Tuesday, July 17, 2012


I had Mohs Surgery today.

About two months ago, a little growth appeared under my lip. It almost looked like a wart, and it's not like it was huge or anything, but it was annoying. It was perfectly smooth and perfectly round.


After about a week (it grew to a certain size, then stopped), being a guy, I took fingernail clippers and clipped it off. It came off perfectly, bled a bit, and I congratulated myself on being so clever. Damn, I'm good!

In three days, it grew back.

At this point, I immediately made an appointment to see my dermatologist, because I wasn't going to screw with anything that had multiple lives. I went to see her and she froze it. Ballgame.

It grew back about five days later. A little bigger, this time, and a little ragged as well.

Back to the dermatologist. This time, she cut part of it off to do a biopsy. The results indicated "atypical squamous cells", which often indicates an actinic keratosis, or pre-cancerous lesion.

It could also be skin caner.

At this point, my dermatologist said it would be reasonable to proceed with Mohs Surgery.

Mohs Surgery is, conceptually, pretty cool. What they basically do is take out the lesion, then biopsy the tissue while you sit in the waiting room. They want to find a clean "border" around the tissue without any cancerous cells (in my case, squamous cells). If they find some in the border, they take out more tissue around that area, following the "dirty" border until everything is cleared.

Particularly for the face, this is a great approach, because it takes as little tissue as possible, far less than other techniques. And really, it's just a matter of time before I get an interview in Wired where they take that epic picture of me in profile, looking like a complete asshole as I stare out over wheat fields or something. So I've got to stay on top of my facial game.

So I went in for Mohs surgery about three weeks ago, but the surgeon decided not to do it because we didn't have a definitive diagnosis of a skin cancer. So she cut it out, stitched me up (man, your face hurts like hell when people are cutting on it), and sent off the tissue.

A week later, she called and said it actually WAS squamous cell skin cancer, so we did need to do Mohs.

At this point, I'd had my face frozen once and cut on three times in the last two months. I was really sick of my face hurting. But with no choice, I scheduled the Mohs for the Tuesday after we got back from Detroit (and she had wanted the inflammation to heal before we did it, so the timing worked out fine).

In the meantime, the damn thing started to grow back. Incredible. It did not reach its previous size, though, and didn't change while we were in Detroit.

Today, I went in at 8:15 for the Mohs Surgery. Mohs is a crap shoot in terms of length, because if they only need to take tissue once, it takes about an hour and a half (the tissue removal only takes five minutes--it's the biopsy that takes an hour or so). But it could possibly take 5-6 passes--or more. It could be an eight hour procedure.

Going in, I thought my under/over was probably three. I was hoping three would do it. So mentally, I was prepared for about five hours, although I didn't know how I'd respond to each additional tissue removal--not physically, because pain is pain and has no long-term meaning--but emotionally (a first for me), because the anxiety of the border not being clean multiple times would take an unknown (but probably substantial) toll.

I went into the procedure room and the assistant stuck a needle in my face five times. Then the surgeon (who is almost as awesome as my dermatologist) took the tissue. Then she cauterized the wound to stop the bleeding.

I'm not a big fan of burning flesh, particularly when it's mine. That's a smell you just don't forget.

I went out to the waiting room and waited for the biopsy, which took about an hour. Then she called me back in, I sat down, she gave me a big smile, and said, "You're clear. The borders look great. I went deeper than I usually would because I was hoping I could do it in one pass."

Well, hell yes. Deeper FTW.

They gave me more injections in my face so they could stitch me up, but before they did, I had the assistant take a picture for Eli. It's quite a divot.

There are many capillaries in your face, which is both very bad and very good. The very bad is that man, your face HURTS after something like this. I had hernia surgery a few years ago and took nothing but regular-strength Tylenol after the first twelve hours, but this is much more painful. The very good is that my face hurts because of the excellent blood flow provided by all those capillaries, and because of that, the face tends to heal very, very well and pretty quickly. In a month or so, I'll be just as pretty as I ever was.

Quite a low bar.

Here's the thing about skin stuff: lots of people tend to ignore it. They don't get annual dermatological exams. They don't realize that skin cancer is the most common of all cancers, and what they really don't realize is that skin cancer can kill you.

You know, "kill" as in "dead."

Dan Wendelin, DQ Staff Dermatologist, sent me this information when I asked him if there was anything he'd like to add:
I think the most important thing is for people to do a monthly self-exam to become familiar with their own skin and have a low threshold for seeing a dermatologist for new or growing lesions. The warning signs for melanoma are:
Border irregularity
Color variation (uniform brown or tan usually OK, color variation, particularly black, gray, blue, red mixed into the brown are bad)
Diameter (>6mm, the size of a pencil eraser, should be watched a bit more carefully, but not concerning if stable in size)
Evolution: change is probably the single biggest clue, and is a warning is sign for all skin cancer types, not just melanoma.

In addition, anyone with a personal history of skin cancer of any type, a first-degree family member with malignant melanoma or a history of a blistering sunburn as a child should be seen for full skin examination annually by a dermatologist. Age 15 is the age I advise my melanoma patients to start bringing their kids in for full skin exam.

If I hadn't addressed this promptly, if I had just ignored it for a few months (or longer), then the treatment options would have been much more limited and the situation could have been very, very dangerous. Please do not put yourself into that position.

This applies to a bunch of other shit that you need to take care of as well, like annual physicals or heart tests or colonoscopies. Some it might make you feel uncomfortable, but so what? The more you do it, the less uncomfortable you'll feel.

People love you and depend on you. Don't be stupid.

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