Mohs Surgery

[Aerides]

OP here. DH is having issues with his Mohs surgery recovery. He has been having some bleeding, pain, trouble sleeping. He went to his one week follow up with the surgeon and I went with him. It turns out that even though the bump that could be seen was tiny when the the surgeon started cutting the basal cell cancer was much larger under the skin so they had to cut out more than was anticipated. They did a "flap" repair but the flap is not healing well so that is why DH was having some bleeding and pain. The surgeon is sure that he got all the cancer and believes that the flap will eventually heal but it could take a month or more. In the meanwhile DH must continue to wear a large bandage, clean the wound twice a day and coat it with vaseline. The bleeding has finally stopped and the pain is going away. DH will go back to the surgeon in a month. It is possible that DH will have to have more surgery (possible referral to a plastic surgeon).

My Mum had one of these about 20 years ago, right on the bridge of her nose. They had to do about 4 layers of cuts, which they anticipated from the biopsy, basically down to the bone in that area, there's so little skin to begin with. In her case, they did the plastic surgery at the same time (took a layer of skin from behind her ear to replace the gouged area.

She had it done around halloween, and by christmas you had to look close to see it. So, in your DH's case, it seems they are being more cautious in the excavation (which is good!), but the overall thing might take a bit longer. I presume you've made his docs fully aware of his meds and other conditions? It's likely those play a role in his slower healing.

 

[ShokWaveRider]

I still have a "crater" on my scalp from the last one, no other issues though. Luckily, I still have the odd hair to cover it up.

 

[mickeyd]

I have had 5-6 Mohs surgeries during the last 10 years or so. Never had any problems.

 

[Purslane]

Anyone with actinic cheilitis?
Precancerous condition caused by chronic sun exposure primarily affecting the lower lip?
Biopsy is pending until next week but my (new) dermatologist seems fairly certain.
Lip location is more likely to transition to SCC so I want definitive treatment (as much as possible).
Things discussed included liquid nitrogen (cryo) and fluorouracil (5-FU).

 

[HFWR]

Anyone with actinic cheilitis?
Precancerous condition caused by chronic sun exposure primarily affecting the lower lip?
Biopsy is pending until next week but my (new) dermatologist seems fairly certain.
Lip location is more likely to transition to SCC so I want definitive treatment (as much as possible).
Things discussed included liquid nitrogen (cryo) and fluorouracil (5-FU).

Made me look, as my fat lip was diagnosed as shingles. But my symptoms didn’t match the description, so maybe not. Will take note for future reference.

Otherwise, after a recent screening, the dermatologist determined I’m just getting old and growing spots. Nothing worth removing, freezing, etc.

 

[Koolau]

Dermatologist just found Basil Cell Carcinoma on my scalp. I will require Mohs surgery. NOT looking forward to it.

 

[HFWR]

I jogged in the noonday sun for several years, and in the sun in general plenty too, so my day may be coming. I wear a hat most days; that sun is hot on the old bald pate! I do go without a shirt for short periods, so I won’t be mistaken for Frosty the Snowman, or Casper the Friendly Ghost.

 

[JohnRM]

Mohs surgery is a piece of cake, I have had it a few times, if you stay on top of visits to the dermatologist, anything unusual, They can often get it all on the first pass. And now you will want yearly checkups too. My dermatologist has a young Loni Anderson doppelganger working there! Kind of intimidating.

 

[Koolau]

Mohs surgery is a piece of cake, I have had it a few times, if you stay on top of visits to the dermatologist, anything unusual, They can often get it all on the first pass. And now you will want yearly checkups too. My dermatologist has a young Loni Anderson doppelganger working there! Kind of intimidating.

My dermatologist is more of a young Amy Madigan. I've been going to her for years and have gotten used to standing there being examined in nothing but my tidy whiteys.

 

[Purslane]

What is freaking me out is the recurrent nature of actinic cheilitis, and the fact that it transitions to lip scc with 10+x the metastatic rate of other scc locations.
I think the plan is to cryo the entire bottom lip with special attention to one focal point. I think it will take about a month to heal from that.
Of course the biopsy may show something worse and that will be discussed.
I mean who worries about lip skin cancer??

 

[Purslane]

I jogged in the noonday sun for several years, and in the sun in general plenty too, so my day may be coming. I wear a hat most days; that sun is hot on the old bald pate! I do go without a shirt for short periods, so I won’t be mistaken for Frosty the Snowman, or Casper the Friendly Ghost.

stick with the snowman look. it is healthier i am sure.

 

[Koolau]

stick with the snowman look. it is healthier i am sure.

Yes, my dermatologist always congratulates me on my skin care. I look so white you can't see any tan lines at all. I take Vitamin D3!

 

[Purslane]

Yes, my dermatologist always congratulates me on my skin care. I look so white you can't see any tan lines at all. I take Vitamin D3!

me too. seems like a lot of us do.

 

[FlyingCircus]

Dermatologist just found Basil Cell Carcinoma on my scalp. I will require Mohs surgery. NOT looking forward to it.

@Koolau I had it done on my scalp first time a month ago (hopefully last time). It was so easy and really just a minor inconvenience. It was a nickel to quarter sized patch - numbed the heck out of it, one scrape, stitched up (felt like a severe ponytail pull), done. Had the permanent stitches out 10 days later. DW helped change bandage / bandaid and put Aquafor (~vaseline) on it 2x a day, stopped seeping after a few days, just have to be careful sleeping position. Bandage mini-yamulke was on for like 4 or 5 days. Healing up fine, followup visit today was a quick glance, looks good (yeah I could have told you that ;-) Hopefully yours goes this well, but most of them are factory - get em in get em out bada bing bada boom.

 

[Koolau]

@Koolau I had it done on my scalp first time a month ago (hopefully last time). It was so easy and really just a minor inconvenience. It was a nickel to quarter sized patch - numbed the heck out of it, one scrape, stitched up (felt like a severe ponytail pull), done. Had the permanent stitches out 10 days later. DW helped change bandage / bandaid and put Aquafor (~vaseline) on it 2x a day, stopped seeping after a few days, just have to be careful sleeping position. Bandage mini-yamulke was on for like 4 or 5 days. Healing up fine, followup visit today was a quick glance, looks good (yeah I could have told you that ;-) Hopefully yours goes this well, but most of them are factory - get em in get em out bada bing bada boom.

Thanks! I'm not freaked out about it, but not really looking forward to it.

Regards.

 

[Badger]

Thanks! I'm not freaked out about it, but not really looking forward to it.

Regards.

I have had Mohs surgery a number of times (stopped counting after 10). When the few hundred other areas needed attention (not an exaggeration) either liquid nitrogen, efudex (fluoruracil), or "Blue light" treatments would take care of the problem. All of those treatments can be painful. I have been dealing with skin cancer for the past 35 years. Mohs was the easiest and least uncomfortable/painful. My dermatologist is amazing and quite skilled at other surgeries she has performed on me but for the Mohs she decided to send me to a specialist that trained her.

 

[Teacher Terry]

What is freaking me out is the recurrent nature of actinic cheilitis, and the fact that it transitions to lip scc with 10+x the metastatic rate of other scc locations.
I think the plan is to cryo the entire bottom lip with special attention to one focal point. I think it will take about a month to heal from that.
Of course the biopsy may show something worse and that will be discussed.
I mean who worries about lip skin cancer??

A friend of mine had Mohs surgery on her bottom lip. They took a large chunk and she had to have plastic surgery on it but now a few years later you would never know.

 

[Purslane]

A friend of mine had Mohs surgery on her bottom lip. They took a large chunk and she had to have plastic surgery on it but now a few years later you would never know.

that is good to know. was it precancer or SCC?

 

[Koolau]

I have had Mohs surgery a number of times (stopped counting after 10). When the few hundred other areas needed attention (not an exaggeration) either liquid nitrogen, efudex (fluoruracil), or "Blue light" treatments would take care of the problem. All of those treatments can be painful. I have been dealing with skin cancer for the past 35 years. Mohs was the easiest and least uncomfortable/painful. My dermatologist is amazing and quite skilled at other surgeries she has performed on me but for the Mohs she decided to send me to a specialist that trained her.

Thanks for the encouragement. Hopefully I won't need more Mohs surgery in the future. So sorry you've had such a battle with skin cancer.

 

[Teacher Terry]

that is good to know. was it precancer or SCC?

It was cancer.

 

[Purslane]

It was cancer.

Thank you for the reply. I am glad for your friend.

 

[Teacher Terry]

Thank you for the reply. I am glad for your friend.

My mom has been dead for 16 years and for the last 40 years of her life she had various forms of skin cancer including melanoma as did her dad. Luckily they were always on her face or arms so always caught quickly and we all became experts at spotting them too for her. So all she ever needed was to get them removed.

 

[camfused]

I have had Mohs surgery a number of times (stopped counting after 10). When the few hundred other areas needed attention (not an exaggeration) either liquid nitrogen, efudex (fluoruracil), or "Blue light" treatments would take care of the problem. All of those treatments can be painful. I have been dealing with skin cancer for the past 35 years. Mohs was the easiest and least uncomfortable/painful. My dermatologist is amazing and quite skilled at other surgeries she has performed on me but for the Mohs she decided to send me to a specialist that trained her.

I too have had at least 10 Mohs procedures. About one a year. That stopped 5 years ago when my Derm told me start taking Heliocare Advanced Niacin B3 Supplement

https://www.amazon.com/dp/B07MH34HP4?ref=ppx_yo2ov_dt_b_fed_asin_title

 

[Turbo29]

I too have had at least 10 Mohs procedures. About one a year. That stopped 5 years ago when my Derm told me start taking Heliocare Advanced Niacin B3 Supplement

https://www.amazon.com/dp/B07MH34HP4?ref=ppx_yo2ov_dt_b_fed_asin_title

Interesting. I asked my dermatologist about nicotinamide at my last visit and he mumbled that the evidence for it was very weak. Seems like it worked for you though. Maybe my derm hasn't kept up on the latest things.

 

[Koolau]

Yeah, I certainly can't suggest that B3 is ineffective but I've not seen any real data on it preventing skin cancer. I hope it's true and that I can head off the next round of Mohs.