Deja Vu

As most everyone knows, I have been battling skin cancer for quite a few years now.  In my early 20’s I had my first basal cell carcinoma removed off my back.  I also went through, laser treatments, freezing spots, trying various creams, including a chemotherapy based medication, and also participated in a photodynamic treatment at MD Anderson.  3 years ago, I had MOHS surgery on my face, to remove a spot from my nose and from my upper lip.  I blogged and documented the entire procedure here with the goal of educating other people who may be facing the same situation.  I also wanted to bring attention to the dangers of tanning beds and how important it is to protect your skin.  I was featured on MD Andersons webpage and even had Good Morning America feature me in a piece they aired on skin cancer.  I started an airbrush tanning business and constantly posted about recognizing skin cancer signs, using sunscreen, staying out of tanning beds…ect.  I stayed on top of my spots, I went to MD Anderson and stood BUTT NAKED in front of one of my closest friends and 3 doctors and had my body scrutinized from top to bottom, only to learn I had 22 lesions, and even questioned as to whether or not I had ever lived near a radiation plant.  I treated my spots with Tazorac, hoping to see them disappear, a few did but for the most part, it definitely wasn’t enough.  Which leads me to where I am today…

I had a particular lesion on my right shoulder.  It had been there for some time.  Maybe 2 years, possibly 3.  It started out small and red, and eventually grew much larger and became angry, scabbed and never really healing.  I often stood in front of my closet staring at the cute tanks and sleeveless tops that I couldn’t wear, I was so self conscious of the disfiguring growth that was beginning to get worse and worse.  Finally one day I realized that I could no longer put off what I had been dreading doing since my last MOHS experience.  I located a new doctor, this time at the Skin Surgery Clinic in The Woodlands, we met and agreed it was time to start “cleaning” me up as he said.  I made an appointment to have a mini face lift, um, I mean 3 basal cells removed from my forehead for the end of March and went on my way, thinking we could deal with my shoulder and chest and arms and back and lower legs later…oh how wrong I was.

This is what my shoulder looked like this past week, and this was on a good day….IMG_1965

For the most part, it stayed flaky, scabby and sore…it itched like crazy and I felt it all through my shoulder, which was a little worrisome.  My doctor and I decided that it was time to go ahead and get this one off.  He was able to fit me in his schedule and I was arrived at his office yesterday at 1pm, fully anticipating an easy, one cut, clean lines and stitch and go.  I think I was in denial.

A brief description of how MOHS surgery works.

The Mohs technique consists of meticulously removing cancerous tissue one layer at a time. After removal, the specimen’s surface area is examined under a microscope. If there are any cancer cells seen at the outer edges of the specimen, more of the surrounding tissue is removed and the process is repeated until the sample’s margins are examined and come up OK.

If, on the other hand, no cancerous cells are found on the outer edges of the tissue, only a small wound is left. This technique eliminates the guesswork from determining tumor margins, and is less likely than other surgical techniques to damage healthy skin that surrounds the lesions. Its precision is especially valuable for recurrent or aggressive skin cancers, and for high-risk lesions (such as those near a facial nerve). It also boasts the highest reported cure rate and lowest recurrence rate for basal and squamous cell cancers.

After, removing the first piece, which was the entire tumor including the surrounding the margins, I was left with an open wound about the size of a small egg.

image2(1)

The procedure itself took about 10 minutes, once again, it wasn’t painful (I had been thoroughly numbed with Lidocaine first) but there were some uncomfortable parts, tugging, pulling the feeling and sound of the cutting and the worse part the cauterizing, nothing is more disturbing than smelling your own flesh burning.  I will never be ok with that!  They then took the sample to the lab where it was studied for clean margins.  After about an hour the results were in…he didn’t get it all, and would have to make a second cut.  So once again, more numbing, more slicing, although this was a much smaller piece.  More waiting and then the results, he didn’t get it all.  Third round, more numbing, more slicing, more waiting…and then the results, he didn’t get it all.  At this point he sat down to discuss options.  The cancer had spread.  He described it as miniscule, hair follicle size tumors that were spreading like seedlings throughout the skin on my shoulder.  My options were to leave the last spot and close, possibly with a lateral incision, OR go back for another, slightly larger slice and try to get the rest.  This would result in a more difficult closing technique, leaving me with a larger “Y” shaped incision.  Of course, I just wanted it all gone…FOREVER.  So back under the knife for the fourth time of the day.  This was the wound after he removed the larger portion.

image1

At this point, the office was closed and the nurse, the doctor and I were the only ones left.  We joked and talked, keeping my mind off of the severity of this MOHS procedure.  The sample was taken to the lab and this time, finally, came back with clean margins!  All of the cancer was gone! Now came the hard part, how to close this up.  My doctor is a perfectionist, he promised and I fully believe that he was going to be meticulous in his stitching and his goal is a hairline scar, however, a lot of that will depend on how easy I take it on the use of my arm.  My right arm. The one I use everyday, for everything.  This is definitely going to be a challenge over the next 2 weeks.  14 days in stitches, lots of soreness today and lack of sleep as I don’t really know HOW to sleep.  Overall, it’s not a bad incision, the stitches were the worse part.  There isn’t a lot skin on my shoulders, imagine pulling a pair of shoelaces as tight as you can and then imagine pulling them even tighter, that is what it felt like as he tried put me back together.

image2

The moral of this story of course is take care of yourself, love your skin, KNOW your skin and don’t be like me, if you have a suspicious spot, just go get it taken care of.  I put this off for way too long and paid the price.  I’m fairly certain that my doctor and I are going to become great buds, we will definitely be seeing a lot of each other over the next few months as we rid my body, the best we can of the basal and squamous cell skin cancer that is trying to take over.  I’ve got news though, I won’t be beat, it may suck and it may not be easy or pretty, but I won’t give up until I have won.  So if you are facing MOHS or fighting the same fight, just remember to keep moving forward.  Kick it now!  And if you know someone who is still using tanning beds, stick this blog in their face! Show them these pictures!  Show them my previous experience, scare the mess out of them…because we all need to really love and take care of the skin that we are in.