My Mohs Surgery - A Personal Narrative

Before I share my experience with Mohs surgery and what I learned, I want to make a very strong point. If you have anything on your skin that stays on for more than 1-3 months, get it checked out. It doesn’t matter what it looks like. We often see the pictures of what skin cancer is supposed to look like: my lesions didn’t look anything like the examples. Personally, I’d always thought skin cancer would appear much worse, but mine didn’t even look odd. I wasn’t even expecting it to be skin cancer. So please, if you have any abnormality, get it checked out.

I emphasize this point so much because when I finally got to the position of having my Mohs surgery consultation, my surgeon told me, “If this was taken care of originally you wouldn’t have to go through this.” That statement was disheartening because up to that point I thought my physicians and I did everything correctly.

I’m in my mid-fifties, and about four years ago I noticed a faint spot on my nose. Approximately one year after I first noticed it, I went into my physical and asked my primary care physician to check it. He decided to freeze it off. But the following year the spot was still pink so he referred me to a dermatologist.

When I went to the dermatologist she gave me a chemotherapy-type medication that burned off the skin. I was told to apply it twice a day for two weeks. This was an extremely uncomfortable process. What made it worse was the fact that I’m a teacher who is surrounded by young children. I must have been asked at least one hundred times, “Why are you wearing a Band-Aid®?” The entire ordeal made me feel very self-conscience and uncomfortable.

When I returned the dermatologist asked if the spot had scabbed over. I confirmed that yes, it had. She told me that the lesion was cancer. That was it. My appointment ended, and she never provided any instructions for follow-up.

I have to admit that from the moment I met this dermatologist, I felt uncomfortable. She didn’t take the time to explain things to me, and my appointments were rushed. I think all this contributed to me not being more vocal about insisting that she educate me about the cancer. I just assumed she was telling me everything I should know… even if I felt a little lost about the process.

This occurred 2 years ago. The spot remained even after the scab healed, and it was still the same faint pink color. About this time I was scheduled for my annual physical with my primary physician. He recommended that I see a dermatologist again. I agreed as long as it was with a new dermatologist. The new dermatologist conducted two biopsies which confirmed that I had basal cell carcinoma.

Despite everything I had experienced, I was still surprised with the actual cancer diagnosis. I shouldn’t have been. After all, I’ve had basal cell carcinoma on my back and I’m fair-skinned with blue eyes. I’ve always been vigilant for abnormal spots on my body. And yet, this spot was so innocent looking it was hard to imagine that it really was cancer. But there it was so my new dermatologist said I’d be a good candidate for Mohs surgery.

My first impression of my Mohs surgeon was the fact that he was so professional and incredibly kind and soft-spoken. It immediately put me at ease. Professionally he focuses extensively on Mohs surgery, which I found very impressive. He carefully explained, in detail, everything about the procedure.

At the time I was anticipating a small scar where the redness was. When the actual surgery happened, I wasn’t at all prepared for how large the tumor had become. I had a very small spot on my nose, but beneath the surface of my skin the cancer had grown quite large. How deep was it? For my answer to make sense you have to understand a little about how Mohs surgery is conducted. Mohs surgery happens in phases. You go in for the surgical removal and then wait in a comfortable room while the physician analyzes the tissue to see if there is any cancer remaining. This removal-analysis cycle is called a “stage.” Usually Mohs surgery requires one stage, sometimes two to remove a cancer entirely. For my cancer, I had to have three stages of Mohs surgery to remove the entire tumor. Even for Mohs surgery, three stages is quite a bit.

I remember the procedure very clearly. For the first removal, I was simply bandaged up. Then I waited. I was called in again, bandaged up, and went back to waiting. Now, there are no mirrors in the room where the procedure is actually conducted. But the last time I went in I noticed a paper towel dispenser that was very shiny, and I could just make out my reflection. My surgeon had taken a black magic marker and made a line that went between my eyes, down to the right side of my nose and then back up to the right side of my tear duct. I couldn’t believe the enormity of what he drew. I can’t quite convey the feeling of what it’s like to think that you’re going to be permanently disfigured, but that’s exactly how I felt at that moment. After the procedure I asked my surgeon how many stitches he had to use. He answered, “Let’s just say... a lot.”

After the final procedure, I knew the cancer was out but still had to drive home for 1.5 hours, and the anesthesia made me feel ill. My cancer was much larger than I expected, and the surgery was much deeper than I anticipated. At that point I just felt so lost and miserable. Slowly, however, over the next few days I realized that everything my surgeon told me that would happen was right on the money.

He warned that I was going to be really swollen and bruised. He specifically said, “You’re going to be feeling this for awhile and in 2 days you’ll wake up and be the most swollen and bruised… it will extend down your face.” Sure enough, that’s exactly what happened. The first week I was horribly bruised. I cried solid for a whole week. I thought for sure I’d be a freak and never look like myself again. But my surgeon assured me that in time the scar would look much better.

I can’t say enough wonderful things about my surgeon. Every milestone that he explained happened just as he said. I found it very reassuring. It gave me direction and a mental path to follow. He also let my husband stay by me as much as he (my husband) felt comfortable. My surgeon was genuine and accommodating to my husband throughout the process, which really helped my healing. My surgeon also called me a couple of times at home just to see how I was doing. I thought that was a very caring thing for him to do. His collective efforts helped me feel like a human, not just a patient, and it really made a difference in how I felt.

After 1 week he removed the stitches and put Steri-strips™ on my nose. After 2 more weeks I had another follow-up appointment. At this point I got another surprise, but this time it was a wonderful one. I expected my surgeon would provide a traditional surgical follow-up and say great, let’s just let it heal up nicely. But what he said was that I needed another consultation! For a moment I was stunned. After everything, the thought of needing another surgery was just too much. But what my surgeon wanted was a consultation to do a possible laser therapy treatment for aesthetic purposes. He was actually concerned about the healing after the surgery and was tuned in to how I felt and would look to the rest of the world. I never even thought about that as an option!

Today, my life is back to normal. My face almost looks exactly the same. Where the skin was manipulated one nostril was pulled up, but it has relaxed for the most part. I’m very self-conscious of it, but when I wear makeup I don’t think most people even notice it. And of course I do have one small scar across my nose. If I touch my nose I can tell it’s been dug out a little bit. I have no family in town who saw me during the procedure. However, I e-mailed them regularly, and based on my descriptions they didn’t think I’d ever look them same. Truthfully, right after the surgery I didn’t think I would either. But when they saw me last autumn for the first time after the surgery, they were surprised that I looked as good as I did.

Before my surgery I participated regularly in a swimming class. During the surgery and healing I didn’t go for 3 months. When I returned, no one noticed a thing. One thing that is different is that I’m more vigilant than ever about my skin. I wear big floppy hats and lots of sunscreen. I’m also adamant about checking my skin. It’s so easy to not get something checked out and to justify it by thinking that it’s nothing.

Speaking from experience, peace of mind is worth a lot. So please, check your skin. And if you ever do need Mohs surgery, make sure you find a surgeon who comes highly recommend and specializes primarily in Mohs surgery (that Mohs just isn’t something they do in addition to everything else).

Published on 10/11/2011 | Last updated on 12/20/2016