Scar Face

surgical scar

The stitches were taken out of my left temple surgical site on Thursday. It was quick, easy and painless. I was in and out of the office in less than ten minutes. My only instruction for post-op at this point is to keep  putting vaseline or something similar on it for one more week. I'll be glad when that's done as it makes my hair greasy.

The swelling has gone down a lot over the past week, and the bruise has lightened. The bottom part of the scar is still puffy, but I am hoping that it will continue to flatten out. The surgeon said it can take a year to settle completely down. I guess I'm lucky that it is located so close to my hairline as I can probably cover it somewhat with my hair.

Surgery Number One Done

Wednesday I saw my dermatologist for an ED&C, the procedure she uses for removal of small basal cell carcinomas. She's done a few on me in the past, including one in March on a basal cell that was near the one she removed this week on my right arm.

The procedure itself is not too bad, once you get over the sting of the lidocaine shot. The whole thing only took about 10 minutes. For me the issue is my allergic reaction to anything with adhesive. They want me to keep this covered for two weeks, and that will definitely be a challenge. I have tried every type of bandage out there, including the so-called sensitive skin ones. They all make me itch and break out. 

Last night I put on a gauze pad and wrapped an elastic bandage around my arm to hold it in place. It held up pretty well, but even the elastic bandage irritated my skin a bit. I'm going to try a different brand tonight and see if that works better.

My Mohs surgery for the basal cell on my left temple is scheduled for September 25th. That one will take several hours as they remove tissue, wait for it to be read by a pathologist, and then take more as needed. I'm definitely not looking forward to that, and pray that the doctor will get it all in one or two tries. It was really unnerving when it took five attempts to get all the cancer on my nose in 2019.

Also on Wednesday I had my annual mammogram. I had to go to a different radiology center as my insurance changed January 1. The office was very efficient, and I was in and out in no time. Now I just have to wait for the pathology report.

ED&C Number 4

basal cell removal

On Wednesday I had my fourth Electrodesiccation and Curettage (ED&C) performed to remove the basal cell carcinoma from my right arm - my 20th skin cancer surgery to date. As I have posted in the past, the dermatologist scrapes off the top layer of cells with a curette until healthy cells are revealed. Then an electrocautery device is used to apply small amounts of electricity to the treated surface to burn away any remaining cancer cells. This is performed as a less invasive cancer removal option.

As with every time, they bandaged the spot before I left. And as with every time, the skin in the area broke out in a rash due to my adhesive allergy. You technically don't need a bandage for the wound, but since I have to keep vaseline on it for two weeks, the bandage protects my clothes and sheets.

Today my arm is feeling sore and a little warm in the area of the excision. I have it totally uncovered except for the vaseline. I am a little concerned that it is getting infected. I'll keep an eye on it and call the doctor if necessary. Only once before has a skin cancer surgery resulted in an infection, so I guess I have been pretty lucky. I pray that my luck will hold in this case as well.

feeling lucky

While at the office I had the doctor treat two sun damaged spots on my lower lip with liquid nitrogen. She had done this once before in July of last year, but the spots came back. Does that ever hurt when she zaps them! So far they have not turned into large blisters like they did last time, but instead have gone directly to the draining stage. Hopefully this time will do the trick. 

More Basal Cell Surgery

basal cell surgery

Yesterday the dermatologist performed an ED&C to remove the two basal cell carcinomas they found on my neck last month. Basically this involved them numbing the two spots, and then using a tool to scrape off the skin cells. She performed this procedure three times on each spot, using a cautery machine between each scraping to stem the bleeding. It really didn't take her too long, and the worst parts were the shots to numb the areas and the smell of something burning when she used the cautery machine.

The two spots were bandaged when she was done, and I reminded them that I have an allergy to the adhesive on bandages. This time they used gauze and some non-latex tape. I'm supposed to keep Vaseline and bandages on for two weeks, but I doubt I'll be able to tolerate that even with the new tape. She said as long as I keep the spots moist with Vaseline, the bandage really doesn't matter. I suspect they are really to protect my clothes from the ointment, as well as the sores from being rubbed by my clothes.

I haven't removed the bandages yet as I am going out to dinner and to a play with a few of my female pickleball players from the neighborhood. I wasn't sure I would be able to secure the gauze as well as the nurse did. I'll definitely do it when I get home tonight though. It will be interesting to see what the wounds look like since I haven't had this procedure done before.

More Skin Cancer

Because of the two basal cell carcinomas found in my scalp last November, the dermatologist wanted to see me three months following the Mohs surgery. I went in the end of February, where she did an all body scan. She asked about a spot on my left neck, and I reminded her that she had put liquid nitrogen on it the last time I was in. She decided to biopsy the spot, along with one a few inches behind it. They put bandages on both before I left due to bleeding. I left those on overnight as I didn't want to get blood on my pillowcase.

Unfortunately, I have an allergy to latex - specifically bandages, oddly enough. By the next morning the spots on my neck had angry red welts, and they itched like crazy. I put an antibiotic ointment on them, and recovered them with bandages that have paper tape on them. That was also a mistake, as the welts and itching got worse. So I had to leave them uncovered, and used Benadryl cream on the welts.

Both the biopsies came back positive for basal cells, but apparently they are in the very early stages. So instead of having the plastic surgeon in the office do Mohs surgery, she is going to do an ED&C on them. I wasn't sure what that meant, so I had to ask Dr. Google. It stands for electrodesiccation and curettage, and is a procedure where they basically scrape off the cancerous cells. I have not had this done before, despite being on cancer spots number 17 & 18. I'm not sure exactly how they will know if they have gotten all the cells. With Mohs they examine each removal in the lab to make sure that they have gotten clean margins in the piece. If not, they go back and take more. Apparently with the ED&C, they will make three passes over each of the basal cells to try to remove all the cancerous tissue. The procedure has a 95% success rate, so hopefully I will fall into that category. I'm not scheduled until next month, so I'll report back on how it goes.

I'm not sure I followed up here regarding the infection in my scalp. Two weeks after they took a scraping to check for infection, it ended up that my one wound had a MRSA infection. This was definitely a surprise to me, as the most common way you get this type of infection is from a hospital or other health care setting. My guess is I got it when they removed my staples back in December. I opted to continue with the topical antibiotic rather than taking an oral antibiotic. Fortunately after another week of use the infection went away, and was cleared up before we went to Africa. I'm praying the next surgeries will not have any surprises coming out of them. 

Monday morning I got up early and walked down to a nearby point on the lake. It was cold, and fog was rising off the water. I'm reminded that beauty is all around us if we only look for it.

Mountain Island Lake

Keeping me in Stitches

This morning I made an unplanned visit to the plastic surgeon. The smaller of the two basal cell surgical spots in my scalp had begun to bleed. As I am 8 weeks post surgery, this is really surprising. The wounds had been healing nicely, and I even colored my hair with no problem a couple weeks ago. The only thing that had been bothering me was the dissolvable stitches that were popping up through my scalp.

I called the office when I noticed the discharge, and they told me to come right in. The technician clipped the stitches, and then took a scraping of the head wound. It will be sent to the lab to check for signs of infection. When the doctor was able to see me, he cleaned the wound up but didn't seem overly concerned. He said that because of my hair, it's likely that one of the hair follicles formed a pustule due to the dissolvable stitches and that it has erupted. He gave me a prescription for a topical antibiotic to put on the wound, but didn't want to start me on an oral antibiotic until the lab results come back. That might not be until next week, so I'm sure that's why he went ahead with a topical in the meantime.

By the time I got home, the wound was bleeding quite a bit. I know that head wounds have a tendency to do that. So I put a cold compress on it until it slowed, and then put an over the counter ointment on it to help stop the bleeding until my prescription is ready. This is the first time in the 15 skin cancers that I've had removed that there has been an issue, so I guess I can't complain. Hopefully the lab result is negative, and the topical ointment does the trick. 

Dissolvable Stitches?

Who would have thought that the term dissolvable stitches is actually an oxymoron? Before the plastic surgeon stapled my head wounds closed following Mohs surgery for basal cell carcinoma, he stitched them with "dissolvable" thread. Supposedly your body gradually absorbs the sutures so you don't have to return to the doctor to have them removed.

When I went in two weeks post surgery to have the staples removed, I was told that the other sutures should dissolve on their own. If not, I am supposed to go back in and have them removed in the office. I wasn't too concerned about it, but now that all the scabs have come off, the other sutures are poking through my scalp. They feel like fishing line. While no one can see them due to my hair, I know that they are there and I pick at them.

While I do know some people who have removed their own stitches, mine seem pretty attached to my scalp. I'm going to try to leave them alone for now. I see the dermatologist again the end of February, so if they are not gone by then I'll just have her take them out at that point. I may have to at least trim a couple of them in the meantime though. I don't want my comb or brush to catch on them. Dissolvable? I don't think so.

Medical Staple Removal

Thursday I went in to the plastic surgeon's office to have the Mohs surgery staples removed. I just assumed my plastic surgeon would be the one doing the removal, and I came prepared with a joke to play one him. I bought along my staple removal to suggest he use it to remove the staples. The joke was on me as a physicians assistant came in to take the staples out.

surgical staple remover

The bottom jaw of the surgical staple remover is placed under the staple, and when the handles are pressed they bend the staple and pull it out of the skin. Theoretically, anyway. They do not give you any anesthesia for this procedure. 

The first couple staples came out with little effort on her part or pain on mine. Then she got to the tougher ones, and those hurt! I knew she had a total of 22 to take out, so it was not a fun time. There ended up to be 4 that she couldn't remove, and she had to get my surgeon after all. He did a little clean up on the crusted areas around the wounds, which seemed to help him get the last of them out. It was no picnic, and the larger wound ended up bleeding again. I'm not sure the staples are a better option than dissolvable stitches for wounds in the hair after all.

More Mohs Surgery

two grinches

Last Thursday I went to the plastic surgeon's office. I wore my grinch face mask as it mirrored my mood at having more skin cancer. It was ironic that the grinch greeted me in the waiting room. I was scheduled for Mohs surgery to remove the two basal cell carcinomas they found on my scalp. I had a tiny one in my hair on the left-hand side towards my forehead, and a larger one further back in my hair on the right-hand side. 

Dr. Mu was my surgeon again - she removed the squamous cell and the basal cell hiding below it from my nose in December of 2019. While she was unable to get clear margins on either of these after the first excisions, at least she was able to get all of them in the second cut. The one on my nose took five tries!

After she was done Dr. Freeman came in to do the closings. He discussed the pros and cons of stitches versus staples, and we decided to do the staples this time. I have not had them before, and it sounds just like you think it would. Imagine someone holding a staple gun up to your head and firing away. It took 8 staples to close the one on the left and 14 to close the one on the right. 

Mohs followed by staples

hair loss

I was able to manage the pain with Tylenol, which is good as stronger drugs make me sick. The larger wound did bleed a bit that night, so I covered it with Neosporin and a gauze pad. Though I was advised I could wash my hair after 24 hours, I chose to wait an extra day to do so. A large chunk of my hair came out, I'm guessing from the area of the large incision. I'm not sure why they didn't just go ahead and cut the hair in that spot. While the dried blood came out with the double shampooing, the solution Dr. Freeman used to clean my head before closing up the incisions did not all come out. I can still feel it caked on my scalp. I guess I'll need to pick on it a bit before the next shampoo.

Next week I go back in to have the staples removed. Hopefully that won't be too bad.

More Skin Cancer

The dermatology office called to say that both of the biopsies taken last week are basal cell carcinomas. These are my 15th and 16th skin cancers. Ugh! We do not have a family history of basal or squamous cell carcinomas, and I was not out in the sun more than any other kids growing up in the 60s and 70s. I always say I wear my Irish heritage proudly with the red cast in my hair and my freckles, but it stinks that my skin has to suffer for it.

Now I have to wait for the scheduling office to call and see when they can get me in. With our granddaughter making her big debut next week, it will take some planning to coordinate when I want to have the surgeries done. Since these are very slow growing cancers, it won't be a huge rush. Celebrating my first time as a grandma is going to take precedence for sure!

Skin Cancer Strikes Again!

When I saw my dermatologist (Dr. S.) in late July for my normal (if anything about my skin can be considered normal) six month check-up, I mention that a spot on my upper right chest had not responded well to the cryosurgery he had been doing on it each time I came in. He said it was time for me to see the plastic surgeon again. I would say it was past time, actually. I rely on him to tell me when it is time to get things surgically removed, but in light of recent developments I can see that I will have to be more assertive. Dr. S. then proceeded to burn about 13 spots on my head, chest (including two above the spot I believed to be skin cancer), back, shoulders and arms, and I booked an appointment with the plastic surgeon (Dr. R.) Between his schedule and the trip we had planned to Seattle, I could not get the surgery done until September 16th.

When I arrived at Dr. R.'s office, I also asked him about a tiny spot on my shoulder that had also not responded to the liquid nitrogen. Typically, a benign area will crust over and peel following treatment, whereas skin cancer spots essentially stick their tongues out at the doctor and do nothing. Dr. R. agreed that the small spot looked like a basal cell to him. But he was also concerned about two other spots above the growth on my chest that he was going to remove. He referred to it as a multi focal cancer, meaning the additional two had popped out as a result of the first one. He did not use the word "metastasis", which was somewhat comforting. But this was certainly a first for me. He decided to take all three of the spots in one incision. Needless to say, that was a little more involved than I was expecting, and will result in a longer scar. After that procedure, removing the one on my shoulder was a piece of cake. That made me realize I need to get into the plastic surgeon much sooner than my dermatologist is referring me. Dr. R. also suggested that I might need to go see Dr. S. more often than every six months. Yippee...

There was some pain that afternoon and a little on Saturday, but nothing like when I had the two removed from my forehead earlier this year. In fact, I felt good enough to go and photograph migrating pelicans with my friend Sunday morning.

Unlike any incisions Dr. R. makes on my forehead, these two incisions were covered with bandages so I didn't need to worry about clothes rubbing on them or dirt blowing in them. I have to wait for the bandages to come off on their own, and am not supposed to be doing any exercise or movement that may stretch the incisions. The biopsy reports came back that the ones on my chest were basal cells, but the small one on my shoulder was just a mole. That surprised me, as I have many moles and none of them look like that one did. But I would rather err on the side of caution at this point.

Silver Games pickleball

In light of the exercise restrictions, it was a good thing that I scheduled my surgery for after the Silver Games in Washington, MO. I played in my first pickleball tournament on September 14th, playing ladies doubles with my friend Audrey and mixed doubles with my friend Leon. In both cases we only won one game out of three, but we had a lot of fun despite the disorganization of the tournament. We arrived at the sports center at 12:00, and games were supposed to begin at 12:30. In fact, they did not begin until 1:00, and Leon and I did not finish our last game until 10:00 that night. Frankly, by then we did not really care if we won or loss. But it was still pretty fun to hang out with many of my pickleball friends for the day.

me & Leon

Audrey & me

Mini Facelift for a Cause

March 7

On March 7th, following two weeks of celebrating Jim's big milestone with a cruise and company, I went under the knife to remove the two skin cancers on my head. The plastic surgeon began with the one on my temple as he deemed it the "simpler" of the two. For whatever reason, it takes a lot of local anesthesia to numb anything on me. The shots to deaden the area are no fun, but they beat the alternative. Except that I felt him cutting the first spot. Yelping in pain, he quickly gave me another shot. Yay. The removal went quickly, but the stitching seemed to take forever. Why does it feel as though your skin is being pulled 10 inches away from your face? It doesn't hurt, exactly, but it kind of makes me sick to my stomach.

Moving on to the second one, which was centered on my upper forehead but extending into the hairline, he commented on the amount of nerve endings in that part of your head. "This will be painful," he predicted. I could tell the second cut was larger than the first by the amount of stitches he put in. How does that old song go? "The first cut is the deepest?" Not so, mister songwriter.

Things didn't look or feel too bad when I first got home from the doctor's office. But then the anesthesia began to wear off, and boy howdy! I was allowed to take Extra Strength Tylenol, but not aspirin. And then the cuts began to bleed some. Because they hurt so much, I did not touch them. The post-op instructions say to wash the wounds with soap and water several times a day. No way was I touching them. Needless to say, I did not get too much sleep that night.

March 8

The next day I attempted to wash the wounds despite the pain, and honestly I thought I was going to pass out. I had to lie down between each one. As I mentioned these are my 9th and 10th skin cancers, but I have never had any that hurt me this badly. It may have been a mistake to have both done at the same time as they were competing for the same skin on my forehead, which was stretched super-tight. I think that combined with the swelling added to the discomfort. There was little sleep on night two either.

It took several days before I was no longer taking Tylenol every four hours. The surgeon actually called me on Thursday the 10th to let me know that he had the pathology report. Both of the lesions were basal cell carcinoma, and he had gotten clean margins on them. I was so concerned that he would have to go back in, but this was overall really good news. If you have to get skin cancer, at least basal cell is the least invasive. He asked about the pain level, and I told him it was still pretty bad. He said he wasn't a bit surprised because of all the nerve endings he disturbed.

March 16

I did not even leave the house except for small walks with the dog until Friday, and then only because I needed food. Jim's aunt had died earlier in the week, so he drove up to Iowa to get his dad and sister to take them to the funeral in South Dakota. He wasn't home to help me out, so if I wanted to eat, I had to go to the store. I slapped a bandage over the most offensive looking wound so I wouldn't scare small children, and headed to the grocery store. It was so sweet because the bagger was all concerned about what had happened to me. I suppose I looked like I had been in a car accident or something.

By the end of the weekend I was able to take long walks with the dog again as my face didn't get jarred with every step I took. But it took until the next Saturday before the rest of the dried blood came off and I could use my bangs to cover up the surgical sites.

March 20

At the end of the day, I am grateful that this is only basal cell carcinoma and that I have health insurance and the means to be able to get rid of the cancer. But like Cher says, "If I could turn back time...", I'd erase the time I spent playing outside in the sun as a kid. All these cancer surgeries are a tough way to get a facelift!