UPDATED: April 3, 2014 – What it looks like now.

I wanted to tell all the lovely people who found this post because they too were facing a Mohs procedure (didn’t even mean that pun) that I meant to get back to you and your comments a while ago, but life seems to take over. Here’s a breakdown of the recovery followed by a photo almost 11 months post surgery:

My Recovery: After my procedure the site was very numb for several months. The swelling and redness went down within a few weeks, but it was quite pink for about two months. My friend Shaugna gave me some Kelo-cote and I highly recommend that or a similar silicone treatment for the texture and color of the scar. The pain was only bad in the first days as the topical wore off, but it was mostly just numb for along time. I’m almost a year out and it’s still a bit numb in spots.

Complications: One of my external stitches didn’t come out with the rest, but luckily I saw it in the rearview mirror before I left the doctor’s office and went back in. They had some trouble getting a grip on it because it was there wasn’t much above the skin and that wasn’t comfortable.

The very center of my scar is a little wide and that’s because it’s where the biggest (both widest and deepest) part of the carcinoma was. It was strained as it healed and wasn’t closing as well as the top and bottom of the incision. It was actually a bit puckered and I saw my doctor about it because I was afraid it was coming apart. It wasn’t tearing, it just had more missing skin to heal over, and I wore a pressure bandage for awhile and had to put pressure on it with my fingers inside and outside of my mouth.

Then in August, three months after my procedure,I had an internal stitch that wasn’t absorbed work its way up to the surface. It looked like a hollywood zit, it was so big and with such an obvious head that it almost looked fake, but when it finally broke through the scar site finished healing.

In the end: I frequently meet women who have my scar. I don’t say anything to them, and if I hadn’t had it myself I wouldn’t even notice theirs. I don’t say anything, but I recognize it instantly because I have spent so much time looking at mine (not in a negative way, just treating it and putting the kelo-cote on) that I can tell exactly what it is.

I’m really good about wearing sunblock all of the time and am more aggressive about it with my kids and my husband (we’re all this fair).I also had my skin check in early January and I’ll be going in if I get suspicious.

The only advice I would have for those thinking about or about to have Mohs is to make sure you have a good doctor. Mine was great, but my original dermatologist should have sent me to him two years before she did. If you have something that bleeds with no reason, go immediately to have it checked out, and if your doctor even mentions that something looks suspicious, it’s better to biopsy it early. Even if it’s just a basal cell carcinoma, the sooner you get it removed, the smaller the injury and subsequent scar.

So . . . here’s the picture. I don’t think it looks bad at all, especially if you compare it to the post-op pictures, and this is with no makeup on the scar so you could see it. It’s a little pinker than normal from me cleaning my makeup off before I took the picture.

Thanks for following my journey and I wish all you Mohs folks health and happiness and a smooth recovery. Happy sunscreening!

UPDATED, May 2013 – stitches pictures waaay down at the bottom.

I wrote this post this because when I learned I needed Mohs surgery, everything I found online was genuinely helpful but very clinical – good example here.  I imagine other people who require Mohs surgery for their carcinomas might like to know what it’s like from inside the chair.  So here is a recap in case you find yourself nervously waiting a slice and dice of your own (it’s really not as bad as it sounds or looks).

In the parking lot Jim took a picture  lot of my little skin cancer.  It doesn’t look that big because it wasn’t large to begin with and then my original (non-surgeon) dermatologist sliced the top of it off for biopsy about a month ago.  So here it is roughly 2/3 of the original size.  It’s very white (and so am I) so it’s kind of hard to see.  I cropped so you can see it better – two white spots slightly left of center in the photo below.  The lower white spot has a darker spot in the center surrounded by a white ring.

I went in to the office (with my ever-lovin’-hubband Jim – man, am I blessed to have him) and paid my copay.  The nurse brought me back to sign the consent form. I felt silly and a little vulnerable because my feet didn’t reach the floor.

The surgical chair is like a dental chair, so the nurse leaned me way back  and gave me the Betadine treatment.  Since Liam (my son whose had 12 heart surgeries) has been doused in the surgical scrub (when he was two I had to bathe him with it before a surgery and I had it pre-op for my c-section for my daughter Moira) that was familiar and no biggie.

When the surgical lamp came on, they very kindly draped my face with a paper square that had a hole cut out in the center for the surgeon, but it blocked the light for me and was kind of like hiding under the blankets.  Cozy and reassuringly hidden, out came the needle.

Honestly the first round of needling was possibly the worst part, especially if you have a good surgeon because he/she will make sure to poke every nerve before the cutting starts.  Lots and lots of deep and meaningful pokes later and my lip was numb as can be.  After that my doctor performed a little artistry with a pen to make cut lines on my now “enhanced” swollen lip.

Nicely numbed, there was some slicing and lifting (felt like gentle tugging), then lots of snipping as the cells were removed for the pathologist.  To control the bleeding the surgeon cauterized my wound a few times.  I experienced cauterization with a previous finger surgery, so I was neither surprised nor delighted with the smell of my own burning flesh.  As it was directly beneath my left nostril it was more powerful than when I had minor hand surgery.

The whole procedure didn’t take terribly long, maybe twenty minutes. I then waited forty-five minutes (they had HGTV in the waiting room so it wasn’t that bad) for my results.  This is what I looked like while I waited.

The pathology report came back and I had three dots of cancer left in the wound area, so I went back and my face was draped again.  I had more shots (which hurt less than the first shots, most of them I didn’t even feel at all).  The doctor used the map to slice around the carcinoma area then clipped it out with scissors.  I will tell you, it’s kind of weird to hear someone cutting  skin off your face with scissors.  Then more cauterizing, bandaging, and waiting for the next pathology report.  The second round provided fewer cells to assess than the first, so it took less time.  This is me after the second surgical dig into my face.

When the second pathology report came back clean, I just had to wait for another patient to finish his procedure, and I went back a third time for stitches.  This took the longest because there was new numbing in new places so it hurt a little, more cauterization (and I felt one of them and it felt like a little electric zap), then even more numbing because I was not supposed to feel that.  When the bleeding was controlled, the surgeon made the internal wound stitching.  After that he began snipping the healthy flesh to make it loose so it could be stretched over the missing flesh, and finally the top stitches.  That part took the longest because he went all the way around the wound to make the flaps and then sewed it up.

As someone who spent significant free-time between age 11 and 29 cross stitching, hearing the thread drag through one’s own skin on the face and feeling the familiar tension of the art of sewing beneath one’s nose is somewhat disconcerting.  However, it went well, and I was bandaged by the nurse who was incredibly kind to me in my nervousness.  I have a lot of local anesthetic swelling now though – see picture below.

That third bandage comes off tomorrow, and I have to 1) keep the wound and stitches moist with Vaseline, 2) try not to talk too much (oh my God this is the hardest part) and 3) eat soft foods so it heals with minimal scaring.  If you have this on your forehead or nose, the talking/eating part need not apply, but because it’s on my lip/mouth area I have to be cautious. Stitches come out next Monday, and I’ll update with a stitches picture later.

In the realm of pain, I think this is no worse than having totally worse a dental filling (so far – ask me again tomorrow), but it’s extremely visible to people around you.  So, that’s a bit awkward.  However, had I not set up an appointment  to see the dermatologist when it started bleeding in March, it would have just kept growing and growing and growing.  Considering the complexity the surgeon faced making the least of the scar, if the carcinoma was much bigger, the wound left would definitely be worse.

Even though I rarely played outside as a child, never smoked, always wear sunscreen and am under 40, I had a carcinoma.  It’s not a terrible cancer because it almost never spreads through the body, but if you don’t take care of it you can lose whole parts of your body (chunks of ear, nose, lip, etc).  Better to have it off before it gets big and even better not to get it at all.  I’d preach about the sunscreen, but I’m extraordinarily SPF compliant, and it still happened to me.  It just happens; the important part is being a grown up and getting it treated.

Now, the anesthetic is wearing off, and the construction crew that was re-paving my street has moved on.  So I’m going to take a nap because I was a bit nervous last night and did not sleep well.  Plus, after surgery crash naps are the best.

If you’re getting your face Mohs’d, or another body part done – good luck! Don’t be afraid, get a good and qualified surgeon, and congratulations for taking care of yourself!

Updated with stitchery pics – I warned you twice.  I had to go to Target for some prescriptions and I now know what it must feel like to be obviously disfigured . . . people kept looking away.  Makes me wonder what they thought.  “Dog bite?” “Car accident?” “Bar fight?” or “Domestic violence?”  I bet few if any suspected carcinoma.  Ah well, it will heal all in good time.  Until then, I’m staying in for a week when I get the stitches out.