My blog series “Your Face, Your Story, Your Results” features patients in their own words as they make the transition through a surgical procedure – whether it be for reconstructive or elective reasons. My goal is to shed insight into the thought process, the emotions, and to encourage conversation and social interaction between patients undergoing plastic surgery.
What is basal cell carcinoma? How should a facial skin cancer defect be repaired? What is the normal recovery from skin cancer? These and other questions were rushing through the mind of one of our patients.
Kay is a 49 year old diagnosed with basal cell cancer on her nose in February of 2016. Here is Kay’s story in her own words.
How can a small, slightly raised area (the size of a pencil eraser), on the left side of my nose, lead to facial reconstructive plastic surgery? I have asked myself that question several times over the past two months. It all started about a year ago, when I sought input from a dermatologist regarding this area of concern on my nose. It was initially treated with a freezer burn technique. Unfortunately, this area of skin grew back and after trying one more non-invasive treatment it was biopsied in early February 2016. My life was already pretty difficult because I was supporting my close friend, and boss, who had been battling Multiple Myeloma for over two years. So, when I received the diagnosis of Basal Cell Carcinoma, I was shocked and upset that I now had my own cancer battle to fight. I had always been alarmed at the number of skin cancer diagnoses each year, but thought I took the necessary precautions to prevent it.
Moving forward with a treatment plan, I was scheduled for a consultation with a Mohs surgeon who specializes in the Mohs procedure – a skin cancer cell removal process. My dermatologist highly recommended Mohs, especially for skin cancer on the face, due to a 98% success rate of cancer cell removal leaving the smallest defect possible. That was comforting and eased some of the anxiety that was trying to build. In explaining the Mohs procedure to family and friends, I found myself assuring them that this small area should only take one or two excisions to remove the cancer cells, followed by a few sutures, and I would be on my way. The reality was that it took 5 passes (4.5 hours) of removing and studying the tissues until the margins were clear. During the waiting time, between each excision, I was texting my family and friends to keep them updated. They could tell concern was setting in after the third and fourth excision. When the Dermatologist reported that the margins were clear, after the fifth excision, I was able to see the defect that the cancer had left. I remember the shock of looking in the mirror and the disbelief – the feeling of “How can I recover from this?”. I had a difficult time looking at the raw skin edges and comprehending that it was actually on my face.
My mind reeled as the Mohs surgeon drew possible options on my face to close the defect. I had questions rushing through my head, like “does this need to be closed immediately for the best outcome or to prevent infection”? I was trying to process the shock of how my face looked and felt pressure to make a decision on closing the gap. As he was explaining my reconstructive options, I took a deep breath and requested to receive a consultation and second opinion from a Facial Plastic Surgeon.
That is what led me to Dr. Rihani’s office. He saw me that same evening and explained my various options, including what his recommendation would be for someone of my age and cosmetic goals. To be honest, there were financial concerns regarding the surgery and meeting my health insurance deductible. It was a lot to process within a short period of time. We came to a decision together to close the defect in the operating room a couple days later. Dr. Rihani also reassured me that it was okay to leave the defect covered for a few days and not perform an immediate closure. I was relieved to have all my concerns and questions addressed, to have a reconstructive surgery solution in place that I was comfortable with, and to have a couple of days to process everything I went through that day.
Finding my New Normal
After the facial reconstructive surgery, I remember feeling relief and ready to move forward into the healing process. The swelling around my eye and nose was extensive and a little scary. I was reassured by Dr. Rihani, when he saw me the day after surgery, that the swelling was normal and that it would get worse before it got better. As the sutures were removed (a painless process), and as the swelling continued to improve, I began to turn the corner 3-4 weeks after surgery. At follow up appointments, Dr. Rihani continues to tell me openly and honestly what to expect during the process, and answers all my questions on the transition my facial skin is going through. There are subtle changes in my appearance that have become my “new normal”, and I continue to improve weekly. The good news is that I am skin cancer free, and I have the best possible reconstructive outcome due to a talented, caring, and compassionate plastic surgeon.
Closing thoughts and key points:
1. It is okay to ask questions and express your concerns. With Dr. Rihani, I was able to take this approach and he did not feel threatened. We worked through the best possible solution together.
2. Trust your gut. I was worried about offending the Mohs surgeon doing the Mohs procedure. But, in the end, I am glad that I sought a second opinion to repair the gap left by the Mohs procedure by consulting with an experienced Facial Plastic Surgeon.
3. Having a support system is important. My sister, parents, and close friends were instrumental in helping me get through the skin cancer diagnosis and the surgeries that followed.