In general, I like to think I keep up with popular trends. But I was less than thrilled this past summer when I learned that I was sporting the highest-trending cancer of all: basal cell carcinoma.

Basal cell carcinoma (BCC) is a skin cancer. It strikes about 4 million Americans a year, (more than any other type of cancer out there) and while it almost never becomes life-threatening, it can be disfiguring if left unchecked. It grows slowly, sending out roots beneath the skin, so even if the innocent-looking mark on the skin’s surface does not change much in size, it is spreading underneath. This cancer can extend its tentacles into bone, muscle, cartilage and other structural tissue, causing serious damage and disfigurement.

In my case, I first noticed a little translucent bump below the left side of my nose a couple of years ago, and just thought it was a blemish. I didn’t give it a second thought because it wasn’t all that noticeable, it didn’t hurt or change appearance, and (this is the part worth noting) - I’d had facials and annual skin exams by my dermatologist and no one (neither esthetician nor MD) ever flagged it. It wasn’t until I toyed with the idea of trying a facial peel at my dermatologist that I pointed it out during our consultation. She felt certain it was just a common type of mole that people get in midlife, but biopsied it, just to be safe. I went on vacation and didn’t really give it another thought, until I returned home to a voicemail from the doctor’s office. Sure enough, it was a BCC tumor, and had to be removed.

I’m lucky to have pretty smooth skin, but it turns out that wrinkles are handy hiding places for surgeons to tuck away a surgical scar. So, my dermatologist referred me outside of her practice to a Mohs surgeon who is regarded as one of the best in the United States for both efficacy of tumor removal, and for his cosmetic results. He’s so good, in fact, that he’s also pretty hard to get into. I was diagnosed in July, and my surgery was scheduled for mid-October. I highly recommend him, and have linked him below.

Getting Ready: Before Surgery:

I want my skin to heal as quickly as seamlessly as possible. So, I started using a top-shelf skin care serum purchased from my dermatologist a month before my surgery. I’ll link it below - it’s considered the gold standard for protecting and enhancing skin health, and it costs a pretty penny, but it is 100% worthwhile, IMHO!

I also abstained from alcohol for a couple of days before the Mohs, and tried to stay hydrated (I’m not very good about drinking water throughout the day.) I took the day off from work - even though I fully expected to be home and back on my computer by lunchtime …which turned out to be a little naive!

What to Expect During a Mohs Surgery

If you have to have Mohs surgery, here’s what to expect:

Photos:

Lots of pictures - (and yes, I wore lipstick and mascara to the appointment because I do that every morning and a little stinkin’ basal cell cancer isn’t going to cramp my style!) Anyway, first, they took my vitals and asked me to point out the offending spot on my face (presumably so we would all be in agreement about where the scalpel was going.) Then they took lots of photos of my face, from lots of angles. Then, they marked a circle around the perimeter with a felt-tip pen.

Getting inked

**Me, all marked up and ready to carve!**

Next came the needles

For me, this was the most uncomfortable pat of the whole experience. Before the actual surgery, the nurse numbed me with lydocaine and epinephrine, and boy oh boy, did those needle sticks hurt! However, I think it’s because my BCC was located right smack in the middle of my face (how rude!) where there are lots of nerve endings. Luckily, the discomfort didn’t last long and the numbing worked great, and I was told the initial anesthesia would last 2-3 hours. Since I ended up needing multiple rounds under the scalpel, they hit me up a few more times with the anesthesia throughout my treatment. The epinephrine in this numbing cocktail gives you a little adrenaline buzz, like you just took a nice shot of Starbucks Nitro Cold Brew, but it wears off pretty fast.

The procedure

You’re awake during Mohs surgery, and I got to stay in my street clothes. They laid me on a table under very bright lights. The surgeon came in, draped a paper sheet over my face and cut through the paper, into my poor little numb face. However, I couldn’t feel a thing, and it was over before I had time to mentally chide my 19 year old self for all those sun-worshipping beach days that set me up for this moment. Then, they bandaged me up and sent me out to the waiting room while they took the dime-size layer of my face that they’d just removed, and examined it under a microscope to determine if they’d gotten all the cancerous cells.

The Mohs surgical process involves mapping the cancerous tissue, and if there are any signs of abnormal cells at the borders, they do another round of tissue removal, until they get “clear borders”, indicating that they’ve removed all the cancer. The whole idea with Mohs surgery is to leave as much healthy tissue as possible, so the process is slow, conservative and meticulous. In my case, it took 3 rounds of removal, and a full 8 hour day! Depending on where the resulting wound is located, you might need a skin graft or flap, or like me, you might just need stitches.

Some Mohs patients require further cosmetic repair by a plastic surgeon, but I’m thankful that I won’t be one of them! For a week, I sported 10 neat little stitches from the corner of my nose to the corner of my mouth, and faithfully kept it clean and moistened with peroxide and Vaseline. A week after the procedure, my stitches came out (quick and painless) and because my surgeon was so good, I’m already able to hide the red line with makeup, and expect it will fully heal in the next couple of months with a near-invisible scar.

My Advice, if you need to have Mohs:

Find a Mohs surgeon who has plastic surgery experience or that level of skill at repairing the surgical site. Your dermatologist should be able to refer you. And, have a good plastic surgeon in your back pocket, just in case. Mohs surgery can be very invasive and difficult to repair, which matters a lot if your site is on your face. Meet with your back-up plastic surgeon ahead of time and show him/her where the trouble spot is. Ask how he or she will work you in, if you need to come in for a repair on the same day as your Mohs surgery. The trouble with Mohs (and BCC’s in general) is that you don’t know until the actual day of surgery just how extensive it will be - so you won’t know how complex it will be to patch you up. So, just work out a game plan ahead of time to cover this possibility.
This is the #1 piece of advice that people gave me over and over again. Especially, (if like me), your cancer is on your face, you want a good cosmetic outcome. Mohs surgeons all know how to do stitches, but they don’t all have the training of a facial plastic surgeon, and that can make a big difference in the long run. My Mohs surgeon had tons of experience, was referred to me by my dermatologist specifically for his aesthetic repairs, and he works with the plastic surgery residents at Duke University medical school, so I felt that I was in good hands. I booked a consultation and met with him beforehand anyway, to discuss my concerns about scarring. Again, not to be vain, but my cancer spot was smack in the middle of my face, so the repair could have pulled my mouth into a permanent snarl…I’m too friendly a person for that!
Dress warm or in layers. Surgical suites are kept cold, and you’ll likely be there for a few hours.
Bring reading materials and snacks - again, this is a waiting game, so bring something to keep you from going stir crazy (and you will get hungry, if you’re there as long as I was!)
Have someone drive you. It’s good moral support. Even though I didn’t have any drugs in my system and I could have driven myself home, the whole experience is more tiring than you might expect.
Follow the post-op wound care instructions closely. My surgeon said ‘greasy’/damp wounds heal the quickest and leave minimal scars. Vaseline is your best friend!

Be thankful! You’re taking care of yourself and getting those nasty cancer cells out of your system. It’s totally worth going through the Mohs, which, incidentally, has the highest BCC cure rate of any treatment option (99%).

Supplements and Lasers Can Help Heal and Prevent

Nicotinamide (Niacinamide): Niacinimide is a form of Vitamin B3 that helps damaged skin cells repair their DNA. (Note, this is not the same form of the vitamin as Niacin). A study published in the prestigious New England Journal of Medicine showed that taking 500 mg of oral niacinamide twice daily reduced non-melanoma skin cancers by 23% in the study’s patients. The same study showed that this supplement helped reduce precancerous skin lesions by 15%. And, participants did not report any side effects from taking it. You can buy it over the counter, just be sure the label says “niacinamide” not “niacin”.

Laser Peels: Certain laser skin resurfacing treatments target the basal layer of skin, where BCC’s form. By periodically removing this layer and allowing new, healthy skin cells to take its place, you may pre-empt the development of new BCC tumors.

DNA Repair Enzymes: Some dermatologists recommend topical DNA repair enzyme creams, which can boost the skin’s natural resistance to cancerous cell mutations. These enzymes are molecules that prompt chemical changes at the cellular level, to repair UV damage. I’m still researching which creams work the best, but you can find these over-the-counter; just be sure the label or ingredients contain all 3 words : “DNA repair enzymes.”

Be vigilant! Keep an eye on your skin and get anything that looks different to you checked out. It’s up to you to manage your health. As I mentioned earlier, my well-regarded dermatologist did not catch the offending BCC because it was pretty small and hard to see; I had to point it out! If I’d waited even longer, I surely would have required even more extensive surgery to address it. I’ll continue to research and post about skin care, and will certainly recommend products that work for me.

From a strictly anti-aging standpoint, I absolutely love the Alastin skin care line and religiously use the eye cream and skin nectar - both of which I truly believe have visibly improved my skin texture and tone. I’ve also been using the neck cream, but can’t say I see as much of a difference there as on my face. These products are expensive, but I love them and will trust the skin nectar to help further heal my Mohs scar.

I hope this post helps! Take care of your skin and let me know in the comments if you have products or tips related to this topic that you can share!

Til next time,

xoxo ~ Sue