Wednesday, October 23, 2013

Mohs the Merrier. Not Really, But Better than the Alternative

The dermatologist shaved off another portion of my nose Tuesday, the first step in confirming my fourth basal cell carcinoma, the third on my proboscis (the fourth was on my forehead). At this rate no one will be able to tease me about having a big nose.

This time I suspected the worst. I had a slight bump at the flare of my left nostril. When I touched it my nose would sting. Initially, the doctor thought it was just a pimple, but upon deeper examination he agreed with my suspicion. So off to the lab went a piece of my schnozzola. Assuming it is a basal cell I'll undergo a Mohs procedure.

Some 20 years ago I was surprised when my first basal cell revealed itself. I had noticed some blood along the ridge of my nose after I showered and toweled dry. When it happened a second time I visited the dermatologist. A biopsy confirmed the carcinoma.

For those not familiar with basal cells they are the mildest form of skin cancer, usually contracted through exposure to the sun, often during one’s youth. Though I am careful when I go out these days, usually wearing a hat, during my childhood and throughout my teenage years I spent many hours each summer playing outdoors, often without wearing a shirt or hat or any sunscreen. Untreated, or if all the cells are not entirely removed, they can bore deeply into your body. When finally treated a face can be left with a disfigured nose, cheek or ear. A visit to a dermatological surgeon’s office can be like a walk past a circus freak show aisle.

Until the Mohs procedure was developed surgeons could not be certain how deep to make their incisions to extract all the basal cells. Using Mohs, doctors take off thin slivers of skin, each layer studied to determine if more carving is required. It takes about 15 seconds, if that long, to slice. You wait about 45 minutes for the evaluation. My first nose job I was lucky. One cut. Next time, not so lucky. Three cuts. A plastic surgeon had to sow up the area of that second excavation, shifting skin around from one part of my nose to the affected area. 

You might be wondering why I'm relating these private details. First, it's to imprint on you the need for annual check ups with a dermatologist. Basal cells generally won't kill you but other types of skin cancer, like melanoma, can if not discovered and treated in a timely manner.

Second, it's to educate you to the process which really begins with self examinations. This is one medical condition you can proactively monitor and combat. 

Third, as whimpy as it may appear, wear hats when the sun’s out, even during winter or when it’s cloudy. The sun’s rays penetrate the clouds. And don’t forget to slather your children and grandchildren with sunscreen. They might not appreciate it when they’re young but trust me, they’ll thank you by the time they get to be my age.