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.

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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.

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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.

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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.

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Ding, ding, ding…Round Two

This morning came much faster than I wanted it to.  I actually didn’t sleep well all night long and was awake before the alarm even went off.  Surgery was scheduled for 8am and like last time, I was ushered into a surgical room where I met with the nurse who took my blood pressure (154/108, yep, just a little stressed!) and gave me 2 Valium to relax me.  My doctor came in and we visited briefly about what was to come…measuring, numbing, cutting, cauterizing, cutting, cauterizing, waiting and waiting, and then finally results.  This is what I looked like going in, after he had measured and marked off where he would start the procedure.

As you can see, the outline is a little bigger than the actual defect.  The reason is to try and get all the edges clean of any cancer cells the first time around so as to not have to go back and do it again.  This time, the spot had to also be biopsied.  It did come back as another basal cell, which we were very thankful for!  It sounds funny to be thankful for cancer, but in this case, I have the upperhand over this type and plan on kicking it right out of my body before it can cause any more destruction.  My biggest fear is melanoma…I think I will always be looking over my shoulder for it to make a sneak attack.

Anyhow, after the lab came back and said we were clear and I could be stitched up, the fun began.  Apparently my nose doesn’t have a whole lot of excess skin.  This time a procedure, called a flap was performed.  According to the website healthcentral.com, “a skin “flap”, is where skin is moved and shifted to allow for stitches to pull the skin together.  For example, moving skin from the forehead or cheek onto the nose.”  Once again, I was numbed up, which was not pleasant at all this time around, not only were new areas numbed, but the lidocaine was also injected directly into the open wound.  Here is what this one looked like, just about the same size as the one on my lip…

The stitches were done, I’m not even sure how many this time, I just know it took longer and it seemed like there was a lot more cutting involved.  I still swear that the cauterizing and the sounds of the cutting are really the worse part of the whole procedure.  I also learned that there is an artery in your nose, a fact that was pointed out as my doctor looked at Tyler and said “don’t be alarmed, we will probably cut an artery here…” and then “Yep!  There it is!” followed by the sound of sizzling flesh…blech!  It is really a disturbing thing to smell.  About 20 minutes later, he was done.

So, here I am…while I am so passionate about sharing my story and teaching others about the dangers of irresponsible tanning…I am kind of tempted to explain these battle wounds on something more exciting, like say I got too close to the tiger enclosure at the zoo and one took a swipe at me, or I decided to take up a new hobby juggling knives and it didn’t go so well.  However, I feel inclined to continue sharing my story and to continue encouraging people to wear sunscreen, stay out of tanning beds, get airbrushed tans and most importantly get to know your skin very, very well.  If you think something doesn’t look or feel right, trust your instincts and get it checked out sooner rather than later!  Go to your dermatologist or check with MD Anderson if you are in Houston.  Most dermatology departments will offer free skin screenings occasionally.

Stay tuned tomorrow, with the amount of swelling that is already occurring, I should look like I just came out of a boxing match when I wake up in the morning!