Mohs Surgery: Why You Should Use Sunscreen - Not for the Faint of Heart

I grew up two miles from Venice Beach.  I spent a lot of my school years at the beach.  We didn't have sun screen in those days.  It was called sun tan lotion.  I had a great time in the sun and surf.  But today there was some payback.

I had a basal cell carcinoma on my left cheek.  That was confirmed a couple of weeks ago and today I went in to have it cut out ("removed" is too benign sounding.)  The Mayo Clinic website says:

Basal cell carcinoma is a type of skin cancer. Basal cell carcinoma begins in the basal cells — a type of cell within the skin that produces new skin cells as old ones die off.
Basal cell carcinoma often appears as a waxy bump, though it can take other forms. Basal cell carcinoma occurs most often on areas of the skin that are often exposed to the sun, such as your face and neck.
Most basal cell carcinomas are thought to be caused by long-term exposure to ultraviolet (UV) radiation from sunlight. Avoiding the sun and using sunscreen may help protect against basal cell carcinoma.

I decided not to put up photos the normal way today.  Two of these are pretty gross.  So I'm embedding a Slide Show that you can view or not.  But if you think, as I did, that a basal cell was a minor issue, then look, and use your sunscreen.  What you see in the slide show is:

1.  Outpatient surgery room - leave your clothes on, lie back.  In five minutes or less he'd sliced out the cancer cells using something called Mohs Micrographic Surgery.  The description is from the college where they teach doctors how to do this, so I'm guessing it's not totally unbiased.

The Mohs procedure involves surgically removing skin cancer layer by layer and examining the tissue under a microscope until healthy, cancer-free tissue around the tumor is reached (called clear margins). Because the Mohs College surgeon is specially trained as a cancer surgeon, pathologist, and reconstructive surgeon, Mohs surgery has the highest success rate of all treatments for skin cancer – up to 99%.

"Mohs surgery is unique and so effective because of the way the removed tissue is microscopically examined, evaluating 100% of the surgical margins. The pathologic interpretation of the tissue margins is done on site by the Mohs surgeon, who is specially trained in the reading of these slides and is best able to correlate any microscopic findings with the surgical site on the patient. Advantages of Mohs surgery include:

• Ensuring complete cancer removal during surgery, virtually eliminating the chance of the cancer growing back
• Minimizing the amount of healthy tissue lost
• Maximizing the functional and cosmetic outcome resulting from surgery
• Repairing the site of the cancer the same day the cancer is removed, in most cases
• Curing skin cancer when other methods have failed" [From Mohscollege]

2.    The surgeon sliced through the tissue to where he thought he got it and I was bandaged up until they could check that the tissue was cancer free.  That was about 30 minutes.This second picture was right after they took the bandage off to do the reconstructive surgery.

3.  The third picture is after they cleaned the hole.

4.  The last one is after they stitched it up.  When I saw the hole, I asked how they were going to pull the skin back together.  He said he would enlarge the hole to make it more a straight line and then he was sewing it up.  First he would sew up inside - and those stitches would dissolve on their own, and then he'd sew up the outside.  I go back Friday to remove those stitches, which you can see in the picture. It's covered by a big bandage now.

As I say, not for the squeamish.  But a good reason to use your sunscreen. 

Basal Cell Removed [UPDATE Dec. 17, 2011 - Two months later] Here's the scar now. (Compare to last picture on slide show above.

[UPDATE February 22, 2012: Here's what it looks like 4 months later: