I’ve just been diagnosed with a basal cell carcinoma. What’s been your experience with this, especially with regard to the surgery to remove it?
January 2017 I had a BCC on far edge of my cheek on the left side of my face. It was just far enough around that I couldn’t get a good view of it in the mirror, particularly as it was hidden under my beard. But I realized that when I would run my fingers through my beard and scratch a bit this one spot would consistently bleed a few drops.
I mentioned it to my primary care doctor. He referred me to dermatologist. Dermatologist took a brief glance at it and she asked if I had ever had skin cancer before?
Uh… geee doc. No. Maybe better to try breaking the news that it looks like a BCC first and that those are generally no big deal.
She set an appointment to get it removed. Couple weeks later went in on a Sunday morning (doc is a traveling doctor who visits our island on weekends) and had it carved out. Worst part was that I had to shave about a two inch diameter spot out of my beard beforehand.
Removal was not much different than having a mole removed. Doc injected a few drops of anesthetic all around and then covered my face with a drape while she cut. Used a small scalpel blade as well as scissors to cut perhaps a half inch diameter of tissue. And then threw in two or three stitches. She sent the sample off for pathology. She advised she thought she got good margins and that if pathology confirmed that and that it was a bcc then no further treatment would be required.
I set a follow up with my primary care doctor in about two weeks. Nurse cut and pulled out the stitches and doctor read me the path report which confirmed the bcc diagnosis and that margins were cleaned.
As promised no further treatment was needed. Still a good idea for me to do periodic dermatologist checks just in case.
A lot of it can be taken care of with liquid nitrogen, which just causes red spots and scabs which go go away in a week.
Bigger problems require Moh’s surgery which involves cutting away the cancerous cells and requires stitches but it is a minor procedure done with a local anesthetic. It’ not a big deal.
I grew up in Australia running around without a shirt with white Irish skin and is now paying for it.
As said above. IANA medical anything I’ve been dealing as a patient with these for 30 years now and have had many small ones and a few middle-sized ones removed. It’s almost a total non-event.
Small ones may be diagnosed by eye and simply frozen off w/ a dab of liquid nitrogen. Slightly larger ones deserve first a shave biopsy under a local anesthetic. IOW, after a quick jab w a needle of lidocaine, the doc uses a fancy razor blade to peel up a bit of skin smaller than your little finger nail. A Band-Aid covers the wound and you’re done.
After pathology confirms that it’s BCC or even squamous cell carcinoma (SCC) you’ll come back for another office visit. The doc will excise it, plus a margin. So lidocaine an area maybe 2cm around the surface lesion, cut out the lesion plus 1/2cm on a side to a depth of a couple mm, then suture the wound shut. In all it takes about 20 minutes, but much of that is just waiting for the anesthetic to take hold. The actual cut & snip & sew is a minute or two.
The biggest deal, as said above, is Moh’s surgery. Which is used on large or recurring lesions. As with the above, they first biopsy then on a later visit they cut out the suspect area to a depth of a couple mm. Then while you wait they put the removed tissue under the microscope to ensure they got all the cancer. If any edge of the excised part is still cancerous the doc goes back in and digs out some more. Lather rinse repeat until done. It typically takes about 45 minutes per cycle and I’ve sat through as much as 3 cycles.
Of my probably 40 BCCs over the years only 2 have needed Moh’s and one of those was probably an overreaction.
The systemic risk of BCC metastasizing and killing you is negligible. But the smart money is on removal earlier rather than later. The amount of scarring is proportional to the size of the area removed. And given enough time they will grow deeper roots that require Moh’s to dig out. Older people have enough trouble with healing any skin damage. far better to fix a spot 1/2cm on a side and 1mm deep than ignore it until it’s 3 cm on a side and 3mm deep.
SCC is a bit more invasive. It probably won’t kill you, but if ignored long enough may lead to disfiguring removal of large hunks of ear or nose or cheek.
Melanoma AKA malignant melanoma is a whole 'nother kettle of fish. A lesion a couple mm deep is associated with very high 5-year mortality. That is something you want to take zero chances with.
Any given lesion is one of the three types. It’s not the case that a BCC left alone will progress to an SCC or an MM.
You didn’t ask, but there’s also something called “actinic keratosis” AKA “pre-cancerous change” These may develop into overt skin cancer if left alone long enough. So my docs are fairly proactive about freezing these off promptly when discovered.
The more lesion-free you keep the skin the greater the odds of spotting something dangerous before it gets out of hand. Though eventually you do end up with lots of little excision marks on susceptible areas. Still, those are far less cosmetically gross than is untreated cancer spreading across your face or hands or shoulders. Besides, at our ages, whatever beauty we may still have is definitely on the inside, not the outside. 
My doc didn’t use the term Moh’s Surgery, but that sounds like what I got. Had it twice, once on the cheek, just in front of the ear, and once on the shoulder. Outpatient surgery, in a clinic, local anesthetic, ordinary bandages, drove myself home.
(Might ask for extra bandaging: mine leaked and I got blood stains on my shirt.)
Many years ago my PCP told me that I should always bring any odd moles or spots on my skin to his attention. And checkup after checkup, when I would point something out to him, he’d wave his hand and say “Pfft, that’s nothing to worry about.”
So, one year I had this spot on my upper right cheek just under my eye (right about the edge of the eye socket) about the size of a grain of rice. I had been picking at it for a few weeks, thinking it was just one of those hardened little gobs of dirt and oil, like a blackhead. Knowing that I had my annual checkup coming up, my wife told me I should have the doctor look at it. Yeah, whatever.
I pointed it out to the doctor during my checkup, expecting another “Pfft, that’s nothing to worry about”, but he said “I’m going to have to do a biopsy of that.” And it turned out to be basal cell carcinoma. So yay, all those years of asking about weird spots finally panned out!
He sent me to a plastic surgeon to have it removed. He said in most cases he could do it himself but he was worried about it being that close to the eye. He made a referral, I made an appointment, and had it removed a couple of weeks later. Everything turned out great, no scars or anything, and it has not come back. Yet…
Had one on the bridge of my nose. It had been there a long time before it was dealt with and required surgical removal with stitches. The wound fell apart and I looked like Frankenstein’s monster for a few weeks - hardly any scar now. I was told that you can get a skin treatment that is somewhat painful and inconvenient, but will prevent more from coming up. If I ever get a second I’ll look into it.
My husband had it on the side of his neck, from the ear down to the neckbone. He had Moh’s, which they cut some, bandaged him, told him to come back in 30 minutes to see if that was all that needed to be cut. Then they cut some more, same thing. The second time, he went to Starbucks during his “break.” Unbeknownst to him, the bandage was leaking. He found out that when you are bleeding, people tell you, “Oh, no, please, go on ahead of me.”
It left a horrible scar.
So when I got the same, on my nose, I went directly to a doctor who specialized in reconstruction surgery. If they did to my nose what they did to my husband’s neck, I would end up with a nose like Michael Jackson’s. Fortunately mine wasn’t as bad and they just sprayed it with the cold stuff. No scar. I had another one in my hair. Also sprayed out. I can’t see that one so I don’t know if it left a scar or not, but anyway there’s hair growing there.
In both cases we have been told to watch for more of it.
I also have a bunch of nasty looking things that, to me, are indistinguishable from what I had on my nose. I have been told they are not cancerous or pre-cancerous (therefore their removal is not covered by insurance:mad:) I do get them checked every once in awhile since I can’t tell the difference.
Thanks, all. I’m scheduled for surgery in October, and scheduled for cataract surgery two days later. I’m thinking I should reschedule the cataract (I’m worried the ophthalmologist might accidentally disturb the carcinoma site).
I had one on my face, a little under the right-hand corner of my mouth. My doctor snipped it out and gave me a few stitches. He also gave me a scrip for codeine, which I reacted violently to that night - I discovered that codeine caused a valve in my pancreas to spasm and I had abdominal pain so horrific that I went to the ER, thinking that I was having a heart attack. Vomiting that night did not do the fresh scar any good.
The doc should have told me to try to keep my mouth as still as possible for a week or two. The stitches couldn’t keep the wound closed, and it opened up and the scar healed quite badly and is unsightly to this day. If I had known, I would have lived on shakes and soft pudding for two weeks while the wound healed. I should have gone to a good plastic surgeon for the surgery, but my insurance at the time limited my choices.
Ref the codeine.
FWIW, over my many BCC excisions, most of which included a few stitches I’ve never needed anything stronger than 2 acetaminophen every however many hours the package says. For 24-36 hours tops.
Not that I’m some big tough guy, but these are really minor wounds unless you’re having a multi-square-inch patch removed. In which case you’re probably getting a skin graft, overnight hospital stay, and all the rest.
I also had BCC removed from under my eye–right in the crease under the eye. Took 4 rounds of MOH’s surgery on one day, which got pretty tedious. Ended up with quite a long incision. Had a pretty horrific black eye for a week. The only lingering effect is when I get tired or my allergies flare up my eyelid gets droopy. Definitely bring someone with you to drive you home if it’s near your eye! I’m an idiot and didn’t, and that was a bummer of a drive.
Small one on the nose. The doc I was referred to did the freeze thing and so far so good. He wants to see me every 6 months for a few years and so far I haven’t missed one yet and everything is fine. But I’m taking it seriously and staying on top of checking what I can and having my wife check areas on the neck and ears I can’t see well.