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Wilma is a skin cancer specialist nurse, here to answer your questions about different...
Greetings everyone - I am new to the forum and live in the U.S. I've had a small, cyst-like lump on my cheekbone (about an inch below my eye) for about 10 months. It's about 3mm. For about the first 6 months I assumed it was a cyst and didn't worry about it, but finally decided to get it checked out.
I saw a dermatologist yesterday, and she said she was fairly certain it was a BCC, but needed to do a biopsy to be sure. So she did a shave biopsy right there in the office, and I should get my results back by around Tuesday.
I had always heard that BCCs weren't that serious, so I was truly shocked when she told me about the recommended treatment. Due to the location near my eye she highly recommended Mohs surgery. She said depending on the amount removed, I may need to have a plastic surgeon do a reconstruction afterwards.
I was even more shocked after looking at photos of Mohs surgery patients on the Internet with huge holes in their faces! And since this is right on my cheekbone, it is a super-visible place for a scar.
So I have been trying for the last 24 hours to educate myself but not to panic about being possibly permanently disfigured. I also have been kicking myself for waiting so long to get this checked out - even though the visible portion did not seem to change significantly, I understand that (if it is BCC) the tumor could have been growing under the skin all this time.
I don't have a specific questions but would love to hear from those who have had BCC - anything you want to share about your experience and any words of wisdom you have would be most helpful! Happy to hear from others as well.
Hello and welcome,
I've not had one of these procedures but there are many threads here in the forum about Mohs and I can almost guarantee you won't find any scary photos. Please try not to go looking for photos online - you'll almost certainly find the most extreme, the ones that went wrong and the ones that make for good 'clicks'. Most people who don't end up with craters in their face or scary infections or other nasties, probably aren't plastering their pictures all over the internet.
Have a look at some of the MOHS threads and I think the main theme you'll find is people saying how much they were worried about scarring and about how well things have turned out for them.
Hi sophie521 and welcome to Macmillan's online community
I can understand you panicking at the thought of having a BCC but you're right, they are one of the least worrying skin cancers. You've done the right thing in getting it looked at and your dermatologist will be able to advise you of the best form of surgery to have it removed and leave minimal scarring. Here's a link to Macmillan's page on Skin Cancer where you can find information on BCCs and on Mohs surgery. As Barbara has already said, please don't Google for images of BCCs or information generally as you'll see and read the worst case scenarios. It's better to stick with reputable cancer sites like this one or Cancer Research UK for your information.
Hopefully others who have had BCC and are still on this group will come along shortly to tell you about their experiences and help put your mind at rest.
Let us know how you get on x
I had a BCC diagnosed on the side of my nose last year, and it was removed in November. I had Mohs surgery, and a skin graft by a pkastic surgeon. I'm in the UK, so the system is a little different to you but the procedures the same I think.
Don't beat yourself up about not getting it checked out sooner. Like me, I imagine you had never heard of BCC before your diagnosis. I had thought mine was caused by my glasses rubbing my nose, so only went to the doctor 4 months after first noticing it.
BCCs are slow-growing, and Mohs surgery has the best complete removal rate and the aim is to minimise the amount of tissue removed. They do not know how much tissue will be removed until they operate. You may find that the excision can be stitched up, rather than needing a flap or a graft.
You probably will need a little downtime after the op (a week or so) and it doesn't look pretty when they first remove the dressings. But in the early stages the recovery is remarkably quick. And there are things you can do to manage and reduce the scarring -massage and silicone being the main tools.
I'm almost 3 months post-op now, and while my scar is still plainly visible I can see it improving. And there are ways of coping with it - using makeup or flesh-coloured tape (I love 3M!), so that most people don't notice.
I've put some pics on my blog on this site (under my username Ess). And ignore my moaning comments about the NHS!
Thanks for your replies everyone! Ess, I checked out your blog and will follow you as you progress! The photos are super helpful.
My biggest concern is the lesion is in such a highly visible location, right on the top of my cheekbone. And when I asked about scarring the dermatologist was most unhelpful - she said, "Well, it really doesn't matter what the scarring will be like because you have to have the surgery no matter what." Extremely irritating - I didn't say I would refuse to do the surgery if the scarring would be too bad, but I do want to know what I'm in for!
If I do get a positive biopsy result, I am going to do a consult with the Mohs surgeon and plastic surgeon and hopefully I can get some better answers. :-)
Would love to hear from others who have had Mohs as well. Also, I'm wondering if anyone chose to take the radiation route rather than Mohs? That seems to be the only other reasonably viable alternative for a BCC on the face, so I wanted to look into it (though it seems most recommend Mohs).
I’ve had Mohs on my nose, the procedure is all done in one visit and as it’s tested on the day that your margins are clear you won’t have to wait another week before results, Mine was much worse it had to be repaired by maxillofacial dept at hosp. You need the op as it’s best removed as soon as. If scarring is something you are not happy about you might have to have laser treatment at a later date. ( I had to go privately as nhs won’t always do it, but results were excellent).
I can understand your concern I was pretty stressed at the time also
Take care suelynne
I'm at the exact same stage as you. I went to see the consultant yesterday who told me the spot on the bridge of my nose was most probably a BCC and that I would have a biopsy then and there followed by MOHS micro surgery in a few months time (This is the UK where we have waiting lists!) he said it looked like quite a deep one so would leave a hole but not to worry as my nose would be restored afterwards!!.
I had the biopsy and will wait about 6 weeks for the result but as I have already had a BCC on my neck, I imagine this is the same intruder. My mother had skin cancer so I think there is a family tendency.
All the best for your treatment and outcome.
Thanks so much for your reply! I am sorry you are going through this, but at the same time it is very helpful to hear from others in the same boat and feel less alone. I should get my biopsy results in the next week or two so I will let you know what I learn (sounds like we get them much more quickly in the US).
How long had your spot been there before you had it checked out? I have been kicking myself for waiting for 10 months hoping it would go away, but many people have said that this wasn't unusually long. I hope not.
Also please keep us posted on your results!
My spot was noticed when I had the patch on my neck removed so that was last August. I think these things are slow growing. I hope so anyway.
Let us know how you get on please.
I'm also in the U.S., Austin to be exact. Well, your dermatologist could likely use some more training on communicating with patients, but I hope that what she lacks in people -kills she makes up for in her medical skills. It's good you're being a proactive patient and researching this for yourself.
I feel those who are able to have MOHS surgery are quite luckier than I. I had Melanoma right on the tip of my nose (can't get more visible than that). The dermatologists I see here, who I think are super, use wide lateral excision for Melanomas, and only use MOHS for the less invasive cancers. By contrast to a facial BCC, the excised melanoma skin is sent to a lab to ensure they got it all. That takes about a week. Then you have to heal 3 weeks from your last excision to have another excision--have it sent to a lab again to see if it's all been removed. So, I had two wide lateral excisions on my nose, leaving me with a pretty big hole. With MOHS, it's much less invasive. It may be a long day for you, but they'll take a bit, check it immediately while you wait, take a little more, and so on until all the cancerous cells are removed - in other words they'll take the least amount possible. They may even do your graft the same day.
3mm sounds pretty small. They will likely make the excision bigger, but if you are seeing a plastic-surgeron or MOHS trained surgeon, they may make the stitches from the inside. And, the end result will be barely visible. After my first Melanoma excision, it was completely concealed by make up and not visible at all. I suspect you will have a similar experience.
As to all the gorey pics on the internet, they may be extreme cases, OR, they could be taken at the time of surgery. It is amazing how well they can suture a fairly sizeable hole leaving very little of a scar, if at all. It's really remarkable.
Awww, and don't kick yourself. Getting it checked within 10 months sounds pretty reasonable. I really sense you are going to come through all of this just fine, and looking much better than you're afraid of. To reduce the look of the scar, you may want to try silicone scar sheets (Scar Away), which are available at the grocery for about $20. Make sure to stay out of the sun (the scar sheets can be cut to size and will provide some protection from the sun and conceal your scar while it heals). I also have a prescription for Pracasil-Plus, which I learned about from a compounding pharmacist. My cost was about $40. Your derm or plastic-surgeon may not offer up a prescription, but if you want it, just politely tell them you'd like to try it anyway and may you please have a prescription. Any compounding pharmacy can fill it. I also wear visors, or some kind of hat to keep my scar out of the sun. Sunlight will cause a scar to get dark. And, when you are first healing, remember that it takes about a year for scars to reach their highest level of healing.
Best of healing to both of us!
Thanks to both of you for your responses! I got the biopsy results today and yes, it is basal cell. I was hoping to avoid it, but oh well. I've been referred to a Mohs surgeon and will let you know what he says. Given the prominent location on my face I may also consult with a plastic surgeon. I've decided to assume for now that the scarring will be minimal and barely noticable unless I get information to the contrary when I talk to the surgeon. :-)
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