I’ve written before about my experiences with Mohs micrographic surgery for skin cancer but since skin cancer is such a common occurence among senior citizens my report may be of help to other old folks. (Yesterday, in the waiting room, there were three old men, one with a bandage on his nose, another on his forehead,and the third on his right arm.) I had had a biopsy of a lesion on my right cheek several weeks ago and it came back with a diagnosis of squamous cell carcinoma. I was told to bring someone with me to drive me home after the surgery since the pressure bandages under my right eye would be likely to obscure my vision. They were right about that!

The doctor first drew a circle about the spot where the biopsy was done, as well as a line indicating the direction for the final sutures.  The nurse injected me with anesthetic, draped my head with a hole to allow the procedure, and turned on a bright light overhead.  Doc then came in and proceded to remove tissue, quite painlessly.  Nurse applied great big pressure bandage and sent me the waiting room to await microscopic exam on the removed tissue.  By this time, my coffee in the waiting room had cooled down and was very welcome.   I had brought food with me but had no appetite for it.

About an hour later I was called back it with the happy information that the edges were clear of cancer and I could be sewn up.  Back to the drape and the lights and more anesthetic and Doc proceded to stitch me up.  All I could feel was a little tugging.  It seemed there were lots of stitches and the final suture line was measured  at 3.5 cm.  More pressure bandages, good-bye, go home, come back in a week for suture removal.

At home I was to strictly limit activites for 24 hours.  Apply an ice pack for 20 minutes each hour for the rest of the day.    “If surgery is performed on head, face, or neck, AVOID STOOPING OR BENDING, AVOID STRAINING WITH BOWEL, MOVEMENTS, SLEEP WITH AN EXTRA PILLOW TO ELEVATE YOUR HEAD.”  I could take Tylenol if needed for pain.  No Ibuprofen, Aleve, Advil, Excedrin or any products containing aspirin.   I did not feel my discomfort needed medication.

After 24 hours remove pressure bandage, wash with gentle soap and water, apply Vaseline and a bandage.  ONLY IF a bloody crust develops over the wound site, add one tablespoon of hydrogen peroxide to a cup of water and clease the would with this solution.  My surgical site really looked quite messy and bloody, as if blood had oozed from each stitch. and  I was afraid to wash it, fearing it might bleed.  But I did, and it didn’t, and I proceeded with the peroxide solution which helped the appearance considerably.  On with Vaseline and a bandage, and that is where I am right now.

I can finally wear my glasses and see what I’m doing on the computer.  For the time being, I am content with my progress and, God willing, stitches will be out in a week.  Thanks for listening and may your Mohs go as well.

One week ago I had Mohs skin surgery for a small skin thickening below my left eye which had been diagnosed as squamous cell carcinoma. The first night after the surgery I had swelling and throbbing and pain (treated with one acetominophen tablet) and 24 hours after the surgery I removed the pressure bandage. Each day thereafter for a week the wound was gently washed twice a day, covered with Vaseline, and bandage re-applied. Though tender to touch there was no pain but it was annoying to look down my nose and see that bandage sitting there and it was close enough to my eye to make using my eyeglasses awkward.

I returned to the office seven days later for removal of the stitches. Stitch removal was done by a nurse and hardly hurt at all. The doctor checked the wound which she described as a little puffy, which should go away, but good overall. I can now do away with the bandage but am supposed to apply Vaseline for another week. An appointment was made for the end of January, 2012, for Mohs skin micrographic surgery on my second lesion on the left side of my nose.

I will try to post a picture, with a little help from my friend.  Behold – this is 10 days after surgery, in natural daylight, no make-up.    The wound is under my left eye (which is the right side of the photo).

The suspected melanoma under one of my toenails (which was what brought me to the dermatologist in the first place) seems to be growing out, which means it is just a hematoma and quite benign. We will keep it under surveillance.

I plan to post the bill for this minor surgical adventure. Won’t that be interesting?

January, 2012 – The Medicare assessment has arrived.  I had only Medicare, no supplemental insurance.

Recently I wrote about having had two skin lesions on my face biopsied with the resultant diagnosis of squamous cell carcinoma. It turns out that I am fortunate that my Dermatology office has a specialist in Mohs surgery on their staff; I’m told that otherwise I would have to go to Yale — which is not at all handy.

When I went for my consultation I learned that there was a special waiting room for the Mohs patients complete with refreshments, water, coffee, — and I’m hoping there is a refrigerator, too, as we were advised to expect to stay there quite a while and to bring food. The one man in the waiting room had a huge bandage on his nose and was complaining about having been there for five hours already!

Mohs surgery is time consuming because the doctor whittles away at the lesion until they find no more cancer. This requires that each little bit of tissue removed be frozen, sectioned, stained, and studied microscopically until the edges are clear of cancer cells.

I was given four full pages of information telling me what to expect, what to do and not do, wound care, what pain medications not to take (some promote bleeding) and so forth. Upon re-reading I learned for the first time that most lesions require the removal of three layers!

All this is scheduled for Pearl Harbor Day – December 7 – please arrive by 7:45 AM!

I would appreciate your prayers  for me and my doctor. You are invited to start now.

IT IS NOW  DECEMBER 8 and my Mohs surgery was yesterday.  As you can see, I am functioning but my glasses sit tentatively on my nose above the surgical site which is bandaged just under my left eye.    I had been told some one should drive me to the office for the surgery as I’d be leaving with a big pressure bandage and might not be able to see around it.   Daughter Terry was kind enough to take me and we arrived about 7:30 AM, the first ones there.  The office soon filled up with various older persons with noticeable bandages on forehead, nose, cheek, etc.  There was a Keurig coffee machine and an assortment of muffins ready for us.  And a TV.  We also brought our own food because we had been told we could be there a long time and would get hungry.

After Doctor Eickhorst  decided she would work on only one of my two skin cancers during this visit,  the area was injected with an anesthetic which rendered the whole procedure totally painless.  My face was draped, the doctor masked and gloved, bright light shone from above, and doctor removed some tissue.   The nurses applied thick pressure bandages and I was sent back to the waiting room.    There was lively conversation with the other patients, all of whom were quite friendly.  We all were, after all, in the same boat.

After enough time had passed for my tissue specimen to be sectioned, stained, and studied microscopically (the surgeon is also a pathologist) I was called back and told that they needed to remove more tissue, as 80% of the edges of the first specimen were clear but all the cancer had not been removed.   Back to the chair, more anesthesia, more draping and lights and surgery, more pressure bandage, more waiting for the verdict.    This time I was told I could go home  but first came the stitching of the face wound  which took quite awhile.  When I asked how many stitches I had I was told I had a running stitch and not separate stitches.   I haven’t mentioned that photos were taken during this whole procedure for the record.   Another pressure bandage was applied,  and post surgical instructions given.   The bandage had to stay on for at least 24 hours at which point it could be removed, the site washed twice a day and Vaseline applied.  The surgical site should be covered and not be be allowed to grow a hard scab.   Any thing stressful that might cause bleeding was a no-no, including bending, stooping, straining at bowel movement, etc., as well as instructions on how to cope with bleeding and who to call if necessary.  Sleep with head elevated.  Tylenol was recommend for pain.

The first afternoon there was considerable face ache and throbbing and headache for which I took one Tylenol.  Applying a cold compress had been recommended but really wasn’t practical with the hugeness of the bandage.  That night I slept reasonably well all  propped up and did not need further pain medication.   The next day I started to gently pry away the adhesive strips and loosen  the bandage which was off by noon.

Here I am, rather bedraggled, somewhat swollen and bruised, with a wound about 1-1/2 inches long. But feeling pretty good. I had not been in the Mohs department of this Dermatology office before and on the whole not only found them to be competent but kind. An appointment is scheduled for December 14 for removal of stitches. God willing, I’ll be perky by then.