This was so helpful and I got a whole 3/4 hour with my Consultant.
He looked at my eye through the special apparatus. What do they call that thin tall thing they look through with a light? Said he couldn't see any signs of anything concerning after the biopsy. The missing eyelashes mark the spot. He wrote quite a lot of notes.
Reassured me that the operation won't increase my eye pressure, which I noted the optician had found was borderline high.
I also asked him to check my face for any other signs of skin cancer. The most, to me, innocent slightest looking lump/spot was the one that caught his attention, because it turns out that when examined under the special 'microscope' thingy it's got a scab on it. He said he thought it was worth doing a biopsy and offered to do this at the same time as my other surgery 
. What a boon!
Because my original lesion is on my eyelid, I was referred directly to an opthamologist (eye doctor) and so haven't been checked out by a dermatologist in the usual way. (I'm off to see my GP at the end of the week. I asked her if she'd consider a referral to a dermatologist and she offered to take a look herself.) The great thing is that my consultant is going to biopsy this 'new' one so soon while I'm having surgery anyway. Hopefully if it needs any further removal, he can do that at the same time as my second operation on my eyelid. If he hadn't offered to do the biopsy, presumably it would have meant my GP referring me to a dermatologist, then having an appointment for the biopsy maybe a few months down the line or maybe if it looks urgent within a fortnight. Imagine having two lesions being operated on within the same week under different doctors and at different appointments?! Also I'm really not bothered by the thought of surgery on this other lesion as it's not near any structure like lip, nose and eyes. It's just in a flat part of my cheek.
I learnt a lot from the consultant and my kind, kind friend came with me. She sat further back in the room, behind me and took notes. I had armed her with a comprehensive list of questions that I wanted to ask the consultant. This meant that I didn't feel the need to refer to mine, as I knew she was looking through them to check that they were all being covered by the conversation. At the end she raised some points that hadn't yet been covered. It was so kind having that input and meant that I could give my undivided attention to my discussion with the consultant. it was also helpful to have this friend there in support who is so adept with people, to help make sure that a good rapport was maintained even if I brought something awkward up or something in an awkward way. The consultant himself couldn't have been nicer, or easier to talk to.
I asked him about MOHS surgery early on in the conversation. As expected that wasn't going to be available to me on the NHS and the outline of when it's used was much the same as listed on NHS Choices. I could have it privately. it's always done by a dermatologist. However given that I'd already got the dates for surgery with him so soon, it would be very likely to delay things. If I had MOHS, I could still have the eyelid reconstruction with him. I am low risk but if my BCC isn't dealt with it could become much more difficult to treat, e.g. if it got behind my eye. There could be some squamous cells in my eyelid. Some lesions have some basal cell carcinomas (BCC) and some squamous cells as well. He's treating it as a BCC. Only parts of the biopsy sample are examined so that's why they don't know if there are any Squamous cells as well.
He showed me my histology report (i.e. biopsy results from lab.) which put me as a low risk. I had low spread and low growth or something like that I think. I wish I'd remembered to ask for a copy.
He explained the surgery that he is planning. During the first operation he is planning to only remove tissue from the anterior of my eyelid i.e. the part facing the front away from the eye. He told me that the lower eyelid divides neatly into two sections. Operating on the front (anterior) section won't affect the functioning of my eyelid or it's shape, although I might lose three more eye lashes. I joked that I am not into 'fake' eyelashes and said that is something I can live with.
If the results don't come back from the lab clear, he'll have to operate on the section nearest the eye which carries the fibrous tissue. I'll be offered the choice between 'surgery' as in cutting it out tissue or 'frozen sections'. This means removing a section at a time and looking at it down the microscope. Practically all patients choose frozen sections and I will too, as it means removing less tissue I think. It would mean spending all afternoon undergoing this process and getting my eyelid reconstructed. It is a huge relief that my eyelid will get reconstructed the same day even if the lab results aren't clear . I was really concerned that I might have to go back a third time and spend the intervening fortnight with an unclosed wound and unreconstructed eyelid.
Also he said if the results are not clear from the lab, I will get a phone call before the day of the second op. asking me to come in first thing that morning. I think from a previous conversation that will mean 8am. I'll be able to go away after that and come back in the afternoon.
I told him that I had had some aching in the corner of my eye prior to the biopsy but little since. He is going to check out my tear duct - I don't know how or in which operation. If he has to operate on it, he might have to make an alternative channel for my tears to drain through. My eye might be watery but there are things he could do about that. He confirmed that whether I went down the MOHS route or not this wouldn't make any difference to any outcome re my tear duct.
I can see that for the first operation which sounds unlikely to leave a permanent scar and won't damage the functioning or shape of my eyelid, I don't feel the need for MOHS. From my perspective when it might be useful would be if more tissue has to be removed i.e. from the fibrous functional part of my eyelid on the day of the second operation. But the operation on this won't be removing tissue blind to go off and be tested at the lab with results coming back days later. It'll be frozen sections. I want to read up about this technique. It would, at this juncture, be too late and difficult re dates and co-ordination to arrange for MOHS surgery I think. Or at least to arrange it without a considerable gap between it and the restructure of my eyelid.
I said, "I won't need sedation will I?" He said it's hard to predict how people are going to react in advance. It won't be available for the first operation anyway but I might want to opt for it for the second. He said sedation is a really pleasant feeling. I replied, "That would mean being with a responsible adult for the following 24 hours wouldn't it?" and explained that I don't really want to have someone with me like that, and that I can't necessarily ensure that anyway. He said that as I'd come through 2 biopsies okay, I probably wouldn't need sedation. I think I'll see how the first surgery goes.
He explained that although it's terribly unlikely to happen and very rare, there is the possibility of a bleed into the eye after the operation. This is fixable but has to be done quickly or there is a risk of going blind. I had already read about this and I think I'd been warned about this post my biopsies. It has given me pause for thought though. I live over an hour's drive away from the hospital. I won't have anyone to hand who I can wake up in the middle of the night and expect them to drive me back to the hospital. There is one taxi company that has a taxi operating at night but that could be already busy. I wouldn't want to have to count on an ambulance being able to arrive quickly in such a spread out rural area. The alternative is to stay overnight in the town where the hospital is and I think that this sounds like the best option. Something like a Premier Inn or Travel Lodge where I know the sheets will be clean and the hygiene will be good. it'd be lovely to be driven straight home to my own home comforts. But, although the risk is very small, the effect would be very bad, from a bleed into the back of the eye, so I think I'm going to look into booking accommodation for both first nights after surgery. I can then travel home the next day by getting a taxi to the station, then a train and getting a kind relative to pick me up from the train. (The Specialist nurse doesn't want me travelling on a bus on my own.) I think I'd better research how long a bleed in the eye can happen after surgery.
In terms of what exercise I can do after the op:- I shouldn't exert myself so that my blood pressure increases. I will be able to clean my house though. ;( - so I haven't got out of housework then!
I will be able to wear my glasses as soon as the eye patch comes off. I'll be able to wear an eye shield at night. Hooray i'll be able to read and drive seeing as i'll be able to wear my glasses . I'm not sure if this will alter if I have to have my tear duct operated on. Hopefully not.
Re my Superbug history, he said it was useful to know about it and he's sure I have good hand hygiene. I explained that I can't use conventional soap because I have an allergy to it. He referred to acohol based hand gels. Luckily I can use these.
"Can I take Echinacea to make sure I don't get a cold before the surgery or during my recovery?" I can as long as it doesn't cause bleeding. I'll check this out with a chemist.
I can take Clarityn (loratidine) for hayfever so as to make sure I don't sneeze.
Going on holiday a bit tight for 27th September. As it's not critical better to cancel it now, unless I wouldn't be out of pocket by cancelling just before departure date. No I won't -in which case leave it
open. Luckily Saga (annual multi-trip travel insurance) have said that as long as all the cancer is removed then they will still cover me at no or very little (£5.20) additional cost . Hooray for Saga!
Re going back to work looking reasonably presentable and not off putting for clients, I should be fine after my stitches come out. The stitches will be very fine.
I'll probably have bruising round my eye for about 10 days after the operation.
If I'm very lucky, I might not even need stitches or an eyelid reconstruction. He won't be able to tell me that until my appointment for surgery on the day of the 2nd op. as he has to have a look at my eyelid. "I won't be at all put out to come and find I don't need surgery after all ."
I can wear dark glasses when the eye patch comes off after my first op. He doesn't want me or my relatives to be put off by the appearance of my eye. When I learnt that the biopsy wasn't going to remove too much of my eyelid, I felt brave enough to google pictures of eyelids just after surgery, then after reconstruction and they didn't look as bad as I had thought they would.
I have been warned that my eyes may not end up looking symmetrical. Personally I have found that I really like symmetry.
it's a relief with my first operation only 10 days away that I'm not going to be spending the time looking for MOHS options.
I hope you've found this helpful.
Fraz
