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New on Dig For Your Dinner this Week
Recipe of the Week
Mornings with Mavis
- January 20th, 2017
- January 19th, 2017
- January 18th, 2017
- January 17th, 2017
- January 16th, 2017
- January 15th, 2017
Tips and Tricks
- $250 a Month Food Budget – Groceries, Take Out and Date Nights
- Helping Mrs. HB Get Control of Her Budget Week 2
- What People Stock Up on Before a Storm
- Ship Your Donated Items for Free
Weekly Shopping Trips and Other Stories
- My Goals for 2017: Week 3 of 52
- You Can’t Make This Stuff Up!
- New Rule Let’s Medical Interns Work 28 Hours Straight
- Hess Bakery in Lakewood, Washington
- Ask Mavis
Videos
- Friday Night at the Movies – The Hollars
Peace Out Girl Scouts, have a great weekend!
♥ Mavis
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Em says
Mavis, I recall the Handsome Husband had Moh’s surgery on his ear. I have to have it…on my face…next week. Would there be anything you could tell me about his experience?
Lindsey says
I had it in 2009 on my leg. It’s a fairly painless procedure, mine was sore when I walked for a few days. The scar looks awesome and will heal quickly if you take care of it. once th eincision is healed you can use maderma or vitamin e oil to help fade it quickly. I’m not sure if you have melanoma like I did or if it’s another type of skin cancer but if it’s melanoma be sure to stay vigilant and get skin checks every 6 months. Good luck!
Em says
Thank you for the reply! It’s basal cell. Wasn’t sure what to expect since I don’t know anyone who had the procedure. I’ve had a few bad sunburns, so I do try to get check-ups regularly. Any other comments are welcome!
Mavis Butterfield says
Thanks for chiming in Lindsey. 🙂
Jen says
Hi Em,
I used to be a surgical assistant at a Mohs practice. Is there a specific question that you have? I can tell you that basal cell skin caner is the best of all skin cancers to have, because they are generally slow-growing and fairly superficial. The goal of Mohs is to take the smallest amount of skin around and underneath the cancer until all the “margins,” or edges of the area are free of cancer cells.
I’m sure each practice is different, but this is how it generally goes: You’ll be placed in a reclining chair, and your skin may be cleansed in the area. Just like the numbing for your biopsy, you’ll be numbed again, which shouldn’t be too uncomfortable. Sometimes it has more of a burning or stinging sensation than real “pain.” Once you’re numb, the doctor may or may not place a drape over the area; if you’re uncomfortable with the drape covering your nose or mouth, absolutely speak up and they will adjust it for you. Also remember to speak up if you feel you have any allergies to lidocaine or latex.
The doctor then might use a tool with a tiny loop at one end, called a curette, to scrape away the superficial cancer cells (they are very friable and that’s why sometimes they bleed with the slightest touch). After the area is cleaned of the superficial cells, the doctor will use a surgical blade to cut away the skin around and beneath the visible cancer spot. Think of your skin cancer like a danish; your cancer sits in the fruit-filled middle, and the doctor takes away the bread part. 🙂
After the doctor removes the tiny area of skin, the area will be packed with gauze and taped to create a pressure bandage to prevent you from bleeding. You shouldn’t be in any discomfort, and in fact some doctors put you out in the waiting room while they process the skin! Our patients remained in their reclining chairs, but don’t be startled if they do put you in a waiting room.
The skin section will be frozen, sectioned, and stained so that the doctor can look at it under the microscope to see if the margins of the tissue are clear of any cancerous cells. If it is not clear, the doctor will make him/herself a “map” of the area, mark the specific area that still shows cancer, and come back in and repeat the process until all the cells are gone. This is a skin-sparing procedure so they will not take more than they must to get you fixed up.
If the margins are clear, it’s time to close! Most likely you’ll end up with a few stitches, which really is preferable on the face. Be sure to tell the doctor if you fell the numbing agent has worn off if you feel any discomfort. You will probably be draped if you weren’t before as this part is the “sterile” half of the procedure. The doctor will clean up the edges of the wound to make for a clean and easy closing; sometimes this means he/she will cut the wound into more of an almond with two pointy ends (because you can’t put a circle back together with a clean result). You should feel much except pressure from the stitching.
After your procedure they’ll certainly give you instructions on wound care. Be aware that you don’t have to use neosporin or any type of antibacterial ointment; you can use a clean jar of vaseline with the same and sometimes better result (some people become irritated by antibacterials after a few days). Clean the stitches however the doc tells you to, and keep applying that vaseline CONSTANTLY. Keep it nice and goobered up. You don’t want the area to dry out, because that creates a scab, and a scab equals a bigger chance you will scar in a nasty way. The stitches will come out much more easily if you do that one thing, and you’ll be a much happier camper in the end! Generally facial stitches come out in about 5 days.
Can I answer any other questions for you? Best of luck to you Em! I know it’s not fun, but you will get through it just fine. 🙂
Em says
Jen, thank you for taking the time to write that out for me.
I’ve had one (non-Mohs) procedure to remove basal cell from my face, at a different doctor. Eight years later I have basal cell again and the first doctor sent me to this second doctor for the removal. Thanks for the heads up about possibly being draped. I’ll be ok with that but I’m going to ask if I can use Afrin to feel less claustrophobic.
For the first removal (eight years ago) the doctor basically gave me the wound care instructions and I came back to get stitches removed on the appointed date. In other words it was just like having any mole cut off. The second doctor says I could expect to miss 4-5 days of work after this, prescribed anti-anxiety medicine for the day of the procedure (and I understand that also helps to balance my blood pressure along with the epi medicine that is mixed in with the lidocaine injections). Hopefully, it won’t be that big of a deal, but the thought of “needing” to miss 4-5 days of work has me a little apprehensive about it.
FYI, for any other crazy people reading this for “fun,” they did recommend vaseline instead of neosporin, etc., and no alcohol, blood thinners, etc. for two weeks before and one week afterward. And I expect to be sitting in the waiting room between rounds. They said the cut/examine round takes about an hour, and most patients are there from one to four hours.
I may also be bringing my own blanket (a la Linus) to keep me warm and give me comfort. I do have a friend driving, as well (since I’ll be on medication).
Thanks again for the comments.
Jen says
Hi Em,
Ugh, I’m sorry to hear that you’ve already had a spot removed previously. Is this new spot large? I’m a little surprised you’ll be expected to miss work, but hey, try to relax and let yourself heal. Hopefully you’ll feel pretty good quickly and won’t need to miss so much work, unless you want to. 🙂 I also think it’s great that you can have an anti-anxiety pill beforehand! That way you’ll be prepared all around. Heck yeah, bring a blankie and a book! I would!
I wish you all the best! Let us know how it goes.
Em says
Thank you, Jen!
Em says
Hello all,
For those who are interested, I had Mohs surgery for one of my spots on Saturday (five days ago). I’ll try not to be too graphic in what I write.
From reading the comments before I went, I expected I’d come out with an almond-shaped cut and sutures on that, but I ended up with three cuts, almost like a capital letter “Z” except everything is at right angles, with each leg having sutures. The original spot was 1cm x 1cm, and the area bounded by sutures now is about 1.5″ x 2″ I’m guessing.
With the anti-anxiety medicine and the injections, there was minimal pain. I know I had at least two rounds of tissue removal, but then things got fuzzy after that. (I do remember the doctor asking the nurse to give me another half of a pill at one point.) Between rounds, they had me rest in a giant recliner, with a blanket and space heater to keep me very comfortable. I had friends drive me to and from the appointment, because I couldn’t drive with the medicine.
Instructions were to rest and apply ice packs periodically, not lift anything, etc. I did have (and still have) a little swelling around and under my eyes.
The top leg of the incision looks almost completely healed now. The middle and bottom are still healing.
I go back for surgery on another spot Saturday.
Jen says
Oh, Em! I’m sorry. It must have been a larger spot. A “O to Z” closure is common when the spot is quite large. It results in a much nicer closure and better outcome than it would have for the doctor to cut it into an almond shape after all the cancerous tissue was removed. Was the spot in the same location as your previous spot? If so, sometimes if the cells aren’t removed completely the first time, they can come back, and they grow somewhat quicker in scar tissue than in healthy tissue.
I’m glad you were fairly comfortable during the procedure and that you had lots of support. Good luck with your recovery, and hopefully the next spot you have to have worked on is much smaller and will be a quicker procedure and healing period.
Tracy L. says
Wow Jen, thank you!!! I don’t have that in my immediate future, but I REALLY appreciate your insight. I’m one of those people who likes to know EXACTLY what’s going to happen and be prepared. So, thank you for breaking it all down step by step.
Jen says
Happy to help! I’m one of those people too, Tracy! 🙂 Some may find it to be TMI, haha, but for me, it helps calm me down. I hope Em gets to read it and it helps her.
Em says
Hi Jen,
I can’t reply to the post you just made in response to my experience, so I’m replying to an older post you made.
Thanks again for all your comments. I appreciate them, and I know others do, as well.
The one he worked on was right next to the basal cell spot I had eight years ago. I wouldn’t be surprised if the previous doctor did not get it all (it was not a Mohs procedure), or if I developed some more near there.
Thanks for the explanation of the type of closure I had. I think it should heal well, and I believe this doctor does know what he’s doing. He also mentioned some kind of “flap.”
I’m kind of afraid I’m in for the same experience on my cheek Saturday, as it appears (to me) to be bigger than the spot on my forehead was. But… I’ll be glad to get it taken care of.
WEAR YOUR SUNSCREEN, FRIENDS!
Jen says
Sometimes dermatologists believe the spots are small enough that it makes them confident they can do an excision and get all of it, but sometimes it just doesn’t work that way. The good thing now is that you know what to watch for so you can get in quickly if you sense something isn’t right.
Yep, an O to Z closure requires the doctor to create two “flaps” of skin in order to close the area. You can google it but beware of what you may find. 🙂 Basically they make a small incision at the top of the O, then the bottom of the O in the opposite direction, then pull those flaps together to close the area.
Sometimes they’ll use an O to Z on a spot that doesn’t seem large. You have these things called Langer lines, or lines of tension, built into your skin. It’s like fabric; one direction has a lot of give, but the other direction doesn’t, and that determines what kind of closure gives the best result after surgery. It’s a pretty cool trick.
In fact, funnily, I had a lot of female patients (including my mother-in-law) who “hoped” they’d have a spot on the other side of their face because the closures would give them a mini face-lift and they wanted to be even, haha! Crazy, right?
Here’s to hoping this will be your last Mohs. 🙂