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.