procedure and a few weeks of healing they did the reconstruction in the office. The whole thing was extremely painful. I only mention the my process so you don't procrastinate, like I did when in doubt. It could've have been much, much worse had I waited any longer. So get it taken care of right away ! My nose and surgery healed remarkably well and is unnoticeable. So in spite of everything it was well worthwhile.

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  78. I am 3 weeks post MOHS on right side of nose. The procedure required three removal attempts before getting an all clear so the hole is deeper than yours appears to be. Thanks for sharing your photos. I am encouraged that this "self closing" miracle might actually happen. White, female and trying to come to grips with being disfigured. Fingers crossed that I will heal as well as yours appears to have healed.
    .

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  79. Thank you for sharing. I just found out today I'll be following your procedure. Complete concern yet appreciate knowing what to expect. I'm one that likes the facts and you documented them very well. Thank you. Well wishes to all! St. Paul MN

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  80. Many thanks for sharing your experience and photos - I have been agonising over the "hole" but your time line has been most reassuring!

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  81. Thank you so much for sharing your pictures. It is very reassuring.

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  82. Thank you so much for posting this. I just got my MOHS today and the surgeon suggested the flap repair but I was to afraid, so they said go home and do research to make a decision. I was so happy to find your posting. I felt a great weight lift off of me. I will now to nothing and let nature take its course. I can always have more needles and knives later if I choose. You have been a great help...you're awesome!

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  83. How is it that you don't have any scabbing? I'm on day 10 and have scabbing even though I have kept is moist with antibiotic ointment and Vaseline. Did you pull of your scabs or shower a lot? I try to not to let it get wet. Your pics look so clear.

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    1. I kept antibiotic ointment and a small band-aid on it 24/7, so it was too moist to form a scab.

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  84. Thanks Bert for taking the effort to post this to help others in their decision. My Dr. was flap happy but I was doubtful and took my chances and decided to heal naturally. Then I saw your posting. With a sigh of relief I felt sure I would do fine as you did. This was so stressful for me but now I'm healing just fine. Yahoo!

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