Squamous cell carcinoma and MOHS surgery UPDATED

[Zebra]

I had this weird spot on my face that I just had biopsied and came back as skin cancer.   I know people get skin cancer all the time, but I am still a little bit shaken.   I know it's not a huge deal in the grand scheme of things, and it's much better than melanoma.   But,  I have always been such a sun avoider and I getting this wasn't really on my radar.   It's in an awkward spot, and although it's not a huge deal, it was gross and been hard to deal with since the biopsy.

Anyway, I was wondering if anyone had any experience with this and had any advice?   Either squamous cell or MOHS?  The scheduler just asked me if I wanted to come in and discuss my options before the surgery, but I didn't realize I had any options so I declined.   When they did the biopsy they told me they were fairly certain it was squamous cell, and that I would need MOHS surgery.   Then the person who called with the results explained the surgery I would need to have and said someone else would call to schedule.  But now I am wondering if I should have opted to go in and "discuss" my options?

My only experience with this IRL is much older people getting it.    (I'm in my mid 40s).   Any thoughts would be appreciated.

Edited March 31, 2022 by Zebra
added updated to title

[ktgrok]

I've only had Basal Cell tumors, and did not do Mohs, so cannot speak to any of that, but wanted to offer a hug and support, and bump up the thread 🙂

[freesia]

6 minutes ago, Zebra said:

I had this weird spot on my face that I just had biopsied and came back as skin cancer.   I know people get skin cancer all the time, but I am still a little bit shaken.   I know it's not a huge deal in the grand scheme of things, and it's much better than melanoma.   But,  I have always been such a sun avoider and I getting this wasn't really on my radar.   It's in an awkward spot, and although it's not a huge deal, it was gross and been hard to deal with since the biopsy.

Anyway, I was wondering if anyone had any experience with this and had any advice?   Either squamous cell or MOHS?  The scheduler just asked me if I wanted to come in and discuss my options before the surgery, but I didn't realize I had any options so I declined.   When they did the biopsy they told me they were fairly certain it was squamous cell, and that I would need MOHS surgery.   Then the person who called with the results explained the surgery I would need to have and said someone else would call to schedule.  But now I am wondering if I should have opted to go in and "discuss" my options?

My only experience with this IRL is much older people getting it.    (I'm in my mid 40s).   Any thoughts would be appreciated.

I've had squamous cell,but my dermatologist did an excision. I would go in and discuss. I think MOHs is a lot more expensive and you'd need to make sure your insurance covered it. Mine was on my upper chest. It may make a difference where it is.

 

[EKS]

My husband had Mohs surgery on his lip for SCC.  It went well, and he is fine.

I've had Mohs on my nose for BCC.  It also went well, but it was more debilitating that I thought it would be (as in, it was a bigger deal than getting a biopsy).  

My father had Mohs on his nose for BCC.  He had no problems, and he was 90 when they did it!

There are creams that they use sometimes for certain types of lesions.  You may be a candidate for those.

Anyway, my main points here are that you don't want to mess with SCC and that Mohs is a big deal but not overly terrible (if that makes any sense!).

ETA:  Do NOT look at photos of Mohs excisions on the internet!

Edited March 9, 2022 by EKS

[Zebra]

Thanks for the replies!   I really appreciate any thoughts or experiences.

It's hard to interpret what the doctor is saying sometimes.    I'm pretty sure they said, it's an awkward area (above my lip) but they didn't DIRECTLY SAY so that's why you need the MOHS.   I'm having to deduce that NOW.  

I have been having new and sudden medical problems the past 5 months, it's bizarre that this is happening too.   It just appeared on my face when I started having issues in October and then got bigger and bigger until I couldn't ignore it anymore.   And ironically, even though I have been going to the dr all the time no one noticed it because it was under a mask the whole time, and my problems were in other areas of my body.   I thought maybe it was mask irritation or something.

[Pawz4me]

Both MIL and DH have had Mohs surgeries. MIL's was for SCC and DH's was for BCC. Both did fine and once healed the surgery sites were almost unnoticeable. MIL has also used the cream for a SCC. It truly does a number on your skin--I think it's essentially a chemical burn--and I don't think she would do it again in lieu of just getting the surgery done and over with. Or at least while she was using the cream and waiting to see if it worked she said she wouldn't do it again.

[KrissiK]

((Hugs)). I had a melanoma removed from my inner right ankle about 10 years ago. I don’t think it was MOHS surgery, though. I just wanted to chime in support. It can be scary, but it’s important to trust your dermatologist. Mine is amazing.  She excised a pretty big area and went deep, but now, 10 years later you can’t even see a scar.  I have graduated to once a year check-ups with the PA now, but they all know around there that they have take everything off that they look twice at. I don’t “wait and see what it does.”🤣. My motto is, “If it’s not there, it can’t turn into anything.”

[MEmama]

I’ve had MOHs surgery for a rare deep tissue sarcoma on my leg. I have a pretty 5 inch scar as a souvenir. 
 

It was a long, arduous process, but also significantly more complex than the carcinoma you have. I had an excellent dermatologist; I had to be calmed repeatedly from breaking down several times. DS was just a year old or so and the sarcoma exceedingly rare (and the process, as I said, lasted hours) and I truly worried I was going to die and leave him motherless and that he would never know me. It was a vastly different experience than what you are facing, though. 
 

All that said, the surgery was successful. I think it’s quite a common surgery (though I had never heard of it). I would encourage you to talk with your doctor about the procedure ahead of time, if only to get a better sense of what you can expect (including potential scarring, since it is on your face). I’m glad you are getting it taken care of! 

 

[ShepCarlin]

I had a MOHS procedure a few years ago. It was on a spot on my body that was, ummm, rather intimate. From what I remember, they recommended MOHS because it helps determine exactly how much needs to be removed. So what they did was make an incision and removal, examine it, determine if they needed to remove more, remove a little more if needed, examine it, determine if more need to be removed, etc. I was lucky, I think they got it all in one swoop. What was surprising to me was how utterly exhausted I was afterwards. I really should have let my husband accompany me so he could drive me home. I went to bed that night very early. 

[ktgrok]

31 minutes ago, KrissiK said:

((Hugs)). I had a melanoma removed from my inner right ankle about 10 years ago. I don’t think it was MOHS surgery, though. I just wanted to chime in support. It can be scary, but it’s important to trust your dermatologist. Mine is amazing.  She excised a pretty big area and went deep, but now, 10 years later you can’t even see a scar.  I have graduated to once a year check-ups with the PA now, but they all know around there that they have take everything off that they look twice at. I don’t “wait and see what it does.”🤣. My motto is, “If it’s not there, it can’t turn into anything.”

When in doubt, cut it out, is the saying 🙂

And same - after having TWO dermatologists tell me something was nothing, only to find out from the third that it was a BCC, I now ask that ALL lesions be removed. And they do, because they get it. 

[EKS]

5 hours ago, Zebra said:

t's hard to interpret what the doctor is saying sometimes.    I'm pretty sure they said, it's an awkward area (above my lip) but they didn't DIRECTLY SAY so that's why you need the MOHS.   I'm having to deduce that NOW.

Generally speaking, if a lesion is on your face, they will do Mohs.  A regular excision when it's not on the face removes an extraordinary amount of tissue.  The Mohs allows them to creep up on it so that they only take what is absolutely necessary.

Edited March 9, 2022 by EKS

[VickiMNE]

5 minutes ago, EKS said:

Generally speaking, if a lesion is on your face, they will do Mohs.  A regular excision when it's not on the face removes an extraordinary amount of tissue.  The Mohs allows them to creep up on it so that they only take what is absolutely necessary.

Yes, this!  There is a very fair-haired doctor in our church (living in sunny So. Cal) who has had multiple lesions of skin cancer over the years and he recommended to me MOHS surgery for the face when I was diagnosed.  As the quoted poster said, they take microscopic skin layers, examine under a microscope, and repeat until *all* cancerous cells are removed.  The "ordinary" way is to guess at the extent of the cancer spread (with a good margin of error) and remove that--ending up with a bigger, deeper scar/healing *and* the possibility that some cancerous cells were missed.  There is a definite tension between minimizing facial scarring and yet removing all cancer cells.

[Resilient]

I've had MOHS for a basal cell on my nose that for years I ignored because I thought it was eczema.  Would that I had gone in sooner! BUT the MOHS got alll of it.  This is a good thing.  A friend didn't catch hers in time and she has had to have major plastic surgery to reconstruct her nose. 

I had plastic surgery because I was not 80+ years old.  (I guess by that time you're not supposed to care how you look).  

The surgery was to reconnect skin and blood vessels from living skin under my nose, and to put cartilage from my ear into the nostril so it had some shape and didn't just flap around with every breath. After 80, they would most likely have done a "patch" of skin which doesn't heal as cleanly or prettily.  That's what they did on my mom who had a similar surgery. 

The scar is in my smile line and no one sees it unless I point it out.  

POINT is: go talk about it and find out what the options are, and what the long-term consequences of each are likely to be.  I elected to go MOHS because it was the best option to make sure they got alllllllll the cancer.  That was 10 years ago or more, and apparently, they did.  If I had waited much longer, though, the plastic surgery would have been a much bigger deal...and it was a big enough deal as it was. 

Start to finish: 6 weeks.

 

[J-rap]

My mother has had about 20 MOHS surgeries for cancer on her face.  When she was a young teenage, they treated her acute acne with x-ray treatments!  I guess that was done back in the 40's.  Anyway, they think that's part of the reason why she had so many skin cancers.  She often had them in very awkward, obvious spots:  like, on the end of her nose, on her eye lid, etc.  Each time, she'd worry that there'd be a problem, or they wouldn't get it to look good after removing it, etc.  It was truly amazing the work that they did.  First, they are very, very careful, in that they kept checking the margins over and over again to make sure they got everything, right as she waited.  But then the surgery they did to repair it was pretty amazing too.  They'd often use skin from other parts of her body.  You could barely even tell that she had about a 1/2 circle of skin at the end of her nose replaced.  (In fact, unless you knew she'd had the surgery, you probably wouldn't notice it.)  Her insurance always covered everything.

ETA:  It may have been a plastic surgeon who did the repair work sometime after the surgery.  I believe it was after the actual surgery to remove the cancer had healed.

Edited March 9, 2022 by J-rap

[Corraleno]

I had a keratoacanthoma under my eye, which is often considered a type of squamous cell carcinoma, although it seems to be somewhat less dangerous. The first surgeon I consulted drew a large circle around it and said he would need to coordinate with a plastic surgeon to do the repair after he removed it. So I sought a second opinion and found another surgeon who was willing to start with a much smaller area and stitch it up herself as long as she didn't have to go beyond those boundaries. She said the risk was that once she started surgery she would have to take a larger area than I wanted, and then I would have a big bandage on my face until I could get in with a plastic surgeon. But I'd done a lot of research on keratoanbcanthomas by then and was comfortable with that risk. Happily, she was able to remove all the necessary tissue with a much smaller wound than the first doctor insisted was necessary, and I only needed a few stitches. It healed up really well with no visible scar.

[BakersDozen]

I had MOHS on my forehead in 2017. It was super duper easy even though it took all day (doctor was very surprised at how much more extensive things were once he got started). I think I went through 5 "rounds" before I was done? It was very easy and relatively painless. I was so excited when the plastic surgeon pulled my skin up and tight on my face - facelift!!! He assured me it would not last (sigh) but for a few days I felt young-ish again. 🙂

I am very glad the MOHS was done as it was minimally invasive and a slower, one-step-at-a-time process.

[popmom]

My husband had MOHS done on a squamous cell lesion on his arm about 10 years ago. It wasn’t bad at all. 

[TechWife]

You might want to consult with a plastic surgeon since it’s on your face. I had a derm once that told me she’d only let plastics do anything on her face. I had a benign mole/growth removed from the side of my nose by a plastic surgeon she recommended. 

[dirty ethel rackham]

1 hour ago, TechWife said:

You might want to consult with a plastic surgeon since it’s on your face. I had a derm once that told me she’d only let plastics do anything on her face. I had a benign mole/growth removed from the side of my nose by a plastic surgeon she recommended. 

6 hours ago, ShepCarlin said:

. What was surprising to me was how utterly exhausted I was afterwards. I really should have let my husband accompany me so he could drive me home. I went to bed that night very early. 

3 and a half years ago, I had BCC removed from my upper lip area - I had 2 lesions, one about a half centimeter above my outer lip and one on the lip border.  The dermatologist used mohs to remove the lesions.  Fortunately between the initial biopsy and the 1 pass of mohs, they got it all.  There is a plastic surgeon in the practice who attends and closes all facial surgeries that day (unless they may need to remove more.)  He did his best to hide the scar in the smile line.  I did have extra inflammation as a reaction to the suture material, which was really scary to me.  Due to my experience with my ankle surgery, I was terrified it would get infected, stop healing, and leave me with a huge scar. 

Most people have no idea I had surgery, but I notice it every day, mostly the shadow that the indentation makes.  I am missing part of my lip so I draw a new lip line with lip pencil.  

I do wish they had told me to minimize moving my mouth in the initial healing process.  A hard thing to do.  Also, I am so glad I made my husband come with me.  There is no way I could have driven myself home.  

 

[Pawz4me]

6 hours ago, dirty ethel rackham said:

The dermatologist used mohs to remove the lesions.  Fortunately between the initial biopsy and the 1 pass of mohs, they got it all.  There is a plastic surgeon in the practice who attends and closes all facial surgeries that day (unless they may need to remove more.)

 

That's how it's done where MIL and DH had theirs, too.

[Stacia]

I had MOHS for basal cell under my eye a few days before Xmas 2020.

It was very close to my eye and the MOHS surgeon said he didn't want to be the one who stitched it up. So, he and an eyelid specialist coordinated so they could both work on me the same day. (The eyelid specialist was the one who had biopsied it in the first place.) I went in for the MOHS early in the morning and they thankfully let my sister come in the room with me, which helped provide a nice distraction. The area was numbed but it was so close to my eye that I could see the knife. (I had to keep my eye open for them to cut it properly.) And I made sure I was very still. He had to do three rounds to get it all; I am so glad my sister was there to chatter to me during the wait between cuts (probably about 20 minutes each time). It's not like I would have felt like reading during the downtime. It was very nerve-wracking (in hindsight a valium or something might have been nice) because it was so close to my eye. I think I might be less nervous if it had been a little further away from my eye.

Then, they bandaged up my eye and my sister drove me to a nearby surgical center where the lid doctor was performing surgeries that day. Originally I was supposed to have twilight sleep but since the MOHS was more extensive than she anticipated, they actually put me fully under anesthesia for the repair work. It has healed well.

My dad has had MOHS twice on his face/nose and had no problems. In his case, the MOHS surgeon sewed the places up.

Don't beat yourself up about not going in for a consult. I was under a strict timeline because of upcoming insurance changes and was glad I was able to get it done prior to the end of the year during the pandemic. My timeline didn't give me much time for consultations, just happy the two offices could coordinate something for me on short notice. It worked out ok, thankfully.

Eta: I did not meet the MOHS surgeon prior to that day. He works with my dermatologist's office so I picked him for that reason. He had photos and measurements from the lid doctor and then his office contacted me to say they wanted to coordinate with the lid doctor for the repair because he wasn't comfortable stitching that close to my eye.

Edited March 11, 2022 by Stacia

[Zebra]

Thanks for all your replies and info.   This board is a wealth of knowledge.

I ended up going in for a consult.   I had to drive an hour away to another location, and they had to squeeze me in.   The dermatologist told me that because I don't have any wrinkles(!) and have very well defined lips there is going to be a scar.   

I had the surgery 2 days ago.    It went as well as possibly could.   I definitely needed a ride home.   

The recovery has been a bit difficult.    I actually spent a lot of time on Google beforehand trying to make sure I was ready.   I am really glad I did, because the dermatologist did not prepare me enough.   Due to the location of it, my lip is severely swollen.   For 2 days my top lip was 4 times the size it should be, it looked utterly ridiculous.   Like a cartoon!   I had this gauze mess on my face up into my nostrils and hanging out over my lip.    I was unable to blow my nose or even WIPE my nose, and I still literally can't use a cup, spit,and I have to carefully position a straw (that isn't exactly easy to even suck on), and use a spoon with small pieces of soft sticky food and sort of try to turn it over in my mouth to put it in.   I knew I would have to eat soft food, but I can't even slurp soup!   I had the brilliant idea to start eating popsicles today (I was supposed to use ice packs, but I literally couldn't position an ice pack where it needed to go) and I think that might be helping a little.   Or maybe I am delusional.

I think if this had been on my arm, or even my cheek it wouldn't have been such a big deal.    So just like real estate, it's all about LOCATION LOCATION LOCATION!!!!  

Hopefully this update is useful to someone out there!

[ktgrok]

On 3/8/2022 at 7:25 PM, BakersDozen said:

I had MOHS on my forehead in 2017. It was super duper easy even though it took all day (doctor was very surprised at how much more extensive things were once he got started). I think I went through 5 "rounds" before I was done? 

This is why I didn't want MOHS when I had BCC removed a few times. 1. my redhead genes mean local anesthetics don't work well and wear off really fast, so all day would have meant being stuck over and over and over again. 2. I have enough relatives with ASD and enough traits of my own to be Autism Adjacent as they say, with SPD issues, and there was no way I'd be able to handle that all day. Not without GOOD drugs. 

On 3/8/2022 at 9:11 PM, TechWife said:

You might want to consult with a plastic surgeon since it’s on your face. I had a derm once that told me she’d only let plastics do anything on her face. I had a benign mole/growth removed from the side of my nose by a plastic surgeon she recommended. 

I did have a plastic surgeon do mine - as others said, he rotates between the practices so it was at the dermatologist office, but with plastics guy. 

8 minutes ago, Zebra said:

I had the brilliant idea to start eating popsicles today (I was supposed to use ice packs, but I literally couldn't position an ice pack where it needed to go) and I think that might be helping a little.   Or maybe I am delusional.

 

Not delusional! I keep popsicles stocked all the time in my freezer in case someone gets a fat lip, bites their tongue, etc. They work GREAT, get the ice right where you need it, and taste good as a nice distraction, lol. I even hand them out to neighbor kids who get hurt on the mouth (with parent permission). 

[MEmama]

Yikes— I’m sorry recovery has been rough so far. That sounds miserable. 😞 

Were you given a general idea how long recovery will last?

 

[Zebra]

I'm not supposed to do anything for 3 days, and then very light stuff (not lifting more than 5 lbs etc) until my follow-up next week.    But, I read on another dermatology website that lips can stay swollen for 5 days.   

I am really fortunate that I am in a position that I can deal with this.  

[Zebra]

1 hour ago, ktgrok said:

This is why I didn't want MOHS when I had BCC removed a few times. 1. my redhead genes mean local anesthetics don't work well and wear off really fast, so all day would have meant being stuck over and over and over again. 2. I have enough relatives with ASD and enough traits of my own to be Autism Adjacent as they say, with SPD issues, and there was no way I'd be able to handle that all day. Not without GOOD drugs. 

 

It's interesting you say this because I always have problems with numbing at the dentist.    I talked to the dermatologist about it my numbing sensitivities and they said they would "top it off" after every round.    During the stitch up it had started to wear off, because I just about jumped out of the chair.  I don't think it would have been so painful in another area.   But they were doing some sort of burning thing on my face,  maybe to stop the bleeding or something?   Some of my instructions included when to take sedatives, which I have never taken, but clearly a lot of people must for a procedure like this.   I think I might look into it if I am going to ever go through this again on my face.

I think what is good about MOHS is when you leave you KNOW it's all gone.  Definitely  a nice feeling.

[ktgrok]

8 minutes ago, Zebra said:

It's interesting you say this because I always have problems with numbing at the dentist.    I talked to the dermatologist about it my numbing sensitivities and they said they would "top it off" after every round.    During the stitch up it had started to wear off, because I just about jumped out of the chair.  I don't think it would have been so painful in another area.   But they were doing some sort of burning thing on my face,  maybe to stop the bleeding or something?   Some of my instructions included when to take sedatives, which I have never taken, but clearly a lot of people must for a procedure like this.   I think I might look into it if I am going to ever go through this again on my face.

I think what is good about MOHS is when you leave you KNOW it's all gone.  Definitely  a nice feeling.

Any red hair in your family?

[Zebra]

36 minutes ago, ktgrok said:

Any red hair in your family?

Some, not immediate though.   My hair definitely has a reddish tone in the sun.    I don't know if that counts.

I just googled the redhead anesthesia thing, and I had no idea.   Really interesting.   It would explain a lot of things, I have a terrible time at the dentist, they can never get the novocaine right and I always feel like a whiny baby. 

 

[mmasc]

I’m so sorry! This sounds really miserable. I had a “punch” done a few years ago on my chest, and let me tell you, it was much worse than I expected! Mu doctor did NOT prepare me for the procedure or recovery either. During the procedure, the Anesthesia wore off and I could feel the cutting (did that for far too long before speaking up), had much more stinging and pain than I ever expected after the numbing wore off (and I have a fairly high pain tolerance), and I have a noticeable scar even though my derm sent me to a plastic surgeon. So yeah, I’m not sure why the doctors don’t spell it out better, but I understand! 
 

I hope your recovery is speedy and your scar is minimal!

[ktgrok]

52 minutes ago, Zebra said:

Some, not immediate though.   My hair definitely has a reddish tone in the sun.    I don't know if that counts.

I just googled the redhead anesthesia thing, and I had no idea.   Really interesting.   It would explain a lot of things, I have a terrible time at the dentist, they can never get the novocaine right and I always feel like a whiny baby. 

 

Yes, reddish tint counts. My son barely has that and has it too. If you tell them up front and mention the red head thing they can sometimes alter what they use which helps. 

[Tap]

I’m glad you got it all taken care of an now you only have a few days of recovery left. ❤️
 

I had basal cell on my neck and chose Mohs. I wanted the smallest scar possible and to know it was gone!!!!

my regular excisions of moles have left much larger scars and they are often raised. The mohs left the smallest scar (maybe half inch) and it is narrow and flat. It’s barely noticeable! I hope you have the same results 😀absolutely follow all the instructions from the doctor on keeping it covered and what ointment they recommended. 

[Anne]

So sorry you have had to endure this - hope you recover quickly!!

 

Anne

[Lisa]

Praying your recovery goes well and you heal quickly.

[J-rap]

I'm sorry it's been hard, but glad you had it done!  Hopefully things start going more smoothly soon.