First derm did the biopsy, which came back positive from the pathologist.
Derm who’d done a fellowship in Mohs did the Mohs surgery, but based on the advice of the 1st derm given the location of the lesion, before surgery I scheduled a consult with a plastic surgeon who was in-network.
Insurance pre-approved Mohs and reconstructive surgery.
Mohs was just done with numbing by derm #2, and he left the wound open (but covered!) afterwards.
The next day I went to the outpatient surgical center, and under full anesthesia the plastic surgeon did the wound repair. (He said he didn’t want any of his patients looking at him, talking or making faces during procedures.) This was a hospital-affiliated surgical center, and I had a real anesthesiologist.
There was aftercare, including a silicone patch once the closure had healed. Plastic surgeon wanted the wound to heal from the inside out, so I had to keep the surgical area from scabbing with some kind of ointment.
@zoeydoggie …oh my. How big was what you could see before all of this…a penny? Or was that the size after they cut it out. Thank you and @arabrab for your stories, as they really have helped me understand what I will do if I go down this path. I am so sorry, Zooey, that this happened to you and I wish you much luck in your surgery next week. It’s Upsetting to read, but just know your sharing might help me and others in making the decision to have a plastic surgeon take it after the hole is made.
I have a vacation if a lifetime to go on in 2 weeks, and I made an appt. With a more seasoned plastic surgeon in a month. I’m going to try to put this out if my mind for a few more weeks. I have to be honest, begore I was feeling better, now I’m feeling unnerved…but thank you all.
If it helps I’ve heard that skin cancer is slow growing. For the 1 on my lip I had the confirmation of Basal cell cancer but also had a big trip planned. I scheduled the surgery for right after I returned.
I had a biopsy done before both of my MOHs. Over the years I have had lots of biopsies and lots of stuff just burned off. In some cases I’m not sure why they do one or the other. My insurance usually only approves MOHs if it is on the face. I’ve not heard of anyone having it done without first a biopsy.
Conmama-the spot on my nose was a tiny red spot. My best description of size was the diameter of a pencil lead. There is no way to tell beforehand how much is beneath the surface, or so they told me. It was about a month, from Thanksgiving to Christmas, that I just wondered about it before I called. Make your plans, enjoy your trip, and deal with it when you return. The point of my story was to make sure you have a good plastic surgeon lined up if you need one and don’t believe a dermatologist who claims he’s reconstructed more noses than anyone else in the area.
I had a skin cancer removed from the side of my nose. The dermatologist used a conventional procedure. MOHS was not necessary. The healing period was exceedingly messy, but the scar is minimal.
I had a biopsy beforehand. But then again, I’m always having biopsies because I’m a very light-skinned, freckly, speckly person. If I were a dog, my name would be Spot. I’ve probably had 30 biopsies over the years. Only the one was positive (so far).
I have a friend who had MOHS surgery. He told me that if I ever have the procedure, I should bring a really long book. It takes hours. The procedure consists of (1) Remove a little tissue. (2) Send it to the lab. (3) Get results. (4) Repeat, possibly several times. It’s extremely boring for the patient (and perhaps also for the staff).
@zoeydoggie, what a lot of inconvenience for just a basal cell! You must have used up several years’ worth of patience by now.
@conmama, I had the exact same thing last January - a whitehead-type growth on the bulbous part of my nose that had bled in the past. My regular dermatologist biopsied the growth and it was a basal cell. Since it was on my face I went to a Mohs dermatologist who had a relationship with a plastic surgeon. She did the Mohs (took 4 passes) on Martin Luther King Day and I saw the plastic surgeon the next day. He took a cartilage graft from my ear and a skin graft from my hairline to repair my nose. No one can tell I’ve had the surgery at this point. Without the second step plastic surgery, the left side of my nose would have been flattened. It was frustrating, and all done under local anesthesia, so somewhat uncomfortable, but the results are aesthetically great. PM me if you want more detail…it wasn’t fun, but it’s fine now.
I’ve told my story on CC before, but I’ve had 3 Moh’s on my face. My regular derm sent me to a specialist because she doesn’t do them. He has an extra year of training in Moh’s and another year of plastic surgery.
The first one on the side of my nose was only a pinhead scab that didn’t heal. That took 3 passes and went down to the cartilage. Think pencil-eraser size. It was too big to take a graft from my ear, so he took a flap from my cheek in the smile fold and stretched it to cover the side of my nose. 30 stitches under-layer, 30 more to close. 6 months later he lasered it to smoothe out some of the scar tissue. He would like to sculpt a little more, but it’s fine to me. That was 14 years ago.
The second one was on the vermillion border of my lip. He didn’t even want to do it, but I insisted on a biopsy and it was positive for BCC. Turned out deeper than expected; two passes to get it clean. When the temp is cold outside, the fine scar looks white, similar to a cleft repair. 12 years ago.
The third one was high cheekbone, just under my eye, one pass, 10 stitches, looks the best of the three. Two years ago.
I just had a biopsy on my back, two spots burned off my hand, and a small spot burned off the tip of my nose. As a blue-eyed redhead, I’ll never be done.
Had it done on my nose 23 years ago. Had top derm do the mohs surgery and then had a skilled plastic surgeon do the repair. It was the size of a dime under the skin. Excellent results. Was all covered by insurance.Can only see scar if you are looking for it,
I had a melanoma too. For that one they took 7 mm margins and I still have an enormous scar. For something that was not much bigger than an eraser head.
DH had Mohs surgery on his nose, performed by an experienced plastic surgeon, with excellent results! Our family doctor wholeheartedly recommends never letting a dermatologist remove skin cancer or do any kind of surgery. Says one should always go to a plastic surgeon. Says derms just don’t have enough training. We’ve always used that policy as a guideline!
Ok CC peeps…help me think this through. I saw Plastic Surgeon #2 today. I was referred to 2 plastic surgeons, I’ve known of both. PS #1 didn’t take insurance, but he has employed one of his fellows from 2 years ago. These fellows are handpicked, one a year, to work and learn with this surgeon, who has now employed him. He is 30ish, an ENT who has gone into plastics. (which I like since it’s on my nose) He was young and full of himself. I had done research beforehand and knew about MOHSs surgery…but I let him ttalk.
Surgeon #1 recommendation: Scrap off what is on top of my nose and biopsy. If positive, go to dermatologist who does MOHS, and then come back to surgeon with hole covered (of any size) and let surgeon repair.
From what you all had recommended, this is the way to do it …but I wanted to see someone more experienced and get their feedback.
Surgeon #2 (established, well known, about 65): Take the whole thing out himself and have it biopsied. He said just scraping the surface will not tell. I waited for him to mention MOHS, finally I did. He doesn’t do this and even seemed sort of impatient that I even asking about it, or mentioned the other way (MOHSs derm first, then he take over)
My thinking is that PS #1 is younger and more up on the new way to do these things. He also said we won’t know how big it is until it starts getting extracted. PS #2 said it was little (how would he know?)…I can’t remember who but one of you posters said yours was just a pencil lead size on top, but huge underneatth. Do you think just scraping the top of will give a good biopsy? My gut is telling me to go with #1 even though he is young and not experienced.
I think I’ve made my decision just typing this out. I just wish he had more experience.
That was me. They don’t know how big it is until they do the Moh’s. I only have had one but the biopsy was not just a scrape. It was a chunk out of my nose that took about 3-4 weeks to heal. At the time I wondered if the biopsy had removed all the cancer because it healed when the spot they dug into never did. I say go with Option 1.
Thanks so much. I looked up MOHS and its really the gold standard for this type of surgery for BCC, so that makes me very leery of Surgeon 2. Unfortunately, Ithink in any profession, when you get to a certain age you don’t maybe want to learn new things…I know I can be that way…but not good when you are dealing with someone’s face.
Not sure if I should go with Surgeon 1, since he is so young…or find a MOH’s dermatologist and talk to him/her about plastic surgeons. I’m going to have hundreds in just consult fees!
Conmama- can you locate an “experienced” MOHs surgeon???!!
I took my uncle for nose procedure at upenn, many years ago. It was compacted and advanced problem
I would only want dedicated MOHs professionals to do a nose procedure- after seeing what he went through.
Apparently, there are some derms who get MOHs certified after a very short training- and I would want only someone who specializes and does tons of these.
The Upenn MOHs derm sent him to plastic surgeon for the next step, which was needed.
Google American College of Moh’s’s Surgeons. There is no board certification of Moh’s but there are professional organizations to show someone has had the training. My doctor was the only one in my area on this list and I have no reason to believe he didn’t do a good job with it. Where he failed me was the repair. Find the best Moh’s person you can and then find the best plastic surgeon to be ready if needed.
Thanks Zooey…there are about 5 in my area. I’m not sure the best way to proceed. I was thinking I should find this person first and they could recommend a good surgeon, but I imagine they probably want to do the repair, too, like yours did. so perhaps I need to ask the surgeon who they would use and hopefully they would say one of the Moh specialists. Or…maybe I have to find each on my own. You know…I came to CC to talk about college, and have found in the time I have been here a tremendous amount of help in so many different other ways…life changing help.
We are all so lucky to live in the age of the Internet.