Ah, but underneath
Here we go! Karmic payback for Paris and my wicked sunburnt youth. I figured you might not all appreciate the full-color version, and the bonus with black and white is that you can so clearly see I'll be keeping dermatologists and skin cancer surgeons in business for years to come. Thanks for the golden ticket, genetic lottery.
Basal cell carcinoma is the most common type of skin cancer. It rarely metastasizes or kills, but it is still considered malignant because it can cause significant destruction and disfigurement by invading surrounding tissues. Statistically, approximately 3 out of 10 Caucasians develop a basal cell cancer within their lifetime. In 80 percent of all cases, basal cell cancers are found on the head and neck.
See that? 3 out of 10. All I can say is good luck to the rest of you.
What I had was a small pearly pink bump on the side of my nose—the left nostril rim—which looked like a pimple that didn't get bigger but wouldn't go away. Didn't look like a freckle, was not a mole, resembled nothing I'd been warned about. You can get some idea of the size if you look very closely at this photo, which was taken right after I had it removed. Smaller than the tip of a tine of a fork. It was there for more than a year.
The first time the dermatologist saw it she said, We can remove it or watch it, so we watched it, me being not so eager to walk away with a big huge scar on my face and all. Six months later we watched it again, because the appearance hadn't changed, but six months after that she said, Let's remove it just to be safe. At the same time, she removed a large mole on my right thigh that did look fishy: darker and bigger than before. (She does a full-body check every six months: front, back, top, bottom, between the toes, all over the scalp, inside the ears, inside the mouth. Then she circles anything that looks suspicious, maps it on a chart, tells me to watch those spots for any changes, and we revisit those the next time around.) I've had moles removed before on my back, legs, and throat, but it's never anything—I do it because skin cancer runs in my family and I spent a lot of time in the sun in my teens and I am not an idiot. I know the odds are high. And voilà: what finally comes back as skin cancer? Not the big, ugly, suspicious-looking but easily concealed mole on my thigh but the small, innocent, pimple-like spot staring right at me in the mirror. Hah ha ha ha ha ha ha hah! Who's the idiot now?
The recommended procedure for the removal of most non-melanoma skin cancers—both basal cell carcinomas and squamous cell carcinomas—is Mohs microscopic surgery. The surgeon removes the skin cancer and a narrow margin of normal tissue around it, which is processed and examined while you wait. If there's evidence of cancer in the "normal" tissue, they remove another layer of tissue to be tested, and continue like this, layer by layer, until the cancer is gone. Mohs surgery has a 99% success rate.
I got into the chair at Columbia Presbyterian at 9:00 a.m., was injected with approximately 1,000 shots of local anesthesia (by far the most painful part of the day), sat with my eyes covered while the doctor went about her cutting and cauterizing, then sat with a temporary bandage in the waiting room for about three hours while they ran the tests. At 12:30 they said ALL CLEAR, we did a little dance together, and I went back in to get patched up.
Now here's the fun part: because of the size (about the width of a pencil eraser) and placement of the hole, there wasn't enough surrounding skin to close it up with standard stitches. Instead the surgeon had to do a graft: she cut a flap of skin from higher up on the side of my nose, flipped that down to cover the hole, and stitched it in place (there are internal stitches, as well). All of this took about 45 minutes, and then I was free to go. There's no pain medication, only Tylenol and ice packs; the whole area is tender and swollen, but it doesn't actually hurt. I don't have a black eye or a fat lip, and all indications so far suggest my nose will look mostly like it did before, which is nice. I like my nose.
If you want a graphic step-by-step tutorial, this slideshow is an almost exact match to my placement and procedure, only with an old man playing the part of me. If you want a better look, go to it. Nurse SarahB had to make a special trip down here before work this morning to do the wound care, because once I saw the blood under that pressure bandage, I was done for.
And that's the long story. The stitches come out next Monday and then guess what? There's me walking away with a big huge scar on my face after all, and feeling very lucky—and asking you to please please please watch yourselves. Because the one thing this hasn't been is cheap or FUN. I guess that's two things.