I Have Skin Cancer - Part 2

On July 18th, I finally saw the plastic surgeon. I left feeling pretty relieved - almost exhilarated.

Here's an excerpt from an email I sent to the kids after that appointment:

I have a carcinoma in probably the worst possible place cosmetically. If he (the surgeon) did surgery now, I would be very unhappy with the outcome because it would leave a divot about the size of his thumbnail.

Therefore, he prescribed a chemo cream to try to shrink it. I will use it for ten days starting on the 24th and see him again on the 4th of August. At that time he will see if it's working. If it is working and he thinks it could do more good, he'll have me continue it for up to two weeks. The best possible scenario is that it would shrink the tumor enough that when he does the surgery, I would have a small scar. If it doesn't, he'll do the surgery but as I said earlier the results would be challenging. He would attempt to fix it by doing a skin graft but the logistics of that are so unpleasant that I won't share it with you unless it comes to that.

Starting about 3 to 4 days after I start using the medication, the tumor will open, possibly bleed, scab, and just look generally terrible. He didn't mince any words about that. During that time will probably be the only time in my life when I might not be excited about seeing any of you. I just called to ask if I can put a band aid over it during that unsightly stage and they said I shouldn't. If I have to for a couple of hours, I can but they'd rather I wouldn't. See? It's going to be very challenging. Can Dad stay with one of you for that time? lol

He did not do a biopsy. He's very sure it's a basal cell or squamous cell and he said I've probably heard pretty dire things about squamous cell carcinomas but it's not that bad. The people in danger of those cells spreading are generally AIDS patients or people taking high levels of steroids so that their immune systems are compromised. He said that in 24 years of practice he's only seen one of these turn out to be a melanoma and that even if it were, melanomas are 90% treatable. I asked, if when I go back, we could still do a biopsy, he said yes. But doing one today would only delay the total treatment by several (or maybe just two) weeks.

I hope I haven't made this seem more scary than it is. I think that it's going to be pretty unpleasant for awhile and I hope you'll all have positive thoughts and stuff that this medication will shrink it, but overall he said my problem is cosmetic not life threatening.

So there you have it.

Stay out of the sun.

Oh, and 90% of all Caucasians will get skin cancer if they live long enough. AND the only effective sunscreens are the ones that thave zinc oxide and/or titanium dioxide in them. They've found that the SPF doesn't mean much at all.

That was the result of my first visit.

I started the chemo cream as directed and I had a pretty good attitude about it but as the end of the treatment time approached, I became more and more stressed. Suddenly the tumor was very evident to me. In the middle of this fire-red blotch covering the whole end of my nose was a bump rising higher and higher every day and there was no doubt in my mind that this was going to be much worse than I'd expected.

The doctor walked in on the 4th of August, took one look at my face, and I think he got mad at me. He asked me to review what I'd told him and I did. Then he bluntly said if I did not trust him or had some doubts about the course of treatment that he'd laid out, he wouldn't be mad or insulted if I wanted to see someone else. This kind of hurt my feelings but I had to acknowledge to myself that there was anxiety all over my face.

I replied that I did trust him but that I needed reassurance that what was happening was as expected. I told him that I wouldn't have been alarmed to see the spot open, ooze, bleed, turn color, or become even more unsightly but that I hadn't expected to see a tumor rise like a phoenix in the middle of everything else that was ugly.

I then asked about doing a biopsy (I didn't say it but I was sure this was something much worse than we'd expected). He said, yes. In fact he INSISTED that I have a biopsy the very next day because he didn't want a patient of his to be as stressed as I obviously was.

Whoa! I didn't expect that, but I was glad. They obviously had to work me into his busy surgical schedule and my instructions to prepare were consistent with a real surgery - nothing to eat or drink after midnight. I was to get to the surgical center at noon but at about 11:30 I got a call saying that the doctor didn't want me there before 2:00. I was pretty annoyed with this at first but by the time we got there, I'd reminded myself that he was a very busy surgeon and that they had worked me into his schedule. When we arrived we were told that he was in the 5th hour of a surgery that was expected to be much shorter and I realized that he'd made some sacrifices just to get me in on his one surgery day a week.

About 4 o'clock he came in and explained that they'd do a small vertical incision and that there would be 2 or 3 stitches. Everyone was extraordinarily nice. The surgery staff was awesome and I woke up to a nurse murmuring in my ear that the incision looked great!

The doctor had ended up doing a horizontal incision and I had 6 stitches instead of 2 or 3, but finally I had full and complete trust in him. He was the best! He told me to come back Monday to have the stitches removed.

When they'd scheduled my appointment back in July, it kind of hinged on his being out of town starting the week of August 6th. When we went in Monday they told me that he would be gone starting Wednesday and that a PA would be removing the stitches. They also told me that the lab report wasn't back yet which would tell us what kind of cancer we were dealing with.

Wednesday, I was on my way to Washington DC to spend a few days with my daughter-in-law and grandchildren while my son is in Afghanistan when my cell phone rang. It was my doctor calling to let me know that I had a basal cell carcinoma. It was so great of him to call and when I said "I thought you would be out of town", he replied that he was actually at the airport but wanted to be sure I knew of the results before he left. Wow!

After about a week, the scab came off and the results looked pretty good. I had some unrealistic hopes that the ordeal was over but my next visit proved me wrong.

The doctor wanted to wait until the wound healed and then start another series of chemo cream. About a month after that, he'd see me again.

When I returned for that appointment, he told me that the tumor had really not shrunk at all and that there was no point in continuing the cream. It had stopped any spread while I was using it but it hadn't reduced the size. It was time to schedule surgery.

Tomorrow morning at 6:30, I have to be at the surgery center for a 7:30 procedure.

I'm very uneasy about it especially after foolishly doing some internet surfing. The doctor will try to close the wound with a flap of skin from an adjoining area but if he can't, he'll take a skin graft from behind my ear. If that doesn't work, they'll do a forehead to nose skin graft which looks particularly unpleasant but I think that would be a separate procedure.

Ultimately, the results should be okay cosmetically and most importantly, the cancer should be gone - but that's not guaranteed. In an effort to minimize the damage, he'll not dig any deeper than he feels is necessary. This leaves some room for a recurrence which would be dealt with if and when necessary.

Finally, I want to reiterate what I said to my kids in the email I sent them:

1. Stay out of the sun
2. Make sure your sunscreen has zinc oxide and/or titanium dioxide in it.

Sixty-Five years old may seem like light years away right now, but it's not. It's right around the corner.