Exeter Mural

The Nose Knows

A couple of months ago, I noticed a small sore on the bottom of my nose. It was located above my upper lip and between the two nostrils of my nose. I didn't really make too much of it, but it didn't seem to heal. I mentioned to Nancy, the next time we go to the dermatologist I should probably show it to her. After showing this sore to my dermatologist she decided to take a small sample for a biopsy. She thought it might be a small basal cell carcinoma, a type of skin cancer. A couple of days later she called and asked me to come back in to see her.

Later that week, at her office, she stated that it was positive, a basal cell carcinoma. I asked her when she would be able to remove it. Since its location is in a sensitive area and it is important to minimize the removal of normal healthy tissue, she felt I should go to a surgeon that specializes in Mohs surgery. An appointment was made to have this surgery the next month. On November 21, I went in to have this basal cell carcinoma removed.

Mohs Procedure
The procedure takes place in an outpatient setting with the surgeon using a local anesthetic to numb the area. After injecting the anesthetic, the surgeon uses a scalpel to remove  a thin, layer of skin.
After each layer of tissue is removed, the specimen is frozen, sliced into very thin sections and processed onto glass slides and read by the surgeon or a trained technician. This process typically takes up to one hour.
If tumor cells remain, the surgeon will remove an additional tissue layer precisely at the area where cancer remains. This procedure continues until the tissue is cancer-free. This spares the maximum amount of healthy surrounding tissue.

My Experience

  • After arrival and check-in, I was escorted to one of the exam rooms. The doctor came in, examined my nose and the basal cell and injected a numbing agent around my noise. She said that it looks like it is a small one. She took out a curved blade and removed part of the basal cell carcinoma. My nose was cauterized to stop the bleeding and I was escorted to a special patient waiting room. I was told it would be about an hour before I would be taken back in.
  • About an hour later I was taken back to that same exam room and the medical assistant once again injected a numbing agent around my nose. I looked at the chart before the doctor came in and I noticed that the circular area she had drawn on the chart was colored in red. When the doctor entered the exam room, I asked her if all of the red on the chart meant there was still some cancer cells. She answered in the affirmative and said it was larger than she thought. Once again she used the curved blade and removed even more this time. Again my nose was
    cauterized and I was sent back to the patient waiting room. In the patient waiting room, I noticed that there were other patients going through this same procedure. A few had temporary bandages on their faces while another had a bandage on his forehead. Each of us were escorted into the exam room for surgery and back to the patient waiting room waiting for the results of our latest biopsy which took about an hour.
  • I surfed the web on my phone while waiting for the results of my latest biopsy. Once again I was taken back to the exam room for further surgery. As I looked at the chart this time I saw two small red dots on the chart. This time she used a scalpel and removed both pieces and I was sent back to the patient waiting room. As I looked around at my fellow patients, I became aware if you went into exam room 8, this was where you would have your incision stitched up and you would be on your way home. I glanced at my watch and noticed every patient who went into exam room 8 was in there for about 10-15 minutes before being discharged.
  • This next hour, as I waited, seemed to take a long time. The medical assistant came and we walked into exam room 8. Whew! Another 10-15 minutes and I would be going home. I told her that I was going to phone my wife and let her know she could pick me up in about fifteen minutes. The assistant informed me that it might be a little bit longer than fifteen minutes, maybe about 45 minutes. So, I called Nancy and told I would be ready in about 45 minutes. A new medical assistant came in and started to give me more shots to numb the area around my nose and my upper lip. At one point, I told her, "you are giving shots on the wrong side of my face in my upper lip. She told me that the doctor was going to probably work on both sides of my upper lip. Now, it finally dawned on me, why it might be about 45 minutes.
  • The doctor said she would need to work on both sides of my upper lip. She was going to raise my upper lip on the left side to make a flap of skin to cover the hole that was now there from the surgery. To make both sides symmetrical she was going to raise my lip on the other side. She used a small towel to cover my eyes and started cutting and finally began to stitch me up. The stitching took forever. I was in exam room 8 for over an hour.

The first photo below shows the bandages on my upper lip, the second photo shows my upper lip two days later after removing the bandages and the third photo shows the area where the basal cell carcinoma was removed.


Last Friday, eight days after surgery, I had the stitches removed, I was told that the flap that was created to cover the area where the basal cell carcinoma was removed, will probably take another two to three weeks to heal. All I can say is - What an experience!