simonov
New User
Joined: 04 Jun 2008
Posts: 2
Location: Costa Mesa, CA
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 Posted: Thu Jun 05, 2008 9:12 am Post subject: A Mohs surgery story (SCC on the nose) |
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I recently underwent Mohs surgery for removal of a squamous cell carcinoma on my nose, and another cancer victim suggested I post my experience on one or two of these cancer forums. He said that many people get pretty nervous about surgeries like this on their faces, and that reading my story might help someone get over his or her anxiety and help folks feel more confident about getting treatment.
The Story
I am 45 years old and have spent a lot of time outdoors, principally hiking and backpacking in the mountains and camping in the desert. I also grew up at the beach. I never used sunscreen as an adult because though I am light-skinned I would typically tan rather than burn. This winter I tried winter mountaineering for the first time, climbing up mountain ice and snowfields. I climbed Mt Baldy, a 10,000 foot snow-capped mountain near Los Angeles, four times in Jan-Mar 2008.
In early April of this year, what appeared to be a pimple formed right at the end of my nose. I let it alone, assuming it would simply go away after a while. My wife suggested I see a doctor about it, but I continued to let it slide until about the middle of May, when I finally called a local dermatologist to have a look at it. I was concerned that it was not going away on its own, and so was not behaving like a pimple.
I live in Costa Mesa, in Orange County, CA, right next door to Newport Beach, which has got to be one of the main plastic surgery centers of North America, if not the world. There are many dermatology clinics here. I simply looked up the closest one in the Yellow Pages, since in the beginning all I wanted was for someone to tell me what was growing on the end of my nose.
I called a dermatology clinic in Newport Beach headed by Dr Kristen Forman (949-515-4111), and was examined by Dr Vip Soni. Dr Soni has a very positive and confident bedside manner. He identified the "pimple" immediately as some kind of skin cancer, hopefully basal cell carcinoma, but decided to take a biopsy to find out for sure. Dr Soni shot my nose full of local anesthesia and essentially sliced off the growth. It was completely painless, though I guess I was a bit nervous (I am not used to doctors at all, and typically avoid them if possible). I felt woozy when the biopsy was over, probably because of an adrenaline rush or something.
Diagnosis and decisions
After about a week, Dr Soni called to tell me it was squamous cell carcinoma, which was good news (since it wasn't melanoma), but which was also sort of bad news because squamous cell carcinoma is only really dangerous (he said) when it is in the middle of the face, where it is getting a lot of blood circulation and is more likely to metastasize.
Now while I was waiting for the biopsy results, I had done a little research and asked around about this, and had decided that Mohs surgery sounded like the best treatment for me. I believe in doing your own research, and getting the opinions of other doctors and patients if you are uncertain. I happened by chance to discuss this with someone who had already been down this path, and he couldn't be more helpful or enthusiastic about Mohs. But find a good doctor, he said.
So Dr Soni started outlining our options on the phone. Radiation was mentioned, and I was already dead set against that. He then started talking about "a procedure called Mohs surgery." I told him I had already decided that was what I wanted done, and all I cared about now was finding a good doctor to do it. As it happened, Dr Soni is himself something of an expert on Mohs. He works with a team in Long Beach, CA, of two dermatologists and a plastic surgeon, and they do about 20 Mohs procedures every week.
Dr Soni also gave me a referral to a Newport Beach surgeon whom he considered skilled and experienced with Mohs, but since that doctor couldn't see me until the end of June, I decided to schedule an appointment for 27 May with Dr Soni and his associates. Dr Soni said he felt it was important we acted fast because of the location of the cancer.
Now, I am a rational person who does not get overtly nervous about surgery and stuff like that, so I was very calm and relaxed going to the appointment. My cancer victim acquaintance mentioned that many people get extremely worried about surgeries on their face, especially the nose, but I wasn't really concerned. I felt like I was in good hands and I just wanted the cancer gone.
Mohs surgery
Dr Soni's Long Beach clinic does all their surgeries on only one or two days a week, so this Tuesday morning was a very busy one. There were maybe fifteen or twenty other patients moving in and out of the waiting room, and I was just about the youngest of them. So many of the patients were seniors, it really made me understand better how the skin damage that causes cancer can have occurred at any time in your life, and can catch up to you much later. It made me sad because I realized that even after I dealt with my current problem, I was doubtless at great risk of continuing to see cancers growing in the years ahead.
Anyway, I was called in and the first thing they did was start shooting my nose full of local anesthesia. That stuff really works (as with the biopsy), but despite my conscious calmness going into this thing I guess I had an unconscious nervous reaction to all these dudes (two doctors and an assistant) cutting up my nose right in front of my eyes. I was anxious and tense and Dr Soni gave me a roll of gauze to squeeze in my fist. The Mohs procedure itself was short, only ten minutes or so, so I didn't have enough time to get really nervous about it. They patched up my nose and sent me out to the waiting room while they looked at the slides.
The waiting room was kind of comical, all these people sitting around with bandages on various parts of their faces. Several of the patients exchanged jokes. You'd hardly believe everyone there had cancer of one form or another.
I waited about two hours, after which they called me back in. They said according to the slides they got all the cancer. I saw a couple of Polaroids on the counter of my nose just before they had put the bandages on, and there was a hole about the size of a marble. Now they were going to fix the hole. The reconstructive surgeon was Dr Jonathan Hoenig (562-420-8333), and he said they could take tissue from elsewhere on my body, or just use what they could find in the nose. I think they were a little concerned because my nose is asymmetrical, with one nostril being much smaller than the other (though this has never given me any kind of a problem breathing). I was cautioned that one of the downsides of using tissue from another part of the body is that it might have a different texture from nose skin. I told the doctor that at this point I just wanted to do whatever was easiest for him. I was confident he wasn't about to do a botch job, and I didn't have to worry about a movie star career.
The reconstructive surgery lasted maybe 20 minutes or a half hour, and of course was much more invasive. There was no pain, but again I became irrationally nervous and tense. The doctors noticed and seemed a little irritated (it makes their job harder) and suggested I take a valium. I had to drive home later, but they offered a reduced dosage and I also decided to walk a block to some lunch when they were done, which would mitigate the drug's effects post-surgery. The valium seemed to make me feel better. Soon they patched me up and sent me out.
In general, I am not one to need pain-killers (for example, after my wisdom teeth removal), but I asked about post-op pain. They said it shouldn't be a big deal, and that I should take Tylenol if necessary. As it turned out, I didn't experience very much pain at all. The nose continued to be tender (and still is, a bit), but I never experienced the throbbing you feel from most injuries. I never needed that Tylenol.
I had an overnight backpack trip scheduled for the following weekend. The doctors quickly and unanimously nixed that idea after I asked them about it. They wanted me to take it easy.
Money
I have health insurance, but prefer to use it only in emergencies (like a car crash or heart attack, etc). If I can afford to, I prefer to pay cash. Making claims is messy and whenever my wife and I do so we continue to get invoices and statements in the mail for years afterwards. So I asked to pay cash for the work.
The examination, including the biopsy, was $230.
The Mohs surgery and reconstructive surgery was $1,000.
I still have not received a bill for the biopsy lab work.
There may yet be some more minor cosmetic procedures to do, but they probably won't cost very much, if anything.
Healing up
Day before yesterday, I went back to see Dr Hoenig to get my stitches removed. He seemed pleased with my progress. So am I. My nose looks quite a bit like it did before the surgery, just not as pointy (as seen from the left) as it was before. He asked that I continue keeping it moist with antibacterial ointment for a few more days, but I no longer need to put a dressing on (I stick a band-aid on to keep the ointment clean).
Yesterday in the shower I found I was able to give my face a thorough scrubbing for the first time without having to worry about hurting my nose. Within a day or so I think I really will be back to normal.
All in all, this entire ordeal was a bit of a hassle, but it didn't cost much in money or discomfort. And I should be cancer-free (for now).
I thought I would post all this, on the advice of my acquaintance mentioned above, to encourage people who were considering a similar procedure. I am not an expert, just someone who has been there, done that, but would be happy to attempt to answer any questions I can.
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