Some two or three decades ago my freckled skin and I became good friends with Hawaiian Tropic, SPF 4 in my pursuit of the teen ideal of beauty. Despite my determination to transform my natural skin tone from its normal translucent hue that would have been coveted in Victorian-era England, I never really tanned. In the years since I have learned to balance my grudge against the lotion industry and its failure to deliver on promises of bronze perfection, with my disdain for my inherited pallor.
Sometime several months ago, I absent-mindedly picked at patch of dry skin on the left side of my nose, creating a small sore that stayed for weeks. A scab would form, which would wash off in the shower, or slough off when I ran and rubbed the sweat off my face with my sleeve.
My family doctor thought it might be Squamous cell carcinoma, which he said (and a Google search confirmed) is easily treated. A biopsy showed the spot on my nose, as well as one on my arm, was actually Basel cell carcinoma, which Google tells me is likely a product of my many misguided attempts at a tan, is also easily treatable, and has nothing whatsoever to do with the Italian herb by a similar name.
A dermatologist scraped my arm clean of cancer cells, then referred me to a doctor who could perform a different procedure called Mohs surgery.
With the Mohs procedure, a surgeon removes a slice of skin from the affected area, examines it on the spot, and goes back for another slice until the area is free of cancer. Because it keeps scaring to a minimum, this procedure is used on sensitive areas like the nose, ears or lips.
Both doctors thus far had gone to great lengths to describe my cancer as one I should take care of, but otherwise need not worry much about. I adopted a laid back attitude about the whole thing. I envisioned a surgery with some sort of robot that could excise a skin cell-deep layer of dermis at a time. Afterward, I’d have a divot on my nose to cover up with one of those round bandages for a while. I’m not terribly vain. Maybe I’d make up something funny about the bandage, or wear one with superheroes on it.
I scheduled the procedure in a window of time between wrapping up my biggest project of the year and running two half marathons, and prior to a family trip to Guatemala for two weeks for a service-related project. There were football games, orchestra concerts and meetings for the three nonprofit boards I sit on to juggle as well.
I met with Dr. Scott for an initial consultation. Dr. Scott is at least ten years younger than I am and has a book of photos of his pre-and post Mohs surgical work. As he described the procedure in more detail, I looked through photos taken of people immediately after the procedure, and then at regular intervals in the recovery process. No one wore a teeny, round bandage with superheroes on it. All had much larger wounds initially than I had imagined, and most of these wounds involved a full third of the surface area on the nose. Reconstruction of this area involved cutting and stretching skin from other areas and stitching it in place. There was bruising and swelling involved.
For the first time I realized this procedure was not going to result in a little divot on my nose – like a pimple I just popped. What’s more, all the people in the photos were much older than I am, with more loose skin to stretch over the wound and stitch into place afterward. I was suddenly very aware of how small my nose is. This was going to be nasty.
I wasn’t going to be able to schedule the procedure in between half marathons, I needed to have at least a full couple weeks of no strenuous activity. I couldn’t schedule it before my trip to a third-world country with its corresponding risk of infection. I wasn’t going to be able to schedule the procedure the morning before a meeting – I could be in the office between 4 to 5 hours and likely come away with a huge pressure bandage and a prescription for pain killers. All of this was news to me as I perused Dr. Scott’s book of surgical horror.
I went home and cleared a more reasonable window on my calendar for the procedure. I Googled “Moh’s surgery,” looking for anyone younger who had undergone such a procedure. There were a few. One woman was happy enough with her experience she positively gushed about it.
“After only one excision, the cancer was gone!”
This same young woman, posted a photo of her swollen face, with black eyes and a bulky pressure bandage. Later photos showed a wound that she said took months to heal and months more to return to a normal color.
I drank a beer and had a minor pity-party (which, in a fit of poor judgment, I shared on Facebook).
In the days after my pity party, I was able to come to grips with the whole situation. I would run my events, travel to Guatemala and return for surgery. Forget about Christmas photos, but whatever, I would be cancer free. Best case scenario: my Moh’s procedure would require only one excision like the happy woman who blogged about it. I might even be able to make an argument against stretching the skin of my nose down over the sore and stitching it up. I’d have a small scar, probably not much bigger than the scar that was forming now over the biopsy site. That wasn’t bad.
The day of the surgery, Mike took time off to hang with me in the intervals between excisions. I thought he was overdoing things, but whatever. I was surely only going to have one excision and we’d be out of there.
After the first excision, where Dr. Scott – not a precision robot stand-in – dug around my numbed up nose for a while, we waited for an hour and I was called back a second time. A nurse showed me the results of the first excision. They had not been able to get all of the cancer, but had narrowed it down to one side of the biopsy site. Okay, so I wouldn’t be the one-and-done patient. The nurse told me the average number of excisions for their patients is two. When we were ready to discuss reconstruction options, whether to stretch and stitch the skin on my nose or something else, the nurse would call both Mike and I back for the conversation.
I returned to the waiting room and let Mike know he’d be able to come back with me next time, assuming all the cancer had been excised. The waiting room was full, and we had very little elbow room, so the armload of work I brought and my laptop stayed stowed beneath my chair. Most of the rest of those waiting were couples in their 70s or 80s. They started a lively conversation about where they were from, how long they’d been married, whether they’d served in Vietnam, and what they thought about the presidential campaign. Every now and then the door to the doctor’s office would open and all conversation would stop while one of us was called back to get the results of our latest excision. At one point, a secretary came through the door looking abashed.
“It’s just me, I’m not a nurse,” she said, crossing to the water cooler. “We all hate coming through here without any news for any of you.”
I was called back a third time, and got up slowly. I waited for the nurse to invite Mike as well. She didn’t.
“Well, you’re officially above average,” she said to me in the patient room.
The fourth time I was called back, again without Mike, the nurse showed me the pinpoint of cancer representing what was left to be excised. She was certain this would be my last excision.
The fifth time I was called back, the doctor said he had run out of jokes. I hadn’t been aware of any he’d made before.
“Now you just get the serious me,” he said.
The sixth time I was called back, the nurse showed me the chart again. A tiny spot remained to be excised.
“Are you sure you just noticed this in June?” she asked.
Finally, both Mike and I were called back to discuss options. It was now early afternoon. All other patients had been cleared from the waiting room, leaving with their post-op kids of bandages and tape.
Dr. Scott explained that my cancer had been extensive, but not deep. He’d had to excise a lot of skin, but no muscle tissue or cartilage, which was a good thing. I had a minor freak out moment when he handed me a mirror and I saw that the “good news” Dr. Scott was telling me was about a hole in my face the size of my big toenail, probably about 25 percent of the surface area of my nose.
My wound was large enough that it would not be possible to stretch the skin above it down to cover and stitch it closed. It was going to require a skin graft. I could choose from skin excised from in front of my ear, which would be close in tone to the skin on my nose, or skin from behind the ear, which might differ slightly in color, but would have the advantage of fewer hair follicles.
Yup, I could choose between having hair grow from the surface of my nose or mismatched skin. I went for the latter.
Now, several days after the surgery, I have mostly cleared my calendar of the more public appearances and workout dates. I’ve resigned myself to having a bandage-covered piece of gauze the size of a marshmallow stitched to the side of my schnoz-a requirement in the recovery process for a skin graft-for the next week or so, and am getting used to the fact that little kids (and some big ones) tend to stare.
I’m finding that it’s time consuming to tell people that I had some Basel cells removed from my nose, that the cancer was more extensive than they expected, that I’m not in any pain and that I’ll be fine. Instead I’m trying to figure out a really good cover story for the bulky bandages that makes me sound as bad-ass as I look and doesn’t invite sympathy or more questions.
A bar fight wherein my nose ring was ripped out? No. I worry about dislodging stitches when I sneer. Caught a stray bullet in a botched mob hit? Too over the top.
I’m thinking maybe “snake bite.”