advice on skin cancer

[bogey21]

I guess that's why they told him to plan on being there all morning.

Last time I had this done it took all morning. I had to sit around for a couple of hours after having a couple of cancerous growths dug out. The reason was that they wanted to do a lab analysis of the tissue on the margins to make sure they got all the cancer before sending me home...

George

 

[geekette]

@VacationForever

HOLY ... !!! ### ?#%)()*#)

I'd forgotten more than recalled from your whack journey. There are no words, only hypoallergenic hugs in quantity.

 

[GetawaysRus]

Is a dermatology practice ( he does seem to have been doing cancer surgery for a long time) the way to go or is there another specialty to get involved.

Mohs surgery is a subspecialty of dermatology. So yes, you want a dermatologist if you are to have Mohs technique. The advantage of Mohs surgery is that the complete excision rate is very high. They keep going until they've got it all. Skin cancers are often larger than they appear.

For small skin cancers, usually the dermatologist will perform the closure. Other specialties sometimes are involved depending on the location of the skin cancer and if a more extensive reconstruction is needed.

 

[BJRSanDiego]

Well today has not been a good day. I was just diagnosed with 2 spots of skin cancer. One is a basal cell carcinoma which is the best kind to have. The other is a squamish cell carcinoma.

When a dermatologist looks at something suspicious, they cannot say with certainty that it is cancerous. But the are saying that it is very likely the it IS cancerous. So, it must be removed.

So, the dermatologist removes the suspicious material (perhaps by freezing it, by cutting it out, by burning it out, etc.). Then they take samples from the "margin" - - the area just outside of the suspicious area - - and send it in for testing. If it comes back negative or clear, that means that they got all of the suspicious material. No cancer remaining. If it comes back positive, that means that they did NOT get all of the cancer. So, they'll have to go back in again.

Personally, I wouldn't worry too much. Especially if the spots are fairly small.

If the spots are quite large, they will do Mohs surgery. That means that they remove material until they find that the margins are free from cancer. They do this to minimize the size of the scar. I suppose that if the area they are working on isn't on your face and doesn't show very much, that they probably wouldn't use this technique.

Have your GP recommend a doctor who you can trust. Then go in and get the spots removed. I've been there, and done that.

 

[tompalm]

Well first, don’t be scared, these are minor skin cancers - the one to be scared of is melanoma. I’ve had basal and squamous removed.

I go to dermatologist every 6 months and have pre-cancerous AK burned off with liquid nitrogen spray can.

I’ve had 7 Mohs procedures from 3 different doctors, I met a woman at one that had over 100. We all sit around the waiting room between layers and compare notes, its no big deal, every Mohs surgeon I’ve used has the same “assembly line” technique. Its the most efficient for their practice, can’t expect the surgeon to sit around holding your hand while the lab tech examines the tissue samples.

What you want is one that is good stitching it up. I have sensitive skin that develops cheloids, lumps on scars. I have one on my neck that raised up, I never went back to that doctor. I like the dermatologist I have now in Newport Beach, a young woman who’s main practice is cosmetic procedures. Her sister performs the Mohs surgeries one day a week, she commutes from LA.

Follow their recommended procedures for wound care and you should be fine.


Sent from my iPad using Tapatalk Pro

Same here for me. I had my first look over 35 years ago with lots of molds that were cut off and six of them were basal or Squamish. Since then I went to see a dermatologist every six months and had more spots cut off over the years and only a few of those were basal cell. My two brothers and sister that are younger than me had melanoma. All of us are doing fine. You have to catch it before it gets bad or grows deep under your skin. No need to worry unless you get melanoma.

 

[bluehende]

When a dermatologist looks at something suspicious, they cannot say with certainty that it is cancerous. But the are saying that it is very likely the it IS cancerous. So, it must be removed.

So, the dermatologist removes the suspicious material (perhaps by freezing it, by cutting it out, by burning it out, etc.). Then they take samples from the "margin" - - the area just outside of the suspicious area - - and send it in for testing. If it comes back negative or clear, that means that they got all of the suspicious material. No cancer remaining. If it comes back positive, that means that they did NOT get all of the cancer. So, they'll have to go back in again.

Personally, I wouldn't worry too much. Especially if the spots are fairly small.

If the spots are quite large, they will do Mohs surgery. That means that they remove material until they find that the margins are free from cancer. They do this to minimize the size of the scar. I suppose that if the area they are working on isn't on your face and doesn't show very much, that they probably wouldn't use this technique.

Have your GP recommend a doctor who you can trust. Then go in and get the spots removed. I've been there, and done that.

The spots were sent out for testing already.

The spots are pretty small in my limited experience. I know the dangers are actually very small. Having said that it still hits like a ton of bricks when you hear the word cancer. Tuggers have been great helping me with info that you worry about having never had any experience with this type of thing. I probably would not have started this thread other than a real life warning not to wait 5 yrs between visits. That one fact is my only real worry.

 

[BJRSanDiego]

I went through the same shock when I heard that I had skin cancer. Perhaps if I share more own experience it may be helpful to you.

About 15 years ago, I went to a dermatologist because I had a small spot on my nose that wouldn't heal. The dermatologist looked at it for perhaps 15 seconds and said "I think you have basil cell skin cancer". My mind began to spin with this sudden reality. Both my mother and my father died of cancer. I had a million thoughts all at once. I asked what was the most effective procedure and when could we schedule it. The doctor said that he could do radiation therapy, proton therapy or chemotherapy but then paused and put his hand on his chin like he was deep in thought. Meanwhile my mind was still spinning. I had cancer. I might need to go through radiation. Is this the beginning of whole new chapter in my life? OMG. After a moment (a theatrical pause) and with a serious look on his face, he asked if I was a movie star. Of course I said "no". He said that if I was a movie star, he wouldn't want to leave me with a scar. Then I asked him what was the most effective procedure to remove the cancer and ensure my highest chance of survival. He said that he would recommend a combination of freezing it and burning it out with an electro knife (or something like that). I told him that seemed like a good choice and asked when he could schedule the surgery. I imagined surgery would be done in an operating room full of people and would happen in the ensuing weeks. He said (with a sly smile on his face) "hell, we can do it right now!" So, about 5 minutes later I had a bandage on my nose, shook the doctor's hand and thanked him and gave my credit card to the office assistant. Bing-bang-boom. On the way home I realized that the doctor had actually "played me" a bit with his dry sense of humor. It put a slight smile on my face. A week or two later I got the all-clear signal from the biopsy.

I now go to a dermatologist about every 6 to 9 months. She removes any precancerous growths with liquid nitrogen and occasionally surgically removes them and sends in a biopsy sample. I am lucky that I have only had squamous or basil cell carcinoma - - the best kind to get.

So, I had the same shock when told I had cancer. But now I understand more about it, have studied the visual signs to look out for, and don't have the level of anxiety that I had fifteen years ago. Plan on seeing your dermatologist whenever you see anything strange. Have your partner check you over for areas that you cannot see. I hope that your biopsies come back negative (i.e., all cancer removed). Let us know when you get the "all clear".

 

[stmartinfan]

In the dermatology department at my clinic, the dermatologists are the ones who do the skin checks and remove any initial "lumps" they discover. When they discover during the testing for cancer that they didn't get clean edges - meaning there was cancerous tissue at the edges of what they removed, then you return for the Mohs procedure. The surgeon who handles the Mohs is a specialist and not someone you see normally for the routine checks.

It's such a quick procedure that there's not much time for interaction with the surgeon. I can see where someone could feel like it's an assembly line, because of the process. The surgeon starts by removing another small amount of tissue, then you go to a waiting room while the lab tests that tissue to see if the edges are clean. If not, then the surgeon makes yet another cut - and you wait again. And yet again, depending upon the results. So there's a few minutes with the surgeon and then lots of waiting around, but that's the nature of the Mohs procedure. They are trying to take as little as possible to minimize disfigurement, but still get all the cancerous cells. I was lucky and it took only one try but others waiting with me had to more attempts.

In my case, I was automatically scheduled for a visit with a plastic surgeon within a day or so of the Mohs. I had an incision about 1-2 inches wide on my shin, with a fairly deep hole. The Mohs surgeon didn't stitch up the wound, just bandaged it up. Then the plastic surgeon did some fancy work where he cut the adjacent skin into strips and rearranged it to minimize the gauge in my leg. They also recommended using silicone cream to minimize scarring. After a couple of years now, it's still a bit red, but nearly smooth. Depending upon the size of your spot and its location it would be worth asking about whether they involve a plastic surgeon for the reconstruction.

 

[DazedandConfused]

My Skin Cancer Notes

Most common cancer in the US, represents 40% of all cancers, affects 20% of Americans by the age of 70
-> 3.5 million people are diagnosed every year
-> 90% caused by exposure to Sun's UVA/UVB radiation

May initially appear as a bump, nodule, irregular patch
-> Can have changes in size, shape, or coloration of skin lesions
-> Cancer lesions can ulcerate spontaneously or with minimal trauma

Changes in existing moles or nevi -> pain is typically NOT a factor
-> recent increase in size or changes in elevation
-> irregular or jagged edge shape
-> presence of bleeding
-> localized itching

Basal Cell Carcinoma
-> most common, 4.3 million cases (80%)
-> 3,000 deaths/year (1 out of 1,430)

Squamous Cell Carcinoma
-> second most common, 1 million cases (18%)
-> 15,000 deaths/year (1 out of 67)
-> Actinic Keratosis is a pre-cancer (60 million Americans)

Malignant Melanoma
-> half are “in situ” (noninvasive) and that is good news
-> 200,000 cases (2%)
-> 10,000 deaths/year (1 out of 20) - from invasive lesions

Diagnosis is by Biopsy performed in office (punch or shave)

Cure rate is very high (99%) when
-> melanoma is detected in early stages (not reached lymph nodes)
-> it can easily be removed surgically (not metastasized)

 

[bluehende]

My Skin Cancer Notes

Most common cancer in the US, represents 40% of all cancers, affects 20% of Americans by the age of 70
-> 3.5 million people are diagnosed every year
-> 90% caused by exposure to Sun's UVA/UVB radiation

May initially appear as a bump, nodule, irregular patch
-> Can have changes in size, shape, or coloration of skin lesions
-> Cancer lesions can ulcerate spontaneously or with minimal trauma

Changes in existing moles or nevi -> pain is typically NOT a factor
-> recent increase in size or changes in elevation
-> irregular or jagged edge shape
-> presence of bleeding
-> localized itching

Basal Cell Carcinoma
-> most common, 4.3 million cases (80%)
-> 3,000 deaths/year (1 out of 1,430)

Squamous Cell Carcinoma
-> second most common, 1 million cases (18%)
-> 15,000 deaths/year (1 out of 67)
-> Actinic Keratosis is a pre-cancer (60 million Americans)

Malignant Melanoma
-> half are “in situ” (noninvasive) and that is good news
-> 200,000 cases (2%)
-> 10,000 deaths/year (1 out of 20) - from invasive lesions

Diagnosis is by Biopsy performed in office (punch or shave)

Cure rate is very high (99%) when
-> melanoma is detected in early stages (not reached lymph nodes)
-> it can easily be removed surgically (not metastasized)

Very nice concise look at the statistics.

One other I will add is that I saw the death rate if the cancer has moved to the lymph nodes is 23% and if it is has moved to other organs it is 70%. This rate is the same for all three types the difference comes in with the aggressiveness of the type. So I will reiterate......get those checkups to catch it early.

 

[buzglyd]

I’ve had all three. Too many years surfing and water skiing in San Diego.

 

[PamMo]

DH is a dermatologist (recently retired). He's been listening to me read this thread out loud. He's insistent that we all need to pay attention to our bodies. If a mole changes shape, color, itches, bleeds, or seems odd to you, have it checked by a dermatologist. Most skin cancers are slow growing, and are relatively easy to manage/cure. Even my brother, who died from melanoma 20 years ago, might have survived with the treatments available today.

Bluehende, I had my own health scare this year, with a possible diagnosis of ovarian cancer, so I can imagine the emotions and thoughts that are going through your mind. My best wishes go to you for a biopsy report that will come back that all is well! Thank you for bringing up the reminder for us to take care of our health, and not put off those check ups!

 

[isisdave]

So my advice is that if you're fair-skinned and/or of northern European ancestry, don't grow up in California or similar places. My first dermatologist visit was at age 30, and now at 70 I set up regular appointments every four months, and there's always something to be looked at.

I had Mohs on two sites the same day, forehead and scalp about 5 inches apart, back in 2009. They were both kinda big, I was there from 8 to 4, and afterwards the surgeon told me "I sure won't let anyone talk me into a doubleheader again."

I still see him and he's done a couple more. It is a round-robin sort of thing: the first patient's margins are examined while the second's initial excision is done, etc. My surgeon might do 3 or 4, depending on size and difficulty. More than that, and you run the risk of some unforeseen problem delaying a lot of people.

Basal and squamous lesions aren't emergencies, so you have time to consult another if you have more near you. How old are you, by the way, and do you live in a big city or somewhere where resources are not so plentiful?

Regarding doctors' personalities: I don't care if he's an Olympic a**hole if he's great at what he does. However, the communication has to be great, in both directions, and the staff has to make up for the personality disorder.

 

[bluehende]

DH is a dermatologist (recently retired). He's been listening to me read this thread out loud. He's insistent that we all need to pay attention to our bodies. If a mole changes shape, color, itches, bleeds, or seems odd to you, have it checked by a dermatologist. Most skin cancers are slow growing, and are relatively easy to manage/cure. Even my brother, who died from melanoma 20 years ago, might have survived with the treatments available today.

Bluehende, I had my own health scare this year, with a possible diagnosis of ovarian cancer, so I can imagine the emotions and thoughts that are going through your mind. My best wishes go to you for a biopsy report that will come back that all is well! Thank you for bringing up the reminder for us to take care of our health, and not put off those check ups!

Thank you for your kind words. My biopsy's are already done. That was why I know the type. One to add to your list to have checked out is a scab that keeps coming back. That is the spot that is the squamish carcinoma.

 

[bluehende]

So my advice is that if you're fair-skinned and/or of northern European ancestry, don't grow up in California or similar places. My first dermatologist visit was at age 30, and now at 70 I set up regular appointments every four months, and there's always something to be looked at.

I had Mohs on two sites the same day, forehead and scalp about 5 inches apart, back in 2009. They were both kinda big, I was there from 8 to 4, and afterwards the surgeon told me "I sure won't let anyone talk me into a doubleheader again."

I still see him and he's done a couple more. It is a round-robin sort of thing: the first patient's margins are examined while the second's initial excision is done, etc. My surgeon might do 3 or 4, depending on size and difficulty. More than that, and you run the risk of some unforeseen problem delaying a lot of people.

Basal and squamous lesions aren't emergencies, so you have time to consult another if you have more near you. How old are you, by the way, and do you live in a big city or somewhere where resources are not so plentiful?

Regarding doctors' personalities: I don't care if he's an Olympic a**hole if he's great at what he does. However, the communication has to be great, in both directions, and the staff has to make up for the personality disorder.

I am 63 and live in Wilmington DE. A good size city. Communication seems to be the problem with this guy. No review has mentioned any problems with the actual surgery. That would be disqualifying. I have an appointment set up already but will see the the gp tomorrow to see if he has a better recommendation and I can get in fairly quickly. That is the only thing I can not wrap my head around. You need to get these things taken care of before they become bigger problems, but there is no hurry.

 

[Patri]

I guess I will share what just occurred to my cousin, age 54, so that we all realize how serious skin cancer can be. He lived most of his adult life in SE Asia, and had a family there, although they traveled back and forth to the US. He came back here in Sept., not feeling well. It took until Nov. for physicians to get a correct diagnosis. They thought it was a 'bug', and he had lesions on his brain, lungs, gallbladder and lymph nodes. He was hospitalized and going down fast when they finally figured it out. Melanoma. He died a few days later.
I don't know if they found any suspicious spots on him. They were checking at the end, but to me that should have been done in Sept. My aunt and uncle are devastated, and I think this will hasten their decline. They are in their 80s.
This has spurred my siblings and me to plan a cousin reunion this summer. That side of the family there were only 12, now 11.

 

[bluehende]

Quick update


Went to the GP today. He said the Dr would be his choice and is the best. Not sure I completely believe he is the best, but I do have a good relationship with my GP. I am pretty sure if the surgeon was a problem he would tell me. The bottom line is I wills stay in this dermatology practice and try and manage the lack of communication skills.

 

[Sandi Bo]

Thanks for the update. I've been reading along... trying to catch up on all the comments.

And I do think it's good to get squamish taken care of as soon as possible. It can spread to the lymph nodes and is a more serious cancer than basil.

I had what I poo-pooed was a small spot on my face. I postposed my MOH's due to health issues with my mother. My daughter, an MD, was not happy and insisted I get it taken care of pronto. MOH's took a couple hours, as many have stated. But it was because they were checking margins and did have to go back for more. I didn't mind the wait. I ended up being sent to a plastic surgeon to close the wound as it ended up larger than expected. Today you would not know to look at my face that it even happened (lots of wrinkles to hide the scar in ). Pretty amazing work by both the surgeon and the plastic surgeon. I don't consider myself a vain person, but this easily could have been far more disfiguring than things worked out and I am very thankful for that. Besides the cancer needing to be addressed as soon as possible.

Grew up on the ocean and the river, never using sunscreen :-( After my surgery I stayed out of the sun for a year, super careful now. And, yes, annual visits for full body checks.

Best of luck to you bluehende (and wow, everyone here). Let us know how it all goes. Thanks for posting.

 

[bluehende]

Update

This week I had the MOHs surgery on the squamous cell carcinoma. It went well as the Dr had a hard time verifying the spot. The biopsy removed the identifying moles in the area. I think because of this he made a larger incision than needed , but to be honest I think that was the right thing to do. I only had one cycle. The area was about the size of a quarter around and a quarter deep when they were done. The whole process in the chair took about 5 minutes. Every indication is that it was caught very early. There were 16 being done that day, The general consensus was that you are still a virgin unless you have had 6 removed. The next day I had the reconstruction surgery. This was a bit more involved as he had to design a flap to cover the area. I never thought about the fact that if you just pull the skin together you leave ridges. Or as he said I would have a smile on my cheek. So now I have 2 weeks of a big bandage on face hiding the 14 stitches.

As for the Dr he was great. Actually very personable. He did not waste any time in the room. but was certainly willing to answer any question I had. In fact we had a nice conversation in the 40 minutes of the reconstruction. The other patients really liked him too. My concerns were completely unfounded. The only thing I can figure is the people unhappy about his bedside manner may have gone in with an attitude and got one back.

 

[bogey21]

Ignore. I see I posted my sentiments earlier...

George

 

[PamMo]

Glad to hear all went well, bluehende, and you're on the road to full recovery!

 

[Panina]

Update

This week I had the MOHs surgery on the squamous cell carcinoma. It went well as the Dr had a hard time verifying the spot. The biopsy removed the identifying moles in the area. I think because of this he made a larger incision than needed , but to be honest I think that was the right thing to do. I only had one cycle. The area was about the size of a quarter around and a quarter deep when they were done. The whole process in the chair took about 5 minutes. Every indication is that it was caught very early. There were 16 being done that day, The general consensus was that you are still a virgin unless you have had 6 removed. The next day I had the reconstruction surgery. This was a bit more involved as he had to design a flap to cover the area. I never thought about the fact that if you just pull the skin together you leave ridges. Or as he said I would have a smile on my cheek. So now I have 2 weeks of a big bandage on face hiding the 14 stitches.

As for the Dr he was great. Actually very personable. He did not waste any time in the room. but was certainly willing to answer any question I had. In fact we had a nice conversation in the 40 minutes of the reconstruction. The other patients really liked him too. My concerns were completely unfounded. The only thing I can figure is the people unhappy about his bedside manner may have gone in with an attitude and got one back.

Good to hear it was done. Wish you a speedy recovery.

 

[itradehilton]

For me the scariest part was hearing the word cancer. I had Mohs surgery on my lower lip, luckily it was caught early and the first slice got it all. Take care.

 

[bluehende]

For me the scariest part was hearing the word cancer. I had Mohs surgery on my lower lip, luckily it was caught early and the first slice got it all. Take care.

Yes by far the worst day was the day I received the call.

 

[Panina]

Yes by far the worst day was the day I received the call.

Thank You. You sharing your story is so appreciated as it is very important. Checking you skin and catching a problem early save lives.

I go to a dermatologist every year for a body check. Even with one you must keep checking. A week after seeing her a pimple scab that kept bleeding began and did go away 8 weeks later. It ended up not being cancer, but if it was waiting a year for my next appointment would have been too long.

As you have said SUNSCREEN is a must. My doctor insists I put it on my face everyday. Between the smells and irritations and trying almost every brand it was hard but finally found one that I actually like, actually got it at my dermatologists office when she changed affiliations.