Yet Another Basal Cell

June 10th was my usual six month checkup with my dermatologist. As usual she found several spots that are precancerous that she zapped with liquid nitrogen. Unfortunately she also found a spot on my left shoulder that she felt warranted a biopsy. Even worse, she told me that she is leaving the dermatology practice where I have been going since my move to Charlotte nearly seven years ago. She will still be practicing in Charlotte, but her new location is further away for me, and also does not have a Moh's specialist on its staff. With my history, I am guaranteed to need that again in the future. So I'll have to decide if I want to leave with her or not. My current practice will not have any female dermatologists at the location I go to once Dr. Seminar leaves. So that might influence my decision as well.

To no one's surprise, my biopsy came back positive for a basal cell carcinoma. I wanted Dr. Seminara to do the ED&C I knew would be required, so I quickly called to see if I could get in before her last day. For the first time, my call was handled by AI. The voice was so good it sounded like a human. It was only when the AI butchered saying Dr. Seminara's name that I realized it was not a real person on the phone. The AI said I couldn't see Seminara since she was leaving soon, and then told me I was being transferred to the Moh's surgery desk to schedule surgery. Fortunately I know enough with my history to understand I did not require Moh's, only an ED&C. But what if I didn't know that? Anyway, I insisted on talking to a real person, and I was able to get my appointment with Dr. Seminar, albeit at a different location than I normally go.

The ED&C went well, and I have now healed from the procedure. I just need to decide which direction I want to go so that I can get a six month appointment scheduled.

basal cell

Biopsy Results

basal cell

The dermatology office called yesterday with my biopsy results. To no one's surprise, both of them came back positive for basal cell carcinoma. My dermatologist is quite accurate in determining which of my spots requires a biopsy. She only missed once, resulting in a biopsy that was negative. I'd rather her err on the side of caution rather than overlook something bad.

With the latest two biopsies, I have now had 22 basal and/or squamous cell carcinomas. Ugh! For the one on my arm, she can do an ED&C as she has for the last four basal cells. However, the spot on my left temple is too large for that procedure. The two options I was given for removal are Mohs surgery and radiation therapy. This is the first time I have been offered radiation. It is not done in the office closest to me, which makes this option inconvenient. It would require me to come in three times a week for seven weeks. Wow! I just don't see making that work with my schedule. I told the gal on the phone that I would opt for the Mohs procedure. Unfortunately the doctor who did my previous Mohs is no longer with the practice, so I'm not sure who will do the surgery. I will ask that of the scheduler when she calls me back to set my appointments.

More Biopsies

more skin cancer

Last week I had my six month checkup with my dermatologist, and as expected needed a couple more biopsies. At my last visit she was going to biopsy the spot at my left temple, but because I was going somewhere tropical where I would be snorkeling, she said I could wait until this visit for the procedure to be done. I also had another spot on the back of my right arm that I wanted her to look at as well. It is very near the location of my last basal cell removal.

She did both of the biopsies, and also used liquid nitrogen on a few spots both on my face and my right neck. At this visit, she brought up the option of using blue light therapy on my face in the future. Apparently at the office they apply a photosensitizing agent to your face, and then you wait an hour before placing your face in a light box. Supposedly the blue light only has an effect on sun damaged areas of the face, such as precancerous cells. The reaction is like a sunburn, and you must stay totally out of the sun for a couple of days. Healing can take 1-2 weeks, and my doctor suggested a series of three sessions spaced at a month or so apart. 

This is definitely something I will need to think about. First of all, I need to see if my insurance will cover the procedure. I suspect with my skin cancer history they will likely approve the procedure, especially if it will prevent some future skin cancer removals. But also, when would be a good time to start this process? We have a lot of activities coming up, so this may be something I put off until 2026.

Another thing that I have going on is a lump on the palm of my right hand. I have had it for quite a while, and believed that it was just a callous from my pickleball paddle. But it has been changing, and now has some lines coming off the top of the lump. So I asked the dermatologist to take a look as I wanted to make sure it was not a tumor. She immediately said, "You need to see a hand surgeon." I know I looked at her in surprise, and she added that I have trigger finger. She gave me a referral for a hand surgeon.

Dupuytren Contracture?

Monday I will call for an appointment, but I have shown my palm to multiple nurses in my community. They all said the same thing - that's Dupuytren Contracture. In looking at photos of this condition online, I have to think that my ladies are correct. We'll see what the expert has to say about it. Hopefully this will not require surgery.

In the meantime I have to wait on my biopsy results. It has taken as long as two weeks for this lab work to come back. My dermatologist has been very accurate in predicting which things on my skin are cancerous. I have no doubt she was correct on these two as well.

Skin Cancer Number 20

skin cancer biopsy

Tuesday was my six month checkup with the dermatologist. Since I have had so many skin cancers, she has me come in every six months for a full body review. There was a pre-cancerous spot on my left arm that she zapped with liquid nitrogen, but also a spot on my right arm near the shoulder that she was concerned about. It looked suspiciously like the squamous cell she removed from my left arm last March. She removed a small piece for biopsy.

Surprisingly I received the path report this morning. That came back fast! It was indeed cancer, only this time an early basal cell. The doctor cannot fit me in until March 5th for removal of it. Because it is so small and a basal cell, she will again do an ED&C procedure to take it off and I won't require Moh's surgery. This makes skin cancer number 20, of which 4 were squamous cell and 16 basal cell. Early detection is the key here, but holy moly that is a lot of skin cancer!

What's Up, Doc?

biopsy

Yesterday was my regular six-month checkup with the dermatologist. She froze one spot on my right cheek that has been continually peeling. Unfortunately, she also saw a spot on my right shoulder that she felt should be biopsied. That wouldn't have been too bad except it is right where my bra strap sits. I am highly sensitive to any adhesives, and I've yet to find any bandage that does not make my skin break out in an itchy rash. While the wound doesn't necessitate a bandage, the fact that I have to keep it smeared with vaseline and its location make it impossible not to keep it covered for a few days.

But I was most interested in hearing what the doctor thought about my lip situation. I showed her a photograph from when it looked its worst, and she does not think it is due to cold sores. She believes it is severe lip damage. I don't know what caused it to react so extreme as I wear a big-brimmed hat if I am going to be outside, as well as Z-Block on my lips. 

She wanted to use the liquid nitrogen on my lip, which she said would hurt and look bad for about a week. As we have company coming today, I did not have her do it. She said just schedule it when it's convenient for me. When would that be? When is it convenient to have your lip look awful for a week, and have issues eating and drinking??? In the meantime she called in a prescription for an ointment that should at least make the lip feel better until I can get that done.

Our community brought in a gal from the Carolina Raptor Center yesterday afternoon to talk about their organization as well as raptors we might see in our area. She was great and very enthusiastic about her job. What I wasn't expecting is that she would bring three birds with her. She also had talons, a small skull and bird wings to show us. It was a wonderful presentation, and well worth missing our normal Wednesday pickleball session.

Carolina Raptor Center

Squeamish over Squamous

squamous cell carcinoma

My biopsy report came back Wednesday, and as expected the spot on my arm was positive for cancer. This time it is another squamous cell. Of my 19 skin cancer diagnoses, 4 have been squamous cell and the rest have been basal cell.

Dr. Seminara offered me two choices for taking care of this spot. The first is to do an ED&C like she did to the two basal cells on my neck in April of last year. That was no fun since the cells are just scraped off and no stitches are given. They took quite a while to heal, and as I am allergic to the adhesive in bandages that made dealing with open wounds problematic. The second choice is to do a deep burn on the spot with liquid nitrogen followed by a topical skin cancer cream. The success rate is in the 96th percentile with the first option and in the 84th percentile with the second. 

On one other occasion I was prescribed a topical cancer cream to use on my forehead. Let alone making my forehead swell so much I could barely see, it burned a lot and made me sicker than a dog. I thought I had the flu until my husband pointed out that I was sick on each day I used the cream, but started feeling better on the off days of usage. Based on that experience, I am opting to go with the ED&C again. I am waiting on the dermatology scheduling department to call me and set the appointment.

In the meantime, I'm just going to enjoy watching the sun from the shade of my back porch.

Mountain Island Lake

When a Negative is a Positive

Christmas blessings

The biopsy report from my colonoscopy was finally posted in my online medical chart folder. The results on both of the polyps removed were negative, which is fantastic news and an even greater reason to be thankful this Christmas. This is a great representation of when a negative becomes a positive.

Speaking of Christmas, both our children and their families will be with us this holiday. We are really looking forward to having a little one around again. We are in the process of baby proofing the house as Baby W is now mobile. Hopefully she won't pull the tree down on top of herself! We are debating moving it to the second floor to be out of reach, but will probably wait and see if it becomes an issue once they get here.

I have our Christmas cards addressed and ready to go in the mail. Nearly all the presents are purchased, and the ones that have arrived are all wrapped. I'm feeling pretty good about where I stand in the process right now. I need to figure out the daily menus and get a start on the grocery purchases. I'll wait on any baking until we get closer to when the kids will arrive. Until then we have a lot of upcoming fun activities coming up over the next couple of weeks. Ho, ho, ho...

Skin Scan

Tuesday was my annual skin check with my dermatologist. It had been three years since any skin cancer was detected, and I had graduated to only having to come in once a year. Well, my lucky streak has probably come to an end. There were a couple of spots in my hair that I wanted the doctor to take a look at, and she decided that both of them needed to be biopsied. As they gave me the shots to numb the area, I kept feeling it when they would stick me to see if it was numb. After three shots in each location, the technician had the doctor come in to give it a try. I still felt her stick as well.

As it ends up, people who have red hair or highlights (that's me with the red highlights and my mom was a redhead) need more lidocaine when having procedures done. This certainly has always been true for me. The doctor said there is a world-wide shortage of lidocaine right now, and it's been hard to get their hands on the higher dosage shots. She went from room to room in the clinic until she located one for me. And sure enough, the extra dosage worked like a charm and she was able to snip the samples she needed.

Now I just have to wait to see what the lab results say. That may take up to two weeks. With my history, I'm fairly certain that it will not be good news. But at least this time the scars will be hidden by my hair. Red highlights and all.

Boob Redo

Yesterday morning I had the repeat right breast core biopsy done. This time I went to the Siteman Cancer Center at Washington University. What a class act, all the way around! The staff, particularly in the treatment room, were exceptional friendly and kind. I had asked the radiologist to show me the film that was taken three weeks ago at the other hospital, and she pointed out the marker that had been left in. She then showed me where the architectural distortion is located, and that marker was nowhere near the distortion. I could see why that had all the radiologists and the breast surgeon concerned.

Unlike the first biopsy in July in which the radiologist was guided by an ultrasound, this time I laid face down on a table with my breast dropping through a square opening in the table. From there the breast was compressed in a 3D mammography machine while the doctors and technician made sure they were getting the correct spot. It felt like the skin from my neck was getting sucked down into the hole as they tightened the machine.

Then the injections were given to numb the breast, and the probe was inserted like last time. Unlike last time, however, I felt it. Ouch! They quickly administered more medicine, and I only felt pressure after that. In the previous biopsy a ceramic marker was left to mark where the tissue had been removed. The doctor had stayed away from a metal marker due to some allergies that I have with pierced earrings. Yesterday they placed a titanium marker as that is all they ever use, and it has a low rate of reaction. It is what is used in knee and hip replacements, so I guess I might as well find out now if I am going to react to it. They said I'll make the medical journals if it ends up being a problem for me. 🎶I am titanium...🎶

ice pack and cover

Adhesives also bother me, so they decided to try putting a liquid bandage over the small hole made by the probe. It should stay on for five or so days, and so far I am not reacting to it. I'm a little sore today, but keeping ahead of things with Tylenol and the cute ice pack they sent home with me home made a huge difference, I think.

When we left I was told that it would probably be Friday before I got the results of the biopsy back. But late this afternoon the breast surgeon called with the great news that the tissue came back benign! She added that we are officially not worrying about this spot any more, and I don't have to have a mammogram for twelve months. I'll need to follow up with my primary care doctor about that, though, as the other breast is due for a mammogram in June. As Scarlett would say, I'll worry about that tomorrow. Tonight I will sleep much easier.

What a Boob!

On the 8th I had the six month follow-up 3D mammogram as requested by the radiologist after the breast biopsy which was done on July 5th. After the test was done, I met with the radiologist to review the new scan. She is not the one who did my biopsy, but she works in the same breast healthcare center as Dr. H. She looked a little concerned, and proceeded to tell me that she thinks I should have a surgical biopsy done on the same spot that was detected six months ago. The same area (not a lump) that pathology ruled a stromal fibrosis. A fibrosis is not cancer, not even pre-cancerous, nor does it lead to cancer. So why another biopsy?

When I asked her that question, she answered in "what ifs". What if there are bad cells behind the ones that were taken? What if cancerous cells are hiding farther back? Really? The ultrasound-guided needle biopsy couldn't tell them that? When am I ever supposed to breathe a sigh of relief following a negative biopsy report?

She wanted me to go right down the hall and make an appointment with their breast surgeon for a consultation. She then proceeded to tell me how the surgical biopsy would go. I told her I would go home and check my calendar, then call the doctor. What I really meant was that I would take some time to think about it, and then make my decision. She had obviously planted seeds of doubt in my mind, so I knew that I would consult with a breast surgeon. But it would be one of my own choosing, not hers. Several of my friends have had breast cancer, so I talked with them and found they had all seen the same surgeon. After reading up on her and looking at online reviews, I decided she is the one I wanted to take care of me.

Jim and I met with Dr. J. yesterday for the consult. She had reviewed all of my mammograms and had met with the Washington University radiologists regarding them. They concurred that I need an additional biopsy. I asked her if there had been any change from the mammogram taken six months ago to the one taken last week, and she said nothing had changed. So why is everyone all of a sudden concerned?

Dr. J. explained that they were worried about the fact that the marker, which is left in the breast following any biopsy, was not placed in the exact location of the distortion that was seen on the mammogram. That indicates that perhaps the four tissue samples did not come from the actual distortion but instead were nearby tissue. That's when the lightbulb went off for me. No wonder the radiologist on Monday looked worried. But she didn't express her major "what if". What if Dr. H. took the wrong tissue???

Obviously I can choose to roll the dice and do nothing, but that is not how I want to play the game of life. Dr. J. offered two options - 1) have an additional needle biopsy done, this time a 3D mammogram-guided biopsy as opposed to an ultrasound-guided one, or 2) have a surgical biopsy done where more tissue would be removed. Obviously #2 is more invasive, and she said she really doesn't want to cut on me if she doesn't have to do so. She feels that a needle biopsy will be sufficient. And she added that if the results come back negative on this test, we can put this matter to rest.

So, I'm scheduled for the needle biopsy on January 30th. This time I know what to expect, so I'm not looking forward to it. Especially since my breast will be squished in the mammogram machine while they are taking six pieces of tissue out. On the other hand, the recovery time will not be as long, so there is that. Any positive thoughts and prayers you can send my way will be most appreciated!

Breast Biopsy Results

Early this afternoon the home phone rang, and caller ID revealed that it was St. Anthony's calling me. I thought that was odd as I had the mammograms and biopsy done at Missouri Baptist. I picked it up anyway, and it was my primary care doctor's office. She asked if I had been given my pathology results yet, and I said I hadn't heard a word yet. She said they had just gotten them, and that the results were BENIGN!!!! What a huge relief, and a blessing not to have that hanging over me the whole weekend. She asked that I call their office back after I heard from Missouri Baptist regarding what kind of follow-up they were recommending.

About a half hour later, Missouri Baptist called me with the same report. She said the biopsy had come back with the cells being identified as stromal fibrosis. Fibrosis refers to an increase in dense connective breast tissue. It is a very common finding, occuring in up to 7% of suspicious breast lesions examined by biopsy. According to the American Cancer Society, fibrosis does not increase your risk of developing breast cancer later on. More good news.

They do want me to come back in six months for a repeat mammogram and ultrasound of the right breast. When I asked why, since the biopsy came back negative, I was told it was to make sure nothing had changed. I have to admit that I am a little concerned about all the x-ray exposures on this one breast. There were the two views at the routine mammogram, three views at the screening mammogram, and two more views following the biopsy. It is something I will be asking questions about, especially since they established a baseline mammogram after the biopsy was performed.

But setting all that aside for the moment, I am one lucky lady!

Breast Biopsy

flowers from the breast care center

Yesterday morning I left the house at 6:35 a.m. to get to Missouri Baptist Hospital by the 7:00 requested arrival time. My biopsy was scheduled for 7:30, but they needed to check me in and all that. Due to it being a holiday week, traffic was light and I got there at 6:50. More time to wait - yippee...

The front desk gal checked me in shortly after 7:00, and I went back to a room for the nurse to go over my information again, and to repeat what was going to occur. Then I slipped on my beautiful pink ball gown, and waited for the radiologist to come in. We have known each other for many years as our kids went to school together. He is the same doctor who drained a couple of breast cysts, and he has been reading my mammograms through the years. I was grateful that he was scheduled for July 5th, and that he had an opening for my procedure.

Dr. H. stated that he wanted to do another ultrasound himself as he wanted to see exactly what the spot looked like. At that point I think he was still hopeful that it would turn out to be nothing, or that perhaps an MRI would do the trick instead of putting me through a biopsy. I didn't realize that was even a possibility, and it was probably just as well.

Once in the procedure room, the nurse and technician went over my name, date of birth and which breast we were looking at - for the third time that morning. As someone who was once Vice President of Marketing and Risk Management for a medical malpractice insurance company, I appreciated all their efforts to make sure they were a) treating the right patient and b) treating the correct body part on the patient. The doctor then came in and performed the ultrasound, and decided he need to go in after all.

While I was told that the local anesthetic could be likened to what you get in a dental chair, that it not exactly accurate. This one went much deeper into the tissue. I am used to needles and anesthesia due to all my skin cancers, but I'll just say that this smarted more than any of those have. On the plus side, it was not as bad as a cortisone shot, so there is that.

Under the guidance of the ultrasound, Dr. H. guided an instrument through the side of the breast to get to the area of distortion. He warned me that I would feel pressure, but should feel no pain. That was the case. Then he said I would hear a sharp noise, so I shouldn't be startled. I took that to mean, don't move. What he didn't say is that I would hear four sharp noises - one for each of the tissue samples that he removed. The sound reminded me of what the ear piercing gun sounded like.

After the tissue was removed, a ceramic marker was inserted into the breast so that any radiologist who reads my mammograms in the future would know that the area had been biopsied. Normally they would put a metal marker in, but since I have had allergic reaction to different metals in my earrings, they decided to be safe and go with ceramic. Then the nurse kept pressure on the entrance site for ten minutes to minimize bleeding. She said that I hadn't bled much during the procedure. Then she said I needed to go and have more mammograms taken. While they had told me I would have a followup mammogram, I presumed it would be after the biopsy site had healed. Not right after it was done! They assured me that rarely does anyone bleed nor does it dislodge the marker they had put in.

The mammography technician reassured me that she would not be putting as much pressure on the breast as she would do during a normal screening, and said this was just to give everyone a baseline of where the biopsy had been done and where the marker was located. While I was in there, I asked her to explain the difference between the 2D and 3D tests as it seems like they are done by the same machine. She explained that a 2D mammogram was like taking a picture of a lump of bread that had been squished. You might see something, but you don't know exactly where in the loaf to go and look for it. A 3D, on the other hand, offers slices of the loaf of bread, so if something appears they can go and look at that slice. I thought it was an interesting way to describe the difference. I had asked Dr. H. if he thought a 2D mammogram would have picked up the architectural distortion. He said, "No way." At any rate, the technician was correct. The squishing in two directions wasn't bad, and did not hurt.

The entrance wound was dressed with steri-strips and then topped with a gauze pad covered in tape. My instructions were to leave the dressing on for 24 hours, with no shower until it came off. They sent me home with two small ice packs to place inside my bra over the wound, 20 minutes on and 20 minutes off to minimize swelling and bruising. The nurse told me to take it easy and load up on Netflix for the rest of the day. Sort of lends a whole new meaning to the phrase "watching the boob tube", doesn't it?

ice pack

dressing

I slept pretty well last night, and removed the bandage this morning. There is a small bruise but no swelling, and not even a drop of blood on the dressing. I continued to use the ice packs off and on today as well since they seemed to help. I took it pretty easy, and should be back to most activities tomorrow.

They said two to three days to receive the results from pathology, and they will call me once they get them. I'm hoping since my test was so early in the morning, that Friday I will hear something. Otherwise, it will be a long weekend. I'm trying to stay off of Doc Google and relying on Doc H. instead.

A Dog's Life

Kirby

In October we found another lump on Kirby's belly, very near the site of the original tumor. We kept a close eye on it, and it began to change so on November 14th I took him back in to the vet. He performed a needle biopsy on the lump, and to no one's surprise it tested positive for mast cell cancer. This is very dismaying as it has only been three months since the last tumors were removed. The vet said that he can remove it, and in fact it would be a little easier than the last one as it is over a bit from his private parts. But he said we have to face the reality that it can and will come back. How many surgeries do we want to put him through? How many surgeries do we want to put ourselves through, not to mention the expense? This type of cancer is incurable, and I honestly don't think the chemotherapy would have made a difference so I am glad we didn't put him through that.

After some discussion, we decided to try putting him on prednisone in addition to the Benadryl and Pepcid AC that he currently takes. The hope is that the prednisone will keep the cancer cells from irritating Kirby to the point that he licks the tumor and forces it into ulcerating like it did last time. This drug can make dogs very hungry and thirsty, and some dogs urinate in the house because they can't control their bladders. We started with a dosage of three pills at a time once a day, which would be modified if he ended up peeing all over the place.

Fortunately, he has tolerated the medicine well. He is drinking and eating more, and also pants a lot. That, too, is a known side effect. Unfortunately, the tumor continued to grow a bit. His prescription was going to run out on the 23rd, the day we were leaving for Washington, DC to be with our kids for Thanksgiving. So I called the vet again to see about refilling the prednisone. He said that drug should have caused the tumor to shrink some, and that it is a bad sign that it grew even while he was on the medication. But I feel it is great that the tumor didn't go crazy in a 48 hour time period like the last one did, so he agreed to renew the prescription to get us through the seven days we would be gone.

The dog sitter called us the night of the 23rd, and she felt the tumor had grown more and was very red. She wanted to let me know that she had called the vet, and he had her adjust the timing of the pills, giving him one in the morning and two at dinner, along with an additional Benadryl mid-afternoon. She felt we would want to know. None of us slept well that night. Jim was even looking into flights to head back home on Thanksgiving Day in case Kirby needed to be hospitalized - or worse. But when I called the sitter the next morning, she was pleased with the change as the tumor didn't look nearly as red as before. She kept him on the new regimen while we were gone, and fortunately that worked out okay.

I honestly did not know if I would get to see Kirby again. I thought for sure based on how the last tumor went that it would ulcerate while we were away, and we would be faced with tough decisions from far away. It was a horrible feeling, and cast a damper on our visit with the kids. The five of us had not been together since last Christmas, so it is a shame that we had this hanging over all of us. But in the end it all worked out and we will just take each day as it comes. For now he is eating and sleeping well, and still wants to go on his daily walks. I don't know how much more time he has to be with us, but I intend to enjoy each and every day we get.