Forehead flap for infiltrative BCC on nose

Hi Lizch and a very warm welcome to the online community and to the skin cancer group in particular.

I'm glad to read that everything has gone well for you and want to thank you for taking the time to put it all down in writing and for volunteering to try and answer any questions.

Unfortunately, or fortunately depending on your point of view, because a BCC is usually easily removed and most people don't have any problems posters seem to leave the group quickly so it can be difficult to find someone who can respond to others' queries.

When you have a minute, it would be really useful if you could pop something about your journey so far into your profile as it really helps others when answering or looking for someone with a similar diagnosis. It also means that you don't have to keep repeating yourself. To do this click on your username and then select 'Profile'. You can amend it at any time and if you're not sure what to write you can take a look at mine by clicking on my username.

x

Hi Lizch. 

Thank you so much for posting you experience of BCC diagnosis and MOHS surgery.  I do hope you are continuing to make a good recovery?

Your experience seems very similar to mine - (I too had a BCC on my nose - on my left nasal alar-  removed by MOHS surgery).  I also  was weepy before the surgery.  Similarly, pain has not really proved a problem - I was anticipating being in considerable pain but was relieved to find that I wasn't.  However, again like you intense itching has been troublesome - a weird feeling an itch when the site of surgery and skin flap is numb!  I'm told though that itching is a good sign and means that it is healing as it should  and also feel that it is possibly a sign that the nerve endings are starting to regenerate - both positive signs.

Once again thank you for sharing your experience.

HI Lulu_67

Lovely to hear from you and find someone else going through this at the same time.  

I took benadryl when the itching became too much.  I think it helped - at least the drowsiness helped me get through the night!  I'm hoping that the numbness is easing off a little. If I touch the end of my nose it feels rubbery to my finger but on my face, I feel it at the donor site on my forehead which is a very strange sensation.

At the moment, the flap and my nose is covered up with dressings and so I haven't yet had to face the scars.  I think you are ahead of me on that.  The tube of skin from my forehead connecting my eyebrow to the tip of my nose will be separated later this week.

Take care - hopefully it will get better each day

Hi Lizch,

Thank you very much for giving this description of your experience. How are you now? I hope you feel you have continued to improve, and the trauma of your operation is starting to fade at least a little.

I had MOHS surgery for infiltrative BCC, which resulted in my nose tip being removed (28mm x 2.2mm deep) down to the cartilage. I had gone privately to avoid the wait on the NHS, and chosen to go ahead even though no plastic surgeon was available. Because of the size of the 'hole' the dermatologist puzzled but found no way to do a skin flap (he did not feel qualified to attempt a forehead flap, and thought if he did a skin graft that would be most straight forward and easiest to correct later, if necessary). The result is not too bad, but not great, either. I have a clear patch of different skin (from my clavicle) on the tip of my nose.

We are now two years on, and I have an actinic keratosis at 12 o'clock on the edge of the graft. I am talking with Dermatology about whether to use Efudix or have cryotherapy, and in the context of that I asked for a referral to plastic surgery to have the conversation about whether the result can be improved on. If they do go ahead with a forehead flap, it would take care of the actinic keratosis as well. I have been advised to use Efudix for that, with cryotherapy as a second option. I lean towards the cryotherapy for fear of introducing toxins into my system (I know it's topical, but it does seem to get absorbed to an extent, and people have systemic side-effects), but I know that will most likely leave further scarring ... 

Reading your account I wanted to ask - how do you feel about the result of your operation now? I know it's still very early days and it takes a year or more to get a sense of the final effect, but hopefully you are already looking a lot better than you will have done to start with. 

Knowing what you know now, would you ever consider going through a forehead flap as elective surgery (i.e. to improve a cosmetic outcome) as opposed to as an essential part of the operation to remove a BCC? 

With warmest wishes, 

Ilona

That is such a hard question Ilona.  I think it all depends on how unhappy you are with your current outcome.  

Mine is good so far, particularly from a front profile, but I am also conscious of the circle of different skin on the end of my nose.  It’s slightly raised and rubbery - will no doubt settle some more - but I will probably need a revision.  I have a tender two way forehead scar above my eyebrow and my forehead and scalp are still numb.  The scalp gets particularly itchy at night.  For all these things, as you say, it’s early days.  

Facial surgery is a huge step though, especially when elective.  You’ve been through it the once with the graft so that takes some of the fear factor away, but I think you have to be quite unhappy with your appearance to contemplate it. 

I think you are definitely on the right track talking to a plastic surgeon about options for your situation.  

I hadn’t heard about systemic effects of Efudix.  I used it on my nose for 6 weeks when my BCC was initially diagnosed as AK and it temporarily healed well

Wishing you all the best x

Dear Lizch,

Thanks very much for your thoughts. I'm glad you are satisfied with the result of your procedure (and it will continue to improve!), but also struck by what you say, that the new skin on the tip of your nose still looks different from the rest of your nose, even though you had a forehead flap done. I thought that was what was avoided by the procedure, because they are using skin from your face. It's helpful to know that it doesn't (completely - your result may well still be better than mine!) solve that problem. 

I suspect the raised effect will diminish over time. I had that, and it went completely. I was told they do it that way to avoid there eventually being a 'sunken' area, which apparently is harder to do anything about. In my case the rubbery feeling has remained, though I have a degree of sensation back in it. 

I suspect (and even more having read your reply, so again - thank you!) that I will have the discussion, but decide to live with my nose as it is. Then the remaining decision is whether to go for Efudex or cryotherapy ... 

I wish you the very best with your own recovery and healing. 

Ilona x

Hi, My na

Hi

I was wondering if there was something that you wanted to ask as your message is only partially complete?

x