BCC on nose, awaiting MOHS and probably a forehead flap

Hi luckylass

Readinng your account I think you've been treated appallingly and is this by private consultants??

I had a basal cell removed from my nose and was concerned about a forehead flap but I didn't need one.

There are some on this site who have had the forehead flap who I'm sure can reassure you.

My treatment was done via NHS the surgeon was lovely.

I don't know where you're from but I'm in South East UK.

Even though basal cell is treatable these things are still terrifying especially when on the face and involve flaps and your treating Drs really should be reassuring you and treating you kindly.

Please keep in touch and let us know how you get on.

If you type forehead flap you should be able to read the accounts of people who have had it done and hopefully that will help you.

Hi Luckylass  Gosh I am speechless reading your account.  I have had two very nasty basal cell cancers removed from my face last year by a plastic surgeon and I did have them done privately.  I had skin flap on the one at the bottom of my nose top lip area ad the other skin graft which was at the top of nose near my tearduct (that was a nasty one).  I elected not to have MOHS as my surgeon was confident that he could get it all out with normal surgery.  He is the most lovely Consultant I think I have dealt with, so calm, understanding, patient and gets 5 star reviews from all his patients.  Where do you live as he works in Nottingham/Derby area.  My scars at first we dreadful and I was so very upset and tearful, but he kept promising in the fullness of time they will be fine, and they are.  I can see them but friends say they wouldnt know if I had'nt pointed them out.  I will send you a private friend request and if you acccept will let you see some pics of before and after. You should not be treated and spoken to like this.  These bcc's are treated by others as "nothing" but they are far from nothing, they are nasty little beasts that keep appearing and cause us so much stress.  Please keep in touch as Puckettyboo and myself have supported one another through our ordeals and will do the same for you.  Good Luck.

Thank you Puckettyboo and Harlyn.  it’s lovely to get some sympathy.  I do feel a bit hard done by, perhaps with good reason or perhaps because I feel vulnerable and in need of coddling.  I live in the midlands of England and the NHS here has some of the worst waiting times.  I gave up on them and went private for two hip replacements, and it does make me feel some resentment that my husband and my life savings are paying for all these consultants’ lovely lifestyles - I can hardly get our shabby old car in the private hospital carpark for all the enormous BMWs and Mercedes in the reserved spaces!  

Perhaps I should have come here earlier for suggestions about where to go.  But I don’t want to rethink and switch around and cause more delay.  I had my second hip replacement at the same private hospital and I didn’t like that consultant either (my first hip surgeon, near where we used to live, was much nicer) but both new hips are miraculous and bring me the joy of pain free movement every day. So the lack of a kindly bedside manner doesn’t matter, this will be fine too, and I am so lucky that the surgery is available.  A century ago, or in some countries still, I would have been limping in pain while a hole grew in my nose.

I will check out the other accounts as you suggest.  Thank you!

Hi lucklylass  Please let us know how you get on . I had my MOHs consultation yesterday for Basal cell on my nose and all very daunting .. my next appointment is with plastic surgeon  to discuss reconstructive surgery . I did ask about radiotherapy as I understand this could be an option .  There is no definitive answer to the outcome once they begin the Mohs ‘ which is terrifying as I wonder how much will be removed .

Hi suzanna1 , my sympathies that you are in this position.  You are doing the right thing exploring options.  Now that I fully understand what my surgery involved, I sometimes wonder if I rushed to surgery too quickly and there might have been an alternative.  Obviously I don’t spend much time thinking about that because too late now.  But having said that, I don’t think that you should be too afraid of MOHS surgery.  Yes you won’t know the amount of repair needed until after.  But with MOHS, (as I understand it and believe in what I have read and been told, not an expert at all) , you can be sure with 99% probability that they have got all the cancer and it won’t come back on that site, and that they have taken away the absolute minimum of good skin.  So the size of the repair depends on the size that the BCC is, and that has already happened.  

Where on your nose is the bcc?  How far from the eye (and therefore tear ducts) and nostril rim?  If it happens to be well away from either of these I think the repair will be easier.  But the right plastic surgeon will sort out a great result whatever the size and location, it will just be a bit more complicated getting there.

My recovery had its miserable times, as I have posted on here, but things are shaping up well now, 9 weeks after the MOHS.  Good luck and stay in touch.  I will send you a friend request so that we can communicate privately if you prefer.

Thanks LuckyLass 

my Bcc is on the nasal alar and has been there years and stupidly didn’t think it was anything to worry about .  It is nodular and started bleeding around Christmas time and decided to get it looked at … so worried that I will look like a freak and that my grandchildren will be scared … I have a new job to start in June and don’t think I can start as I will need too much time off .  The reason for considering radiotherapy , but I don’t think it offers a total cure … All very mind blowing x

Extra sympathy, that the new job adds to your worries, at least I was retired.  You may have caught yours earlier than I did, because I stupidly ignored the bleeding for over a year before I did anything.  Also I had two types in the same area, one nodular and one infiltrating.  I believe infiltrating is worse, and presumably why mine had got as far as the nasal rim.  So fingers crossed for you that you might need only a cheek flap which I would hope would be less of an issue than the forehead flap.

I will try to give you a timeline so you can plan about your job, if you have any flexibility.  Basing it on my experience I think would be the worst case scenario, a forehead flap.  And it depends what your job involves.  But even if you have a desk job without contact with the public, remember to take account of any commuting involved.

My timeline was MOHs surgery on 21 February, first stage reconstruction (create flap) on 23 February, stitches out during this period after 1 week and 2 weeks,  second stage (separate flap) 4 weeks later on 23 March, stitches out a week later.  Now a month on, 9 weeks from the MOHs surgery I feel pretty comfortable about my appearance and feel physically and mentally recovered, to the point that I could do my old job (teaching).   I could probably have struggled back to work at the 6 week point.  And I could have done part time working from home at a desk job earlier.   

The first stage, living with the flap, is the hardest from the aspect of getting about in public.  Because of the appearance, and also the feeling of physical vulnerability, that there is an area of your face which needs protection from bumps etc.   A person with a tougher mental attitude than me might find it not much of a problem at all.  But there are some non psychological issues, such as the flap making it difficult to wear glasses and probably illegal to drive.  Plus the body does need rest to recover from surgery.

From memory, Lizch had a 5 week gap between stages, compared to my 4 which is standard with my surgeon.  I believe 3 is possible.  Lizch sent me a photo of her flap and although it looked odd (I hope she won’t mind me saying) it wasn’t as gruesome as mine.  So different surgeons do it differently and it would be worth getting as good an idea as possible of what to expect when you meet the consultant, both best case and worst case.   I found my flap impossible to conceal in any way and it had a blackened bloodstained dressing on for the whole 4 weeks, so it was very visible.  But this is only a worst case scenario. A lady who had MOHs surgery the same day as me, on a BCc in the nasal crease like mine, coincidentally, only needed a cheek flap and when I saw her 4 weeks later heading for her separation surgery I couldn’t even see it at first, and that was knowing where to look.  The important thing to remember is that it is only temporary.  You might want to avoid seeing the grandkids during the few weeks that it looks bad.  Or prepare them and let them take an interest.  It is quite a fascinating procedure in its way, and some kids would take it in their stride.  What they will see is just a healing process like a scab on a grazed knee.  And once healed, it is going to be barely visible.

Sending hugs

• Hi Suzzan1 Sorry to read about your bcc.  Last year I had 2 bcc's removed from my face by plastic surgery.  I opted not to have MOH's as my plastic surgeon was confident that he could take it all away with normal surgery, which he did.  My first one was done with a skin flap and it was on my face right against the botton bulging bit of my nose.  He cut down my facial line to do the flap from and cut right up to my nostril, scar now is barely visible. The second one was right at the top of my nose near my tear duct.  I had this one removed with a skin graft from the side of my face. I had 50 stitches in this and the healing was slightly worse for this with it being so close to my eye, but again scar barely visible now.  If you dont mind me asking where do you live.  Radiotherapy was mentioned by dermatologist but plastic surgeon said no I was too young (73). If you want to make me a friend on here I could send you before and after pictures which may help you.  Try not to worry, this site was my lifeline always someone to chat to you about their experience.  It is daunting at first but you do get over it in time, although very scared now when the sun shines.  Good Luck.  

Hi Suzanne 1

I had a BCC removed from my nose last year. It had been there I think about three years. This is because it was diagnosed as being nothing to begin with.

It was a nodular BCC and was removed and left to heal by itself  ( secondary intention )

By six weeks it had closed in and there's a barely visible scar now. 

It's a very scary process but you'll find a lot of support on this forum and please feel free to ask us anything.

We've either been there or in the process like yourself 

Thanks Harlyn

its lovely to hear each other’s experiences. I am just starting a new job in June and need to get this procedure dealt with , but I need to try and deal with the new job initially . I know I will need time off and I can’t expect a new employer to understand this . 4 years ago i was diagnosed with a tumour on my ovary that nobody could give me a clear diagnosis.. I was referred to the Royal Marsden who before going for surgery told me that they didn’t know how far the operation would go depending on a frozen section half way through . When I woke up in icu . I was told with relief that the tumour was borderline and non invasive … I am under them for 10 years as a chance it could come back … That was a scar on my stomach … this is facial and I like to smile xx