It all started sometime this summer when the skin on the side of my nose bled spontaneously as I was drying off after a shower. I looked – nothing there, just a spot of blood. I figured I scratched myself and didn’t give it much more thought.
Till it happened again a few months later in the exact same spot. Still nothing to see, but on careful palpation, I noticed the skin there felt just a little raised and irregular.
Now, I’m a girl with my Mom’s Irish skin and a baby oil adolescence who has had four basal cells on my back scraped off in the past 5 years. So I knew before I even saw the dermatologist that this was another basal cell.
But this is not just another basal cell. This one’s different.
This is my Nose.
And that means I need Mohs.
What is Mohs?
Mohs surgery is a special procedure designed to remove skin cancer with the least chance of recurrence and the least removal of healthy tissue.
Skin cancer can grow along the planes under the top layer of skin, so the cancer is often larger than it initially appears on the surface. So when the cancer is removed, the dermatologist will want to take a wide margin of healthy-appearing tissue around the edges of the visible lesion to be sure the cancer is all out.
But on the face, there is not the luxury of wide open space for big margins. And so the procedure of choice is Mohs surgery.
Here’s how Mohs works – The dermatologist shaves off what he thinks is all the cancer, then you go into the waiting room and he goes into the lab and looks at the specimen to see if all of it was removed. If the cancer is growing all the way to the edge of any part of the specimen, that means there’s probably some more still back there on your face. So back you go into surgery to have a little more removed – but just in the spots where the margins are positive. Then it’s back to the lab to see if that’s enough, and so one, till the whole lesion and every last bit of cancer is removed. Each subsequent specimen is smaller and smaller, leaving healthy tissue where it is and just going after the “legs” of the cancer, till finally it’s all out and you’ve got the smallest defect to repair that you can possible have.
But now you have a hole in your face, and it’s got to get closed up somehow.
Closing the skin after removal of skin cancer
After a skin cancer is removed, one can leave the defect to fill in itself. This is how the cancers on my back were treated – They were scraped off, then left to fill in on their own, and in a few weeks, I was left with red round scars that fade with time.
On the face, if the lesion is small, you can do the same thing.
But for the cancer on my nose, this method will not work. That’s because this kind of healing is accompanied by contraction of the skin, which in my case would lead to the nostril pulling up and out on one side.
So I need to have a flap, wherein the skin above the defect is rotated downward to cover it.
But it’s my Nose!
Mr TBAM had a similar surgery this past summer for a small cancer on the tip of his nose – a Mohs procedure followed by a flap. Now he has a sort of Raggedy Andy patch there that you don’t notice unless he points it out to you, at which point you can’t not see it, until you forget about it again.
Now that I am having to have the same procedure, all I can do is stare at Mr. TBTAM’s schnoz and worry about my own. I mean, he looks fine for a guy, but I’m sorry, I don’t want that scar on my nose.
So I asked my dermatologist if plastics could do my closure. He said of course, but that in fact he’s done many more of these than they have. His nurse confirmed that he does 90% of his own closures, and that other dermatologists send their difficult ones to him for that very reason. At that point, what I really wanted to say was “If I was Julia Roberts, would you do the closure or call in plastics?” but that seemed rather rude. So instead I just said that he could do the closure.
And then I spent the rest of the week silently freaking out. And staring at Mr TBAM”s nose.
Three days before my procedure, I happened to mention this to a nurse I work with, who was shocked that there was even a dilemma. Why wouldn’t I want plastics? She then regaled me with stories of deformed faces she’d seen on the subway, wondered how those poor people got through the day, and reminded me how in America appearance is everything. I then called a female colleague who I’d seen as a patient several times. “What, are you nuts? Of course, plastics is closing you! This is your nose, for gods sake! You’re seeing the best Mos dermatologist I know, but he’s a dermatologist, for god sakes! Of course he’s going to tell you you’ll look fine – He’s a guy, they don’t even notice when we get our hair cut half the time! End of discussion. Here’s the name of the plastic surgeon who’s going to do your closure…”
I made the call, dropped my name and I was in.
I have no idea if using plastics for the closure is going to make any real difference in how I look after my Mohs procedure. I adore my dermatologist, and he really is the go-to man for this surgery. But suddenly I’m calm. Not because I don’t think I’ll have a scar, but because I know I will have done everything I can to be sure it’s the best scar I can get.
After all, this is my Nose.
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Less than one month ago I was diagnosed with BCC on the side almost tip of my nose. Frankly, I am scared to death of the mohs surgery and the reconstruction after-wards. After being traumatized by one plastics telling me about the cartilage from my ear or nose would be needed (or possibly needed) to repair the “rim” of my nose I went to another surgeon for reassurance. He did not mention anything about cartilage….but said 75% time he did bilobed flaps. The idea of a forehead flap is scaring me, I wake up constantly at night, zero sleep for almost a month. Unfortunately, I am very vain…any scaring I believe will be devastating. I am 58 years “young” and the idea of being scared for the rest of my life is upsetting. I have searched desperately for support groups but have found none. Anyone had a forehead flap and know the amount of scaring involved and how long before you “no-longer” feel like a monster? Also, how long after any of these surgeries can you have the “scars” treated to make them disappear.
Thank You Sooo much for this site.
Jackie, I worked for a Dermatologist for a while and assisted her in MOHS surgeries. I have seen people who basically didn’t have a nose left after the surgery. I’ve watched her perform regular stitches, Flap closures and Grafts. Some of the patients were very scared and concerned about how they would end up looking, but by the time their incisions were healed, it was unbelievable how it barely showed that they ever had surgery. I’m sure the outcome is related to the skill of the doctor, so if I were you, I would ask the doctor if you could see some before and after pictures of work he or she has done. Maybe that will set you mind at ease.
Dear Jackie,
I am 67 young at heart who is scheduled for my fifth Moh surgery in past 20 years. My cancer is on left side by nostril. I fear the same procedure you are talking about. Could you please email me and let me know your experience. Thank you. I live in Oregon.
I am 63 years young, vain and very active, have had,
melanoma, twice, no problem on my leg, several basal cells, even one on the bridge of my nose and a flap done, none of them show, but I am scared out of my mind with this new basal cell lesion on my left nostril,
how long does it take to recuperate from a flap from your forehead to you nose and is it possible to make
your nose look normal again??/
worried about reconstruction surgery after mohs on
my left nostril. will my nose ever look normal??
My nose looks normal. 🙂
Hi I had the same exact surgery , three cuts same place. Same bilobed flap. My sutures looked identical. My eye was swollen shut for several days so your face definetly looks better in the pics. I had this surgery 10 days ago and really enjoyed looking at your pictures. I was told to use vaseline thru the second week. But nothing really after except sunscreen. Or i could continue with the vaseline. I was wondering what brand of silicone you used and where to purchase. And also how long until your nose was virtually back to normal. And when you could apply makeup. I was also wonderin if i could send you a picture of my nose at 10 days and see what you think. Thanks shawn (48 year old female)
Hi Shawn – Welcome to the mohs nose club! I don;t remember the brand of silicone – I just know it was in a lipstick-like tube and had blue writing on the tube. I imagine vaseline works pretty much the same way. Every doc has their routine post op.
I’m not a plastic surgeon or mohs expert, so sending me a pic probably won’t be useful for you. As you can see from pics, my nose looked pretty darned good at 8 weeks –
http://tbtamnosephotos.blogspot.com/
I honestly don’t remember when I started applying makeup but that’s something you should ask your surgeon depending on how you heal.
Good luck to you!
Peggy
Oh no problem I wasnt wanting a professional opinion, I thought you might want to see how it looked when the mohs surgeon did it versus a plastic surgeon lol I did read the silicone post again and you actually had a link to the product. thanks for the well wishes shawn
I have my second MOHS tomorrow. First one was 1/31/12 and actually looks great. It was on side of my nose and was closed with a flap. Then I had a second BCC removed from cheek but not by MOHS. It also looks good; surgery was 3/7/12–so just over two weeks ago. It is still red, but I am confident that it will get better. Tomorrow’s surgery promises to be more involved. The spot is on the side of my nose and will require a skin graft and possibly cartalidge from my ear depending how deep it goes. I am more nervous about it. My dermatologist was reluctant to biopsy this area as it had no pearly bump, but I insisted and convinced him that the tissue had changed around the same time as the first bump came up. I am glad he did the biopsy. This BCC was under the skin and was a flat, hard white area. Now I think I have detected another small spot on the tip of my nose, so that is a bit deflating. I can’t help but wonder when my skin cancer experience may end. Or if! I know that we must remember our cancers are treatable, deal with them, and get back to living our lives. Our value does not reside in the perfection of our noses–or lack thereof. I am a product of the generation that grew up without seatbelts, bike helmets, or sunscreen, and it seems at least one of those freedoms came at a price! Good luck to us all with our proboscis journeys :). God bless!!!
Oops! Those dates are 2013 not 2012!
I have recently been diagnosed with BCC on the left side of my nostril. My dermatologist sent me to a Plastic Surgeon who is a Mohs specialist. He related he will perform my surgery under a general anesthesia and will go in through the facial fold, (smile line) also…he will have to correct the other side so I’m balanced. In reading about these problems…I don’t see any other procedure of this kind. I have just a small, raised bump on the left side of the nostril. Looks simple…So..why such a large procedure? Any answers? Thanks…I’m scared to death!
I have been to two doctors who have two different opinions about how to treat my basal cell cancer on my right nostril. One doctor said that he can’t even see the tumor since he took the biopsy so he wants to wait three months to see if my body can heal itself and then another doctor said that he talked to the pathologists and that I should consider the mohs surgery so that it doesn’t invade the cartilage. Needless to say this difference scares me a great deal. Have you had any surgery yet Mary? Has this difference of opinion happened to anyone else? I live in Virginia.
I had Moh’s surgery in April 2013. The (Basal Cell Cancer) lesion was just above and in the fold on the side of my nose. My procedure was done by a Moh’s-trained dermatologist and I had a local anesthetic. The donor site was a skinny slice in front of my ear. It’s not pleasant, especially walking around with the dressing(s) for a few weeks. My only advice is…1) Don’t wait too long as it can go deeper. 2) Find a flexible fabric bandage that matches your skin tone and take it to your dressing changes if they are done in the office. Make sure the skin under the tape is very clean and dry before applying. Walgreen’s brand (golden tone) sticks well, as does Bandaid brand (pinker tone). Hang in there!!
Hi My name is Wendy aged 55 years (very young). I had a simple pimple like a chicken pox, pearly on the tip of my nose. Really did not think anything of it. I mentioned it to my doc when having brown spot on lip biopsied and she did one too. It came back BCC. I was just amazed as was my family and friends. Had MOHS surgery done 2 weeks ago by a super man Dr. W. Hussain in Leeds. Had 80-90 sutures inside and out of the repair of my nose. Had a skin flap from forehead but not one of those big ones. My black eyes have nearly gone and just have scabs on tip of nose. Using vaseline and go back in 2 weeks for check up. I have every faith in my lovely man, he is so reassuring. I would not be as scared now if have to have more surgeries done having been through it once. Good luck to all who have to encounter this. I am more prone apparently as I am on a drug called azathioprine for Chrone’s Disease, this is an imuno-modulator, thus giving me a low immune system.
Hi Wendy, I’m due to have MOHs surgery on my nose and found your post so reassuring, I’m having my surgery at chapel allerton in Leeds
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MMP
[…] Moh’s Nose Woes […]
Had cancer on tip of my nose taken out Monday morning and plastic surgery that afternoon with a piece of skin in front of my ear used to cover the hole. The side of my head around my ear is still numb, (Thursday), and side of my face by ear is very swollen giving me a slight ear ache. Nose doesn’t hurt since I don’t touch it but threat is uncomfortable.
thanks everyone for sharing ..im 10 days out and it helps to hear other’s stories. my nose is still really sore to touch..especially the bridge of the nose..i’m discouraged because it seemed to look better a few days ago and it is still really red and bumpy:((
Just removed pressure bandage as I’m 2 days out of Mohs surgery on nose. My concern is dr had to pull nostril quite a bit to close the defect. It is noticibly higher than the other. Has anyone had that experience? Will it get better or is there a later fix? I really hope not to live with that.
Thanks so much for posting about this (so helpful to hear from other women). Even though it’s an old post…I thought I’d share my story a bit. I’ve just turned 50 and have been going through hell with a recent recurrence of BCC that seems to be all over my nose/cheek. I had Mohs 7 years ago for an infiltrative BCC on my cheek ..but it seems I’m in the 1% for whom this surgery didn’t quite work. I’ve seen many dermatologists over the years with some anxiety about how to know if the cancer has returned as my scar is kind of lumpy and weird and I knew it would be difficult to detect. Finally this summer I noticed a spot that was definitely BCC near my eye. While having this biopsied I managed to convince my oncology dermatology surgeon (a very reputable one!) to check other areas I was concerned about. He really didn’t think there was anything there to worry about, but did some additional biopsies to simply rule it out and help me with my anxiety. He was very surprised when the biopsies came back positive! I have a strange form of BCC that is very subtle in presentation (missed by 2 other dermatologists completely). Even if one isn’t particularly vain, having BCC on the face is very upsetting! I’m having my Mohs in two weeks and then travel to another city to have reconstruction by a plastic surgeon the next day. The worst part is all the uncertainty….you only know how bad it is once the surgery is underway. I guess my contribution is to underline how important it is to assert yourself when seeing medical professionals – trust your understanding of your body. I’m really hoping to get through this, but I find it quite traumatic. Thanks again for your most interesting blog and to all the women who have commented above.
I am a 67 year old female who had 3/4 of my nose skin removed including between the nostrils down to my lip and nearly up to my left eye. A large section of skin was cut from my brow, along with an attending vein and an artery that was sewn onto my nose area. The vein and artery had to remain in a “trunk” between my eyes for a month while the section of skin from brow adhered with a blood and vein supply from the “trunk”. I live alone and have no family and few friends so it has been rough, so to speak. That was 10 months ago. Quasi Moto was how I described myself. Dumbeldore’s nose was what a “caring friend” told me I looked like. The forhead is still deformed and now I have bangs to cover it up best I can, but the loss of a vein and artery to my head (after they cut off the “trunk” in one month, the rest of the vein etc just shrivels up and dies within your head) has made a section of my hair to curl up and die and fall off. I’m glad I’m not young since this would have been devastating a few years ago. I’m getting used to my new face but it’s upsetting to know I will never look the same again.