My Mohs Surgery Experience for Basal Cell Carcinoma

My Mohs Surgery experience for Basal Cell Carcinoma on my face. This post contains GRAPHIC before and after photos of Mohs Surgery for skin cancer.

When I was diagnosed with skin cancer, I thought it would be a quick in-office laser procedure by my dermatologist. However, my Basal Cell Carcinoma removal was not that simple. The most effective skin cancer treatment for Basal Cell Carcinoma is Mohs Surgery. The benefit of Mohs Surgery is the preservation of your healthy skin while removing all of the skin cancer cells.

The skin cancer on the side of my cheek grew deeply into my face. Thankfully the Basal Cell Carcinoma did not enter any bones or spread over a larger outer surface area. The lesion was the size of a quarter before the surgeon removed all of the cancerous cells. The cancer free area after surgery was three times the size as the original spot.

What happens during Mohs Surgery?

During Mohs Surgery a dermatologic surgeon outlines the lesion with ink to map the tumor. After a local anesthetic is injected, the doctor removes the thinnest possible layer of cancerous tissue. While the patient waits, that layer is processed in an onsite pathology lab. The surgery is very precise and can last for hours.

If skin cancer is still in the layer of skin, the dermatologic surgeon can identify the precise location of the remaining cancerous cells. At that point, the surgeon can take another layer—and the process is repeated until all cancerous tissue has been removed. 

I spoke to a number of people who had Mohs Surgery before my appointment. Everyone’s account of the procedure was sort of the same – “It’s not so bad!” Patients can bring along a book, iPad, or music to listen to – anything to stay busy since surgery may take a long time.

WARNING:
GRAPHIC SKIN CANCER PHOTOS

I was very nervous on the day of my Mohs Surgery for a number of reasons. First, I despise local anesthesia because it makes me feel weird. Second, I was not allowed to bring anyone in the room with me for support. Despite taking my anxiety medicine, I still felt nervous and sick to my stomach. Thankfully the staff at Yale Dermatology is incredibly sweet with wonderful bedside manners.

My Mohs Surgery lasted a little over three and a half hours. The surgeon first outlined the lesion then a nurse administered local anesthesia to the area. We waited 15 minutes for the anesthesia to numb my face, but the nurse had to administer more because I could still feel around my ear. My adrenaline began to surge as I was nervous for another shot and I began to shake. The nurse and surgeon decided I should take a little more anxiety medicine to calm down.

Once the right side of my face felt completely numb, the surgeon came in to begin the Mohs surgery. As he removed layers of my skin, the nurse and surgeon talked to me about my life. When he was done he took my skin tissue to the lab and I listened to music.

WARNING:
GRAPHIC SKIN CANCER PHOTOS

Unfortunately the surgeon had to come back to remove more cancerous tissue. Once the basal cell carcinoma was completely, he assessed how he would close up the area. Due to the location of the skin cancer, I needed a little plastic surgery.

Forty stitches later – twenty on the inside and twenty on the outside – I was ready to be bandaged up. The stitches inside my face would dissolve on their own, but I had to return a week later to have the outer stitches removed.

Post Mohs Surgery Experience

After my parents drove me home from the surgery I promptly climbed into bed. I felt emotionally exhausted and the wound on my face was starting to hurt. The surgeon prescribed me a pain killer to take every six hours for three days. I took a pill and fell asleep for about an hour. When I woke up, I was in excruciating pain. The right side of my face was also temporarily paralyzed from the anesthesia.

Truthfully, I felt horrible over the next few days. The pain killers dulled the searing pain on the side of my head, but never numbed it completely. The medication upset my stomach too. When I was out of pain killers I moved to alternating Motrin and Tylenol. As long as I took something every 3-4 hours I was able to function.

Showering was unpleasant. I was allowed to let water run over the area, but it felt uncomfortable. Thankfully my sister and husband helped clean the stitches and surrounding area. Sleep wasn’t enjoyable either since I prefer to sleep on my stomach on the right side of my face.

One Week after Mohs Surgery

After a week I went back to the surgeon to have the stitches removed. It was a quick procedure and not too painful. I was mostly uncomfortable while she removed the sharp stitches. Once the stitches were removed the surgeon assessed how I was healing. He said the scar looked great, but I would still need 4-6 weeks to heal completely.

The nurse applied steri strips to cover the scar – which fell off two weeks later. Showering and sleep became a bit easier, but the area on my face remained sensitive to touch. I could also feel pain underneath the skin on my face (and still do from time to time).

It’s been six weeks since I had Mohs Surgery to remove skin cancer on my face. In a few days I will see the surgeon for my final post op appointment. The scar feels bumpy and I hope it’s healed well. I will be back with an update soon!

NOTE: There are different treatments for Basal Cell Carcinoma (BCC) based on the stage of the skin cancer. Some treatments include Curettage and Electrodesiccation, Excision, Mohs Surgery, or Radiation. The first two procedures are not as invasive as Mohs Surgery and can be done in office. Mohs surgery is especially useful in treating cancers that are at higher risk for coming back, such as large tumors, tumors where the edges are not well-defined, tumors in certain locations (such as on or near the nose, eyes, ears, forehead, scalp, fingers, and genital area) (source).

Read more about Skin Cancer here.