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***********  THIS POST CONTAINS SOME GRAPHIC IMAGES  ***********

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In March of 2009, my husband was diagnosed with skin cancer. Basal Cell Carcinoma to be exact. Now as far as skin cancer types go, this is the kind to get. It is extremely slow spreading, rarely penetrates the deeper layers of skin, and almost never metastasizes to other organs or bone. That’s not to say it can’t be pretty serious, but generally speaking, if you are gonna get skin cancer, this is the way to go.

For all the years I can remember, and looking at past photos, I’m not exaggerating,   Hubby has had this white line on his nose. It looked as if someone had stabbed him with their fingernail and left a white half moon on the end of his nose. His nose has always been prone to acne breakouts, some of them quite painful, and all of them boilishly ugly. It is something he has been self-conscious of for as long as I can remember and something he always had said he wanted to get checked out.

Then when he went for his physical, his doctor told him to get a mole he has on his collarbone checked out. There was nothing said about his face. The mole was something he has always had. I’ve known him for fourteen years and he has always had that same mole. He was not really worried by what his doctor said, but decided to follow the advice and while we was there he could have his troublesome nose looked at.

The day of Hubby’s appointment with his dermatologist, his nose breaks out. “Great,” he says, “Of course, the day of my appointment I would get a zit over the area I want the dermatologist to look at.” I tell him to go anyway, the zits are part of his problem. So he goes and is reassured that the mole is simply a mole. His nose, on the other hand, gives the PA pause. She wants to know if he has had a severe sunburn on his nose recently. The answer is no. We are sticklers for sunblock in this household.  She goes and gets the dermatologist. He personally says that a biopsy is needed and that a biopsy should be taken of both the zit and the white ridge (which is barely visible on this day).

As the PA sets about numbing his nose to perform the biopsy, she tells him that she would not have considered testing the white ridge because it doesn’t look cancerous to her, but the zit looked like a cancer flare-up and is what had raised red flags for her. The Doc seemed to be of the same opinion except that he felt the ridge odd enough to biopsy at the same time.

So, Hubby comes home with a couple of divets removed from his nose and pain lancing through his head after the localized anesthetic wore off. He is mildly freaked and paces around more than usual. The Doc’s office calls him the next day to schedule an appointment to talk about his results and he goes in.

The results are positive for basal cell carcinoma. The zit and the ridge tested positive. The recommended course of treatment is a procedure called MOHS surgery. Basically, the Doc draws a circle around where he thinks the cancer extends and then eyeballs the cut trying to remove as much of the cancer in one go as possible. Hubby has had this ridge on his nose for YEARS so the Doc is a bit concerned that the damage could possibly extend all the way through the dermal layers to the cartiledge (but most likely not metastasized) and possibly extensively across his face under the epidermal layer. These are things the Doc can’t tell until he begins cutting. So. He tries to cut away as much of the cancer in the first pass as possible, then he divides the area into quadrants and does a biopsy on each.

This is the pressure bandage Hubby went home with after the proceedure.

Hubby sits in a waiting room with pressure bandages on his face (yes, this is all done with him awake using only localized anesthesia) for about 45 minutes while the labs are run. Then the doc will know where the cancer remains, Hubby is numbed-up again, and Doc cuts where the tests were positive. Rinse and repeat until the biopsies are clear.

The procedure took 6 hours in total for Hubby. I have never seen him more traumatized. He apparently burns through the localized anesthesia very quickly and had to be injected in his face 30 times every time he needed re-numbing. So that after the first couple of times having to be re-numbed mid-proceedure, he just sucked it up and dealt with the pain. He was in a very bad mood by the end of the day.

They sent him home with a giant pressure bandage to keep this gaping wound on his face from oozing all over the place until they were ready to do the grafting procedure. He spent that time staying as doped as possible, sleeping and trying to hold down his food and meds since the drugs and the pain were making him nauseous.

 

He was like this for weeks.

The grafting procedure was one of many options that had been discussed with Hubby when he was told the results of the initial biopsy. This procedure involved drawing an inverse template of the surgical site on Hubby’s nose onto his forhead, cutting that template out while leaving one of the major vessels that feed into his scalp intact (thus insuring the graft says alive and viable as it heals), laying the cutout over the surgical site and then flipping it over so the correct side faces out, sewing the graft on, protecting the exposed vessel with a stiff, yet wet type of tape, and pull the edges of the now damaged part of his forehead as closed as possible.

With the graft connected like this, it still had working nerve endings. Hubby could feel his forehead on his nose. With the highest point being at the tip and the lowest point being up on his bridge. He says the most painful thing was where they stretched his scalp out to make that hole as small as possible. They pulled all of the extra skin and then some toward the front and middle of his head to try and cover that place on his forehead. You can see in this photo how shiny the stretched skin is. His eyes were almost swollen shut for more than a week and he had bruising all around his eyes.

Eventually, the Doc deemed the graft connected sufficiently and severed the vessel and then tucked and sewed the leftover ends. After this, there are surprisingly few things that can be done for the look of his nose.

Right before he started the laser therapy.

All of it requires local anesthesia, pulling up the graft, scraping the graft and reseating the graft with various degrees of complexity involved. I think he’s decided that with some laser help in healing to reduce the scarring faster (which he’s been doing once a month since late July) he can just deal with any imperfections. After all, they won’t be able to give him his nose back, and even if they could, insurance wouldn’t cover it.

What I took away from this:

  1. If you have something on your body that just doesn’t seem right, GET IT CHECKED OUT! This could have been so much worse, but it could also have been much less invasive, much less traumatic.
  2. Localized Anesthesia is crap in this procedure. The Doc knew it was going to be very intense. The could have at least given him an amnesiac like my dentist does when I ask and required that he have a reliable person there to help care for him (namely me since I was there the whole time).
  3. There is nothing like having people around you who love you no matter what when this kind of thing is happening. I love this face whether it has all of it’s parts or not, and thankfully, it does.
  4. Kids are remarkably understanding. We were really worried about how this would effect our kids, most especially Chi. We told them that Daddy had an ouchie on his face that the doctor had to do some work on. This is not how it will be always. They wanted to look and ask questions and then it wasn’t a thing. They didn’t stare at him or poke him and badger him with constant questions. Even kids that didn’t live here looked, asked, and moved on.

Much better, I think. Taken Wed, 19 Jan, 2011

I would like to thank him for allowing me to air this very personal experience here in this forum.

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