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Skin Cancer - Round 2, thank you for all of your help GRAPHIC


DOC

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WARNING GRAPHIC PICTURES:

So after reading all of your comments regarding Moh's surgery for skin cancer, it became apparent that the Dermatologist that operated on me was not a Moh's surgeon.  I mean he cut me, he sutured me, I had to wait for a week for the biopsy to come back.

His comment was, it looks good.  I said, "Well did you get it all."  He said well you can never be 100% sure that you got it all?"  WHAT?  Moh's surgery is 98 to 99% successful because they biopsy as they go.  They cut.  You wait as they do the pathology, if it comes back clear, they stitch you up and off you go.  If it is not clear they cut more until they get it all.

So I finally asked for a copy of the pathology report. It says:  "Skin with residual Squamous Cell Carcinoma.  A small collection of cells within the superficial touching of the margin is present.  It is not clear whether this is residual Squamous Cell Carcinoma.  A similar nest of cells is located 1mm from the left margin."  PLAIN ENGLISH... They didn't get it all!

Let this be a lesson to you!  Be aggressive with doctors.  They aren't God!  Get a second opinion.  Question everything!

So I ask around for the best Moh's surgeon in town.  I find out it is Dr. Fife.  He was actually recommended by a Moh's surgeon who said, you need to see Fife, because this thing is really botched.

So I went to see him on Monday, he said, let's not wait, I want you in here at early tomorrow; 7:45 am Tuesday morning.  I promise you when you leave here you will be cancer free.

So here are the pictures.  The open wound was the second time he had to cut, the fist cut came back with residual cancer.  Second cut came back completely clean margins.

So now that it was all cancer free he had to devise a plan to suture me up. That actually involved extending the incision and making the incision deeper, and doing a little cutting of the meat away from the skull.  He had to cut through the meat all the way to the skull.  He cut under the meat, and pulled it together and overlapped it to eliminate any indentation I might have from the tissue he has removed.  Holy crap, I could feel him pulling that muscle, down the back of my neck, in my ear, in my temple and my eyebrow.  He jokingly said, "It's OK if your left ear is two inches higher than the right ear?"   I said, "No problem, I will have to get my frames adjusted."

Then the second layer had to be stitched together.  Then finally the skin was stitched together..  I don't mind telling you after the lidocaine wore off it felt like someone hit me with a baseball bat.  Being the manly man that I am, (and an idiot) when the doctor said let me give you some pain pills I said, "I don't need no pain pills, what do you think I am?  A pussy?)  Later I learned, YES, YES I AM A BIG PUSSY!  OWEE!  But I toughed it out.

But hey, THANKS TO ALL OF YOU!  I was prompted to find a Moh's surgeon, and I am glad I did!  You guys are like my second family.  I feel like we look out for one another.  Had it not been for all of you talking about Moh's surgery I probably would have never pursued this.

SUN SCREEN GUYS and GALS!

Doc

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For a few minutes it might have been hard for the doctor to tell which end was which. I am glad he didn't sew up the wrong one. 

I think you made a wise choice. It seems it would be much more preferable to get scalped entirely than have any cancer left. Why start cutting at all if you are going to leave any?

I hope you don't have to have any more whittled off up there. I would start growing some dreadlocks on my butt cheeks just in case. 

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Ah Jez, Doc, srry to hear that they had to go back in.

Tom H.

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If I had a big scar like that on my head I would tell everyone it was where they removed the frog....

 

A guy walks into a bar.

He has this frog growing out of his head. Right over the left temple. A big green bullfrog with his front feet sticking out.

The bartender looks the guy in the face and asks him what he will be having. The guy does not even blink. The bullfrog says "Give me a draft beer and a shot of bourbon".

The bartender left and returned shortly with the drinks. He looked the guy in the face and said "That will be six bucks". The guy reached into his wallet, handed him a ten and the frog said , "Thanks buddy! Keep the change!" 

A few minutes went by and the bartender approached the fellow again. He looked him in the face and said, "I hope you don't mind me asking... but what is with the frog on your head?"

The bullfrog looked down at him and said, "I don't know. I just woke up one morning and this guy was growing outta my a---!"

 

 

 

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Wow Doc :yikes:, very glad you followed up on this, I guess now after all the pulling and stretching to get it closed up you won't have to worry about getting a face lift any time in the foreseeable future, I would also guess after the stretching you will also have a permanent smile for a while to come, even though on the inside you're grimacing from the pain!!

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I guess the moral to this story is always listen to your friends and your gut.

I just didn't feel comfortable with that first surgery, and fortunately you guys sharing your experiences got me thinking.

I remember one time sitting in Steinberg Diagnostic waiting for and MRI on my shoulder, (torn rotator cuff)  An 86 year old guy is sitting next to me, he's wearing a hat.  He says what are you here for?  I told him.  "How about you?" I said.  He takes off his hat, and on the right side of his head, about the same spot as where I had my issue on the left, he has a rotting hole all the way down to his skull. I literally can see the bone. He says, I got squamous cell.  I just ignored it, I thought some day it would heal up.  I didn't know it was cancer.  Now it has spread and they are going to have to cut it out, take the bone and reconstruct it with artificial bone and my right eye because it has spread into that too.

Guys I was a cop, I saw it all.  Murders, shotgun in the mouth suicides, autopsies on floaters pulled out of the river.  I have a pretty strong stomach.  But listening to this guy made me want to hurl.

Doc

 

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4 minutes ago, DOC said:

I guess the moral to this story is always listen to your friends and your gut.

I just didn't feel comfortable with that first surgery, and fortunately you guys sharing your experiences got me thinking.

I remember one time sitting in Steinberg Diagnostic waiting for and MRI on my shoulder, (torn rotator cuff)  An 86 year old guy is sitting next to me, he's wearing a hat.  He says what are you here for?  I told him.  "How about you?" I said.  He takes off his hat, and on the right side of his head, about the same spot as where I had my issue on the left, he has a rotting hole all the way down to his skull. I literally can see the bone. He says, I got squamous cell.  I just ignored it, I thought some day it would heal up.  I didn't know it was cancer.  Now it has spread and they are going to have to cut it out, take the bone and reconstruct it with artificial bone and my right eye because it has spread into that too.

Guys I was a cop, I saw it all.  Murders, shotgun in the mouth suicides, autopsies on floaters pulled out of the river.  I have a pretty strong stomach.  But listening to this guy made me want to hurl.

Doc

 

Thanks for sharing the story Doc. And thanks for your service. I can empathize on all of your experiences except for that one. Pretty rough stuff. I thought that floaters were the worst but what you just described, might require some reconsideration on my part.

Best wishes for complete recovery sir.

Mac

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WTG!!

And you are sooo right about Drs not being gods, as much as many would like to believe otherwise..

If you want to find out in a clinical setting for sure if 'your' Dr has a god complex, call him out / question him in front of his students or peers.. If he isn't interested in hearing what you have to say,  pooh-pooh's you or blows his top, walk away; that person is full of himself, or chit -- or both.. All he's doing is protecting his tenured position while having little-to-no interest in learning anything new..

Swamp

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Doc,

In the spirit of, "Laughter is the best medicine", (and inspired by your business address), here's a little humor for you: 

G.M. "DOC" Lousignont, Ph. D. LOGO Pin 50x50.jpg  "DOC's Place" 1180 Wigwam Parkway Henderson, Nevada 89074 

Quote of the Day: Scratched on bathroom wall, "This is a Tee Pee where you're supposed to pee pee, not a Wigwam to beat your Tom-Tom!! :)

 

 

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Good lesson here.  Dr. says "looks good, but you can never be sure if you got it all".  He has a report that shows he didn't get it all.  WTF, was he just going to turn you loose with an unfinished job?  It pays to do your research and be persistent when dealing with your health.  Question everything you are told, it is amazing how many Dr.'s out there are incompetent.  

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Thanks Doc for highlighting an important message: "Do your homework!"  The buck, unfortunately, stops with you at the end of the day.  After residing in major metropolitan centers for most of my life I got accustomed to receiving fairly high quality treatments over the years.  But after re-potting ourselves to Yucca Valley Jill & I discovered that we have to drive 40 minutes "down the hill" to the Palm Springs vicinity to hook up with specialists we are comfortable with.  And even then we do a lot of our own research to stay on top of our various conditions.  Generally what I look for when beginning a search for a specialist is (1) where and when did they obtain their medical degree? (2) where did they do their internship? (3) have they been in practice for at least 15 to 20 years? (4) What items, if any, are reported by the Medical Board?  Certain older doctors in their 70s or 80s may be okay if they have been able to keep up with a constantly developing field, but my preference is for someone at the peak of their game mentally, academically and physically.

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Learned a lot from the previous posts and I appreciate it.   I just had the wife remove 12 stitches from my cheek from my Basal Cell Carcinoma removed last week.  While I was in there, I asked if they were doing the MOHS surgery on my cheek.  They told me that the MOSH procedure was done only on the scalp because of the lack of meat/tissue to take off.(my terminology, can't remember exactly what they said beside it was for the scalp).  Good news... after a week of waiting for results... I heard they got it all.

I never would of asked if it weren't for Doc sharing his experience.  :shake2: Thank you

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Well the great news is that Basal Cell is generally superficial and rarely does it metastasize.  It's generally easy to get all of it with relatively shallow procedures.

However, I have to call BULL on they only do Mohs on the scalp.  Mohs surgery is simply the same thing they did to you, except the surgeon is a certified pathologist who can look at the skin that was removed and immediately biopsy it.  If it is still cancerous they go back and take more.  It has nothing to do with the location on the body.  It has to do with the advantage of the procedure being immediate and thorough.  So whoever told you that is full of CHIT.

So, they cut the affected portion out, leave it open and cover it with sterile gauze while they do the pathology.  If it is clean they sew you up, if not, they "stage" the next excision of skin, and check it.  They keep staging (cutting out more skin) until the pathology shows that you have clean margins and no cancer in the excised skin.  Point being, when you walk out of the office you know you are cancer free.

Squamous cell is more dangerous.  However, it is very slow growing, so if you get it early, you usually have a 99% cure rate.  However, it can move into the lymph nodes, but that is not a common occurrence.

Just make sure you ask for a copy of your pathology report.  You are entitled to it.  Make sure it says that there were clean margins and no residual evidence of any Basal Cell Carcinoma.

Doc

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6 minutes ago, DOC said:

Well the great news is that Basal Cell is generally superficial and rarely does it metastasize.  It's generally easy to get all of it with relatively shallow procedures.

However, I have to call BULL on they only do Mohs on the scalp.  Mohs surgery is simply the same thing they did to you, except the surgeon is a certified pathologist who can look at the skin that was removed and immediately biopsy it.  If it is still cancerous they go back and take more.  It has nothing to do with the location on the body.  It has to do with the advantage of the procedure being immediate and thorough.  So whoever told you that is full of CHIT.

So, they cut the affected portion out, leave it open and cover it with sterile gauze while they do the pathology.  If it is clean they sew you up, if not, they "stage" the next excision of skin, and check it.  They keep staging (cutting out more skin) until the pathology shows that you have clean margins and no cancer in the excised skin.  Point being, when you walk out of the office you know you are cancer free.

Squamous cell is more dangerous.  However, it is very slow growing, so if you get it early, you usually have a 99% cure rate.  However, it can move into the lymph nodes, but that is not a common occurrence.

Just make sure you ask for a copy of your pathology report.  You are entitled to it.  Make sure it says that there were clean margins and no residual evidence of any Basal Cell Carcinoma.

Doc

What Doc said, here's a link to an overview on Mohs surgery on Mayo Clinic's website, no where does it say it only performed on the scalp.

https://www.mayoclinic.org/tests-procedures/mohs-surgery/about/pac-20385222

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The other thing in addition to sunscreen, appropriate clothing and hats is to see a dermatologist regularly to be checked out. Small bits of skin cancer removed early have a good outlook. The larger things get and the longer they have to grow, the worse the likely  outcome..I see mine every year and sometimes more frequently than that. I've only had little stuff removed but that's fine by me.

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On 11/1/2018 at 8:05 AM, kwah said:

Good lesson here.  Dr. says "looks good, but you can never be sure if you got it all".  He has a report that shows he didn't get it all.  WTF, was he just going to turn you loose with an unfinished job?  It pays to do your research and be persistent when dealing with your health.  Question everything you are told, it is amazing how many Dr.'s out there are incompetent.  

Oh his game plan was to schedule me to come back on November 30th to have the "Blue Light" treatment.  This is where they paint your head with chemo therapy solution.  Any pre-cancerous, or superficial cancerous cells absorb this chemo over the next hour.  After an hour they put your head under am ultra-violet light that activates the chemo and kills all cancerous and pre-cancerous cells.   Now the only problem with this is it only works on superficial cancers.  Basal Cells are usually superficial, and Squamous cells can be as well, but Squamous cells have a tendency to go deep, so it is not the treatment of choice for Squamous.

So this doctor was hoping against hope that the Blue Light treatment would hopefully get the remaining squamous cells.  But there would be no absolute way to know.

Now it's still a good idea to get the Blue Light treatment, or to do the Efudex Topical cream treatment, because it can get rid of a lot of pre-cancerous and early cancerous lesions.  It is just like the Blue Light except that it takes about three weeks of putting the cream on.  And your head gets so red and raw. So I am going to get the Blue Light treatment done; just not at that doctor.  I have a very strict code, you lie to me only once, then you are dead to me.

Doc

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Doc's right on with what he says about Mohs surgery  I have had all three kinds of skin cancer and in every instance I waited until the report came back whether or not they got it all in the first round of cutting.  I usually fall asleep waiting for the results.  That is the only way to go, I wouldn't have surgery any other way.  I haven't had any cut out on my head as yet so that idea about Mohs only done on the head is debunked.  

When I grew up on the Jersey shore they didn't have much of a sun block program then.  I spent some time in the Navy on the flying bridge of the ship as a navigator/signalman.  Thirty plus years on telephone poles as a lineman then a cable repairman all exposed to the suns rays.  I only learned to take care of my skin in later years.  The skin is the largest organ of your body.  It is to be taken care of  the same as your heart, kidneys, liver, etc.  Young folks take a lesson from the geezers, You won't regret it.  

   Old Tom    :shake2:     

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33 minutes ago, Au Seeker said:

What Doc said, here's a link to an overview on Mohs surgery on Mayo Clinic's website, no where does it say it only performed on the scalp.

https://www.mayoclinic.org/tests-procedures/mohs-surgery/about/pac-20385222

Heck when I was in there in the waiting room they put you in with all the other patients waiting for pathology to come back, there as a lady have surgery under her eye.  Two guys having surgery on their nose, one lady having surgery at the base of her neck, she was on her 4th cut!  Another lady on her chin. I was the only one having something down on the scalp.

Doc

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I've had 4 cuts on my head and face. One on the back of my head, two on my forehead and one just below my left ear. All were Squamous Cell. First forehead cut was well over ten years ago ... back of the head was the latest just last year. None of them were the mohs type but fortunately for me the pathology back to me a week later was all clear on all counts. If and when the next one comes I will ask about the Mohs procedure now that I know about it. I worried they didn't get it all each time ... sounds like worries over with the Mohs procedure.

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