Nose Mohs...

I had my mohs procedure on Wednesday of this week, and I am happy to say I'm feeling pretty good three days later.  I also want to share about the experience, and some things I have learned.  Most of this is for my record, and a bit of catharsis, I suppose.  I'll consider it icing on the cake if a reader is benefitted from anything I write.  

Of course, as usual, I have to give some background...

A few years ago I had to switch insurance and in 2022 I found myself in a new-to-me dermatologist's office.  I think it was my first routine visit with this doctor that I asked her to check a growth on the side of my nose.  Several years before this, I had been diagnosed with the condition of sebaceous hyperplasia (SH), and this spot on the side of my nose looked very much like SH spots elsewhere on my face, but it had started to bleed.  And I know to not ignore things that bleed.  I also know that growths that bleed usually get removed, and I was happy about the possibility of getting this spot of what I thought was SH removed again.  I say again, because I'm pretty sure my previous dermatologist had removed SH from this spot back in 2014 with electrocautery.  THAT is a shocking experience, if you've never had that done all over your face.  They call it "the poor man's laser".

But back to this thing on my nose in 2022 - it just felt like deja vu, and I didn't think a whole lot about it except that SH is annoying, and not attractive, and anytime it can be removed, I'm glad for it.

The dermatologist did remove the growth and a week later a diagnosis of basal and squamous cell came back, but she didn't get it all.  A few weeks later, I was back in her office having her remove more.

A few months after that (in early 2023), the derm looked at the spot and declared it good, but I was having some issues with the skin being irritated, itchy, sometimes peeling.   At that point, she thought it was a yeast issue, and she gave me some cream to use on it.  The cream seemed to work.  And as time marched on, the place on the side of my nose started to look and feel normal.  At some point I stopped using the cream.  I don't know if that matters to any of this, it's just what happened.

Then in the late summer of 2023, after surgery for breast cancer, I had a series of four chemotherapy sessions over the course of approximately 10 weeks.  Something interesting I noticed during those weeks of chemo was the places of sebaceous hyperplasia (SH) on my face seemed to shrink.  They didn't completely disappear, but I had the smoothest complexion I've had since before middle age.  I considered it a nice, if weird, little perk of dumping toxic chemicals into my body.

Well, all good things come to an end, and with chemo behind me, and after welcoming in the new year, sometime in late spring/early summer of 2024, I noticed all my SH was back, and that spot on my nose was rapidly growing something again.  Of course, this time I was aware that it could skin cancer and not SH.

I called the derm, and they couldn't get me in for weeks, but in late August, I was finally reclined in the surgical chair having a new growth carved off the side of my nose again.  Even before she ran the biopsy, the derm said she recommended I see a mohs surgeon.  I was a little surprised, but glad for the recommendation.  While I didn't have any experience with mohs, I had a very basic understanding of the procedure, and I was happy to have someone else at least looking at this spot.

I went home to wait for the biopsy results - and go online to read about what might be ahead for me.  From everything I read, I expected I'd have a mohs appointment within a couple of weeks.  I also did some research on basal and squamous cell cancers on the nose.  And whoa, did I find stuff to worry about.  But I kept coming back to, "I don't know anything, and whatever it is, it's most likely very treatable, and it will all be behind me in a couple of weeks."  And I started mentally clearing my calendar for the upcoming month in case I needed to heal from some heavy-duty reconstruction.

Not hearing back from my derm's office, a week later I called and asked if my biopsy report was available.  I was connected directly to the pathologist, and after telling me basal cell was found, she told me I was being referred for mohs, who that surgeon was, and as if for good measure she seemed to emphasize that I was not to call them; they would call me.  That last bit seemed unnecessary to emphasize, but okay. I get it. I just needed to be patient.  I was glad to have a referral - even though I realized when the call ended, I didn't have much information at all.   I contemplated calling back, but believing what I'd read online, that mohs surgery is usually scheduled very quickly, I figured the call would possibly come later that day, or the next.  That's how it seems to go for other things I've had to schedule.

Another week later, I finally heard from the mohs surgery center, and I was shocked they couldn't get me in until eight weeks later.  Talk about anticlimactic.  I guess what I read online about mohs surgery being done within a week or two of a skin cancer diagnosis isn't at all reliable.  

But having a date on the calendar meant I could now make plans during the upcoming weeks, and I could try to just put the whole thing out of my mind until I was much closer to November 6th. Accepting I couldn't do anything about the timing, I decided it was actually pretty perfect - it was after all the garden work would be done, and early enough before Thanksgiving that I would, hopefully, be decent enough to look at across the dinner table. 

For two months I did a pretty good job of staying busy and putting it out of my mind.  Until I decided to call my dermatologist's office the week before my mohs appointment and ask for a copy of the three pathology reports they had on what had been removed from my nose since the fall of 2022.

While the reports were minimal, and I knew the dermatologist had left a dime-sized wound and a decent divot, it was interesting to see the actual measurement of tissue that was removed.  And more importantly, I could discern that there were no clear margins in any direction.  I deduced from that the mohs surgeon would surely remove a larger amount of tissue than the dermatologist had. Seeing with my own eyes there's only so much flesh left on my nostril before the surgeon would be on the inside of my nose, I once again started looking up procedures that might be needed to repair the damage (should it come to that).  It's not for the faint of heart, but if you want to see what I was most worried about, google "forehead flap to nose" and click on "images".

Or just don't.  That's okay too.

I'll cut to the chase, and tell you I didn't need the forehead flap procedure, but I am actually glad I did the research to understand and appreciate it.  I was able to go into the surgery accepting of pretty much any outcome - well, short of a worst case scenario, like cancer being in the bone. That was too dramatic for me to contemplate.  I saw no need to prepare myself for that.

Another thing I learned the week before my mohs, is that the more times a spot is worked on before mohs surgery, the less effective mohs surgery might be.  That was unsettling.  Downright disturbing.  There was nothing to be done about it now, but it felt like a kick in the gut, and I wondered if I might have been better off not knowing that.

Because this has gotten long, and I have nothing to share for a YOP post tomorrow, I think my next post will be about the mohs procedure itself.  Or the beginning of it, anyway.

Until then, keep your nose clean!

~~~~~