Two bouts of skin cancer, September 2022 and January 2023

I am going through my second bout of skin cancer and thought maybe I need to do a post, not only to update my health journey, but to remind everyone to take precautions with the sun: wear a hat, protect your skin, and be alert to skin changes.

My first skin cancer was a little place on my shin bone. It wasn’t anything large, but it would go between having a scab and seemingly healing and then repeating over the course of a couple of months. After my husband pushed me to have it checked out, I finally did. I might have done it sooner without much prompting had I not had many other health issues. I sometimes feel like a walking science experiment and I get tired of going to doctors and having labs done.

The dermatologist immediately said we needed to do a biopsy. My thoughts were, “Oh joy.” The shots of lidocaine hurt like hell. After my leg was numb, the doctor did a punch biopsy which sounds exactly like what it is or so I think. I wasn’t looking, but I have a great imagination, much to my detriment.

The punch took out a little round patch from my leg. I left with instructions to keep it bandaged and moist and once the results were in she would call with a plan of action. The results were positive for basal cell carcinoma and the doctor prescribed a chemo cream to apply once the sore had healed and I was to follow up three months after I began applying the cream. I am fair-skinned and I have always healed quite slowly and with leukemia, the healing process is slower still.

After two months of healing and applying the cream for one month, and three months of wait time, I was back in her office for a checkup. She said my leg looked good but we should continue to monitor it. I mentioned the spot on my head that I had noticed and when she looked, she immediately said it needed to be biopsied.

I wasn’t expecting her response so I didn’t take it very well. You could say I freaked out. I was finally having a break from the trigeminal nerve pain and I thought she was going to do a punch biopsy on my head and I wasn’t keen on that. The pain from the shots in my leg was still fresh in my mind and I was tired of the pain in my head. I was headed to Freakville on the fast train; sort of like that meatball that rolled out the door and down the hill…When the nerve is not flaring, I am paranoid about anything triggering it, so anything to do with the face and head freaks me out. I had already been through oral surgery on January 3 so my nerves were still raw. (More about that surgery in another post.)

I do feel sorry for the doctor. She had no idea of the deep down dirty history I have with pain. Most people, doctors included, have either never heard of Trigeminal Neuralgia or know very little and they really can’t comprehend the pain. When she began the prep my first words were, “Is this going to hurt like my leg?” I was already clinching my hands, literally white-knuckled and shallow breathing. She could see the panic setting in. She remembered the communication difficulties during the first visit in 2022 when I couldn’t speak due to pain. I have to give her credit, she opened the door and told her assistant to bring her a syringe with four different things in it. I don’t know what was in it, but I never felt the needle stick. All I remember is her constantly telling me “Stay with me” and “Breathe, breathe for me, now.” I don’t think I’ve ever freaked out a doctor before. I made it through the biopsy and just as before, once she received the results she would contact me for a plan of action.

Since the previous treatment was applying a cream, I naively assumed this treatment would be similar. Never assume. I was unprepared to hear, “I’m scheduling you with a surgeon.” Three months later I was sitting in a surgeon’s chair having my head mapped out for surgery.

And once more I found myself explaining to yet another doctor about my pain trauma and Trigeminal Neuralgia (TN). TN is rare and I have the opportunity to find that out often. Most doctors haven’t heard of TN and no one can comprehend the pain you are describing. Even doctors act like, have you seen a doctor and gotten medication? Bless their hearts, they have no clue. It’s much more complicated than a doctor’s visit and a prescription. It’s frustrating, especially when you are having a flare and it’s too painful to speak, and no, drugs don’t work. Fortunately, I was not experiencing a flare-up but I still have trauma from the pain and I cry. Pain will break you. I saw this saying the other day. It describes me perfectly.

People cry, not because they’re weak; it’s because they’ve been strong for too long.

After unsuccessfully, at least I felt that way, describing the pain trauma, through tears, the doctor spoke about the procedure. The process of deadening my head went about as well as the previous time. Will freaking out doctors be my new normal? At some point, I suspect they may begin noting that in my chart. Once again I was hearing, “Are you with me? Stay with me. Breathe.”

The procedure was nerve-wracking for me. While my head was numb, I could still feel the scrapping of the tissue and then there’s nothing like the smell of YOUR burning skin to top your day as the doctor cauterizes the incision. With the MOHS surgery, the doctor will begin with a perimeter, analyze it, and if there is not a clear perimeter, they expand the perimeter. Each perimeter takes an hour to process which means your procedure can last an hour or a half day or even a full day. The waiting grated on my nerves because you don’t want to be there in the first place, and I am not a good waiter. I’m an ‘identify the problem and fix it now’ kind of person. The doctor ended up taking two perimeters. More scraping and cauterizing!

True to fashion, the tears never stopped. My day didn’t end with the last cauterization. The incision, which had grown with each perimeter now needed to be stitched. Did you know that skin could literally be stretched? I did not know this. For thirty minutes, the assistant worked my scalp, stretching my skin in order to be able to stitch. I just thanked God that I was not in a TN flareup. There would have been no way for me to sit through such an ordeal. After the skin stretch, and loads of conversation, it was time to stitch. I know that people want to make the patient feel comfortable, and for most people that is conversation. It doesn’t work the same with an introvert. I had already listened to four hours of music and I was done. The music went out for several seconds and she remarked that she’d have to check on the radio. I was thinking blessed quiet.

The stitching took another half an hour. The assistant told me the doctor was very good. She was well-liked and did an excellent job. The doctor was meticulous. She stitched inside and out. I thought the scraping was bad. I’m not so sure the stitching wasn’t worse. Imagine someone first pulling your ears enough to tie them on top of your head and then stitching them as tightly as they could. I could feel her tying the knots as tight as she could. I could feel the pulling sensation. By the time it was all over, I was so done. I wish I could find a meme to show how frazzled my nerves were. My introverted self was in dire need of a detox. I let the doctor give the particulars to my husband. I didn’t even listen. I needed a quiet corner. I should have listened. I found out soon enough the instructions were all about cleaning the incision. I had no clue what lie ahead.

I left the hospital looking much worse for the wear. I now had gauze wrapped around my head and also around my chin and head to hold the bandage on. It is impossible to tape the hair so this is what I ended up with. I purposely did NOT take a picture. I felt like one of those dogs who has to wear a cone to keep them from scratching their bodies. I pulled up my hoodie and let myself be led to the truck for the drive home.

I am pleased that the recovery so far has gone well. For the first week, it felt as though an elephant was sitting on my head. I managed to get by with Tylenol and ibuprofen and didn’t need the pain meds. But the cleaning of the incision! Not fun. I have to give credit to my husband. He is a gentle soul, and patient! It was almost impossible to touch my head, much less clean the wound. I had to drum the top of the table with my fingers to divert the sensation away from my head and to move my attention away from the cleaning. Imagine trying to clean a wound and you are afraid to hurt the person and they sit there tapping their fingers throughout the entire time.

Cleaning the wound involves first using Q-tips to wipe off the Vaseline, the same Vaseline that is on the stitches, between the stitches, around the perimeter of the wound, the wound caused by scraping your scalp and then pulling your ears to flap over your head… – you get the picture. Then, more Q-tips with hydrogen peroxide to clean the wound (I won’t go into the gory details) and then to dry the peroxide, and then to apply more Vaseline as the last step.

We are into the second week and the stitches come out on Monday so it is much better. I am even able to shower and wash my hair. I am dreading the appointment. I am sure it is not going to be fun to have stitches pulled out of my head.

I did learn some interesting things throughout this ordeal. My takeaways are:

• You can stretch the skin.
• You can mentally tie yourself to a chair when your nerves have gone way beyond frazzled and you feel the need to wrap your fingers tightly around someone’s throat.
• The doctors now use Vaseline to keep the incisions moist so the wound can heal from the inside out. Otherwise, it would dry and the scab can be deep and wide and cause scarring. Keeping the incision moist prevents itching as well.
• Peroxide has no healing benefits other than it cleanses the blood and dust from the wound. It is actually 3% peroxide and 97% water.
• I also learned the difference between Neosporin, Polymyxin, and Bacitracin. Neosporin has three antibiotic ingredients, Polymyxin has two, and Bacitracin has one. I will link to one of the articles I found that recommends you not use Neosporin as many people have an allergy to Neomycin.
• I also learned that Neosporin does not actually aid in healing. You would be better off using Vaseline or Bacitracin. I have been through tubs of Neosporin thinking I was doing my booboos a favor. After reading several articles, I am switching over to Bacitracin.
• And, lastly (so far) I never want to go through this again!

This is a photo of my stitched incision. It’s about 2.5″ long.

MOHS Micrographic Surgery

The following is some of the information from the handout I received.

Mohs micrographic surgery (Mohs surgery) is a specialized technique for the precise and total removal of skin cancer. It is the most effective method for removing certain skin cancers, especially those that spread deep and wide with root-like projections. Skin cancers include basal cell carcinoma, squamous cell carcinoma, and melanoma. Mohs surgery is the treatment of choice for difficult and recurrent skin cancers. Locations of the body frequently treated with Mohs surgery include eyelids, nose, lips, ears, and all other areas of the head and neck. Other body sites may also be treated with this technique.

Mohs surgery is named for Dr. Frederick Mohs who developed the technique in the 1930s. It is a layer-by-layer surgical removal of skin cancer with the subsequent microscopic examination of 100% of the excised tissue.

Because this technique involves microscopic examination of the skin cancer with precise mapping, the Mohs surgeon is able to pinpoint the areas involved with cancer and selectively remove only those areas. In this way, skin cancer is traced out to its roots. This results in two distinct advantages of Mohs surgery:

• It preserves as much normal tissue as possible and it has the highest chance of a cure when compared to other treatment options.
• The success rate is very high, often 97-99%, even if other forms of treatment have failed.

The assistant told me that they had patients who had gone to other doctors for the same surgery, but ended up in their care because the doctors did not perform the technique correctly. The doctor who did my surgery has earned some prestigious awards and came highly recommended. I sort of fell into her lap as all of my doctors are at Ochsner Hospital in New Orleans, which seems to make it a little easier to get in. My doctors refer me when necessary to other doctors within the hospital and there has never been an issue with appointments. Whether this is my interpretation or it is easier is really unknown to me. This has been my experience.