Mohs on the Nose

In The Beginning….

Posted on: June 20, 2010

This blog has been moved from site to site, and in the process has lost some formatting. The info and photos remain the same. 

How could I have known, back in the 70s, that all those weekends on Panama City Beach would come back to haunt me in a big way decades later? Well, they did, and I hope my experience helps anyone having to deal with Mohs surgery and its aftereffects.

A Little Background

For the past year, I’d had a small sore at the very tip of my nose. It would get red, then peel single layers of skin for a couple of weeks. Eventually it would be raw, and it would bleed. My dermatologist froze the spot twice, and we really hoped it wouldn’t return. Unfortunately, it did, and this time it didn’t heal. My dr. decided it was time for a biopsy, and while he was taking the tissue, he thought maybe it was superficial, and that if he took extra tissue, I might be able to avoid any further treatment. Two days later, tho, he called and said the biopsy came back positive for Basal Cell Carcinoma. The good news is that BCC is the easiest type of cancer to deal with, providing you catch it early. My dr. said he would be forwarding my biopsy results to a Mohs specialist, and that doctor’s office would call me to schedule the procedure.

I researched Mohs surgery pretty thoroughly online, so I had a good idea of what I was facing. What I couldn’t know until the actual surgery was just how advanced my cancer was. I understood the basic process: The surgeon would excise a layer of tissue, then freeze it, then slice it, then examine it for cancer cells. This process would be repeated until no cancer cells could be detected.

My surgery was scheduled for two weeks from the date of the biopsy call. I dreaded it simply because it was surgery on my face, but I also kept reminding myself that a scar was better than having cancer. Not only that, I’ve had close friends with types of cancer way worse than the little spot on my nose.

Day of Surgery

We had to be at the clinic at 6:30 am. I was brought back for removal of the first layer of tissue about 15 minutes later. The absolute worst parts of the procedure were the numbing shots. Imagine having needles stuck into the tip of your nose, and even then, you can’t imagine that pain. My eyes watered like I was crying, although I wasn’t. While the surgeon waited for the anesthetic to take effect, he went into the next room and I could hear his conversation with an older lady who was also having the procedure that day. She literally screamed as she was given her injections, so I didn’t feel quite so bad about being such a wuss getting mine.

The surgeon came back to me and cut out the first layer of tissue. I had DH take a picture of the “hole” with his phone camera. The nurse put a temporary bandage on my nose and sent me back to the waiting room. By now, the small waiting area was full of patients – all of them quite a bit older than I.

Layer 1 

One of my friends in the UK sent me an excellent book, and I brought it to the appointment to help pass the time. I sat and read until the nurse called me back to the treatment room and said they needed to take another layer of tissue. The surgeon gave me a numbing “boost,” which didn’t hurt as much since I still had some numbness from the original shots. He took the second layer of tissue, then the process of taking a picture, applying the temporary bandage and sending me back to the waiting area was repeated. Again, I sat and read until I was called.

The nurse came to get me about 15 minutes later and said they needed to take yet another layer because my tissue still showed cancer cells. Geez… Another numbing boost and another layer of tissue removed. Another picture was taken. This time I was allowed to stay in the treatment room and read while I waited for the results.

It wasn’t long before the surgeon came in and said my cancer had developed “roots” and had spread beyond the small spot on my nose, and that he needed to take a 4th layer of tissue. More numbing, another layer taken, another picture taken, then more waiting. Again, I stayed in the treatment room afterward. This time, I stretched out on the table and tried to relax. The more tissue they removed, the more anxious I became.

Finally the surgeon came in and said I was free of cancer cells. Now it was time for “closure,” meaning, closing the hole left by the surgery. Unfortunately, the hole was too large to just sew it together, and I needed a skin graft to cover it. The surgeon said it would be a lengthy procedure, and he closed two other patients before it was my turn.

“Closure”

I was brought back to the original treatment room and the surgeon said I wouldn’t like this part very much. I had to have more numbing shots, not only ON my nose, but also AROUND my nose. After about six injections, I told him to stop, that I needed a minute to breathe. Then he injected 5 or 6 more, and I needed him to stop again. The last few injections were the worst. One to my left nostril sent a pain all the way to my toes, and I literally saw stars. My eyes were watering like I was having a good cry. Even tho I wasn’t, I really felt like I could. My stress level had reached about a 9 on a scale of 1-10.

As the surgeon got ready for the procedure, his nurse and another assistant joined him. I told him I’d be forever grateful for some Valium for my anxiety. He said he didn’t have any, and that he couldn’t give it to me if he did. If he were to administer those types of drugs, his clinic would have to be classified as a surgical center, blah blah blah. OK, I understood. I was wishing I’d brought my own from home, but it was too late for that.

The surgeon covered the upper part of my face and then my chin, leaving only my nose exposed. While I didn’t feel any pain, per se, it felt like he was building a house on my nose. There was so much pulling, pushing, tapping, and lots of pressure. At one point, I thought he was taking tissue from my forehead; there was so much pressure there. I hadn’t had any numbing shots there, tho, so he must’ve been using my forehead as a work space of some sort. He had removed tissue from my upper nose to graft over the hole in the tip of my nose.

After about 50 minutes, he was finished with the surgery and the tech was left to apply a considerable bandage to my swollen face. I was physically and emotionally exhausted, after all, it was now 2:00 and I’d been there since 6:30. I felt pretty shell-shocked on the drive home, and the first thing I did was to take some Tylenol, as the doctor had advised, then I took a Valium.

I slept until 6:30 pm, then got up to eat something and watch some TV. The more time passed, the more my face started to hurt. I was able to get a good night’s sleep, for which I was really thankful. I was expecting to feel worse the next day.

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5 Responses to "In The Beginning…."

WOW!!! Your were so detailed that I could could almost feel your pain during the whole procedure to the point that my eyes watered. I was a big beach goer/sun worshipper from a child thru my 30’s. I’m 52 now and still wondering if and when some form of skin cancer will appear. I know my Aunt Lorraine had skin cancer but hers didn’t start showing up until she was in her late 60’s. I’ve seen a lot of pictures of skin cancer caused from the sun, some worse then others. Chances of it appearing on myself are pretty high. I don’t know if I can handle going thru what you did if I had to be awake so I would have be asleep for the who procedure. I do know, IF I should ever have to go thru something like this, I will, make sure I have anxiety pills along with a pain pill or two. I’m sooo sorry that you had to go thru that and for anyone else I may know or don’t know. How long did it take you to heal??

If you read further in the blog, you’ll see updates, as well as progress photos:-)

Thank you also for this wonderful detailed post. I was told by my surgeon that it if everyone could afford it, it is optimal to take the option of a general anaesthetic for this surgery. Fortunately i took his advice and woke up after both the removal of damaged skin and the full thickness skin graft to nose tip. No discomfort until I tried to go without pain relief (panadol) but I only did that once. After 24 hours both sites were pain free until I would accidentally knock myself in the nose and of course the inconvenience of not allowing the area to become wet – difficult to bathe and wash one’s hair when one can’t bend forward (risk nose hematoma) or bend head back (donor skin from neck). It has been 7 days now and stitches are out both sites but have been re bandaged for 1 more week. Nose red and numb still. Have been told BCC was 5mm deep, so quite a divot – 12 months before final result. Surgeon also gave me creme (script) to take home and use after bandages removed next week to assist with healing.
Surgeon also left notice with nurses post surgery that if I needed stronger pain relief he would write me a script for that but I did not require anything stronger than over the counter pain relief in the first 24 hours. Thanks again for your story.

I’m 75 and will be having Mohs surgery Nov 7 2013. Plastic surgery to follow immediately after at the surgery center in the next building.. The plastic surgeon mentioned a possibility of a flap from the forehead. That was really frightening. Doing a lot of research online and came across your post. Thanks so much for such a detailed report and the photos. Bless you.

Hi Loretta,

I’ve seen many photos of the process using the forehead flap, and it does look scary. But even scarier is the thought of cancer on your face. This process will only be a few months of your lifetime, and it will be so worth it. I wish you the best outcome. Mohs surgeons seem to be some of the most talented plastic surgeons ever.

Hugs to you.

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