Skin Cancer Nose No Boundaries
Australia has the highest incidence of skin cancer in the world, with over 1600 deaths reported in 2008. The number of similar deaths around the world, plus the fact that the numbers are on the increase globally, is also saddening. “Only through adequate protection from a tender age and early detection can this heart wrenching figure be lowered.” With ongoing skin cancer awareness for all, especially our young, perhaps one day our children’s children’s children will be free of this insidious disease and only learn of it through their grandparents and the Net. “Not yet a grandparent, this is one of my stories on skin cancer. All done to bring to light the damage caused by the sun, to the people with young children and those a little older who are attempting to get that “Golden Tan” under the blazing sun and the shrinking ozone layer.” If my words fall on deaf ears, perhaps the images below that showcase the technique used to repair the damage to my skin after decades of ignorance and “she’ll be right mate” attitude under the hot Aussie sun, will change people’s attitude for the better. Early in 2008 it was confirmed by my skin specialist and friend that I had two basal cell carcinomas (BCC) on my nose. After further follow-ups by my specialist all appeared well as both skin cancers had disappeared with no visible defect caused by the treatment. So, where to from here? After my specialist confirmed that it was a nodular BCC by way of a biopsy, he suggested “Mohs surgery”. “Mohs surgery is a specialised surgical technique in which difficult or recurrent skin cancers are removed using microscopic control which allows for the maximum chance of cure with the smallest possible defect.” The cancerous lesion is removed in horizontal layers and microscopically examined to determine if any more tissue needs to be taken. Further layers of skin are removed if required and microscopically examined. This procedure continues until the cancer can no longer be seen infiltrating through the tissue sample, after which the defect is closed. My first experience with this type of surgery involved the repair of the defect to my ear using a small skin graft. My nose however, required a bilobed flap repair on the 12 January 2009 as you can see below. “Whilst researching this, I believe the flap used was a Zitelli Bilobed flap. If anyone can correct me on this I will be much obliged.” The images below showing my recovery stages were taken after the dressing was removed a number of days later. 14 January 2009 14 January 2009 17 Jan 2009 18 January 2009 18 January 2009 On the 19 January 2009 I returned to have the stitches removed. A minor dressing was applied and removed seven days later. I now have to massage the scar line twice a day for a few minutes to get back my bad looks! Update: Skin Cancer Nose No Boundaries - Part II References and links: * * * To be continued...
One was a very small nodular BCC (NBCC) located on the lower section of the right sidewall. This appeared as a very small pearly white dome shaped lesion similar to the one shown in image below.
The other, a superficial BCC, an extremely small and narrow red scaly patch, was located on the junction of the right nostril and my check.
If left unchecked the two skin cancers would have grown in size destroying surrounding tissue.
NBCC Public Domain Image – Dermatology Department / National Cancer Institute
Both were later treated with Photodynamic Therapy (PDT). This treatment which is not suitable for certain types of skin cancers, is a non-surgical procedure using exposure to a special red light after the application of a light activated cream to the surface of the affected skin to destroy the skin cancers.
Courtesy of
It wasn’t until October 2008 that I discovered that the nodular BCC (see image below) had re-appeared. Yes, it’s my nose and so are the ones further down.
According to my research PDT has an concerning failure rate for these types of skin cancers, but still it was worth the try.
Having had this done before for a BCC on my ear, I knew what I was in for. Mohs Surgery, a day only procedure requiring the injection of a local anaesthetic to the site to relieve pain.
This time round ten milligrams of valium under my tongue before the injections helped make me the world’s worst patient, a whole lot more bearable for others.
Image 1:
Excision below with the two flaps marked in blue aboveImage 2:
Flaps moved into place & sutured
My bilobed flap involved the larger skin flap, outlined in blue in the middle section of image 1, being moved down into the area where the skin cancer had been removed.
The smaller flap at the top of my nose was also moved down to fill the area caused by the rotation of the larger flap.
Obviously a considerable amount of stretching of the skin and fine detailed suturing had to be involved to complete the task. (see image 2)
I hope this post makes a difference in someone’s life.
How much did it cost? A: Thank God I have private health insurance!
Lead up article: Do nurses make the worst patients?
Cancer Council Australia - Skin Cancer Facts & Smart Lifestyle
DermNet NZ - Homepage
DermNet NZ - Mohs Surgery
DermNet NZ - Photodynamic Therapy
Wikipedia - Mohs surgery & Basal Cell Carcinoma
The Victorian Cosmetic Institute - Photodynamic Therapy
USA National Cancer Institute - NCI Visuals Online
Department of Health & Aging - Skin Cancer Awareness
Australasian College of Skin Cancer - Photodynamic Therapy
Dermnet - Skin Disease Image Atlas
Zitelli Bilobed Flap - Explanation
Archives of Facial Plastic Surgery - Zitelli Bilobed Flap
Australian Bureau of Statistics - Stats
World Health Organisation - Health effects of UV radiation
American College of Mohs Surgery – Multimedia
Special thanks goes to DermNet NZ, Artistic Realism Fine Art / Artistic Realism Art Studio for the use of their fantastic images.
88 comments - care to make one?:
Wow, Peter! Great post. With these being so small, how were they detected in the first place?
Dang! Very impressive. I really appreciate your sharing the photos with your readers. I "second" Moonshadow's question about detecting these small lesions.
Hi Moonshadow and thank you! As I have very fair skin and a history of skin cancers, I am always on the lookout for anything suspicious.
One day after working in the garden, I wiped my face of sweat and as I did I felt something on my nose with my fingertips.
On the next trip to my skin specialist I showed him and the rest is history so to speak.
Take Care,
Peter
Hi dethmama and thank you too! I wasn't quite sure about adding the images when I first started putting this post together because I knew it could upset someone when it came out.
But I went ahead with it as they speak louder than my words. I just hope the message gets across about skin cancer awareness and that it helps someone.
This lesion was raised and I could feel it quite well with my fingertip even though it was very small.
Take Care,
Peter
You can never be too careful or aware when it comes to your body. I've got to hand it to you, that looks really painful.
Take care of yourself, there's only one you!
Peter:
That is a great post. It's is also one that I can relate to.
I've had three or four skin cancers removed. Most were frozen off and one was burned with a laser. I never went through the extensive procedure you describe. My spots have never returned, but now you make me wonder if doctor had gotten the entire affected area. My fingers are crossed.
Happy trails.
Peter, thank you for this most needed and informational post. You have answered many questions I have been pondering. The imagery is fantastic. WOW!! ! That's quite a process and I am thrilled you were on top of things.
My last two dermatology visits ended up with pre-malignant lesions being removed. You're keeping me on my toes!!!
What a dear blogging friend you are to us all.
Hugs, JJ
Peter, scary pictures there and you had really done a great research into the topic.
The articles are so well written that I am worried about my own skin!
Excellent work, Peter!
You've done well to detect them and to post this as a warning to others.
Hey Peter,
Oh my...1,600 deaths reported in 2008? That is too much, isn't it?
Ok, now I know that all the times that my mom prevented me from getting a proper tan have saved my life (I used to get annoyed at the time)!
The PDT sounds interesting, less invasive. But if the cancer is more severe this method wouldn't work, right?
It seemed so small your nodule...and I have one similar to this one on my cheek, but it hasn't grown nor changed its colour (that is why I stay away from the sun nowadays). But the doctor said that if it grew that I should see him immediately (so far so good).
Mohs Surgery is some serious stuff! Your poor nose, Pete!! So what now? After you take the stiches, I mean. Will you need a reconstructive surgery or what?
Thanks for sharing this, Peter...this is what I call a proper awareness post! I got my warning now!
I wish you and your nose all the best!
Cheers
Peter something small like that to cause so much trouble. Hope your recover is going well, and soon you will be back to your 'good' looks - I mean it!. Thanks for all the info. I myself try to avoid sun as much as I can. I have freckles and these are bad for the sun. At times I wear long sleeves in the very hot weather, cos I don't like sun screesn either, they make me sticky, lol.
Peter this is great post, I am sure you will make a difference!
Anna :)
BTW Peter I forgot to tell you - you are good in the medical stuff! Very informative, you should be a teacher too! Anna :)
Hi The Muse. It wasn't too painful at all. The excision site is fairly numb at the moment and it will take a while before I get full feeling back.
Have you had your skin checked lately?
Take Care,
Peter
Hi Swubird. Mine have been removed by way of burning, freezing and cutting. I've never had laser treatment before. Sounds a lot better than all of the above. If ever your in doubt, go get your skin checked out again!
Take Care,
Peter
Hi JJ and thank you. My better half took most of the images for me. Great team work! With me the director and her the official photographer!
You and I both know that early detection is the only way to go, so getting this message out to the young and not so young is most important.
Hoping your toes are not too sore from reading this!
Take Care,
Peter
Hi Roentarre. It's great to get your point of view on this aussie blight.
I hope you haven't suffered from the effects of the sun. Especially now considering how hot it is down in your neck of the woods.
Staying indoors for about a week helped me put this one together.
It's funny I thought I knew a lot about this topic but I've only scratched the surface.
Sorry to make you worry but considering I have, put your body and mind at ease by having your skin checked.
Take Care,
Peter
Hi Jayne and thank you! Have you had your skin checked lately?
Take Care,
Peter
Hi Max. I wish I had stayed out of the sun when I was just a lad. That spilt milk saying echoes in the back of my mind everytime I go to the skin specialist.
Yes, PDT can't be used on certain types of skin cancers. If you click on one of the links about PDT it will explain which cancers can and can't be treated.
All I can say when it comes to having your skin checked, is to have it done by a skin specialist and nothing less, Ok!
The reconstruction surgery was the bilobed flap repair that I mentioned.
All's well, with my poor old nose looking far better than before. Just a little numb and tender at the moment but that is expected.
The numbness will probably be there for sometime as the nerves have to sought themselves out.
Take Care,
Peter
Hi Anna. Yes, little things can be really bad so it's good to get them early!
I'm recovering well but the heat down here is unbearable, with Sydney and places down south suffering 110 degrees F plus.
I'd give anything for good skin and ducted air conditioning!
I like your comment about being a teacher but unfortunately I don't have the patience of a saint!
Have you had your skin checked recently?
Take Care,
Peter
Very cool Peter, thanks for bringing awareness to this cancer, why do you guys have the highest rate of skin cancer, is it the climate?
Hey Peter, I been watching TV, boy looks like you can cook eggs on the middle of the road in that heat. Hopefully the heat wave will go away soon.
Glad to hear that you are doing well.
You said: 'I'd give anything for good skin and ducted air conditioning!' - Peter I hate to tell you, but the air conditioning isn't that good for your skin.
You said: 'I like your comment about being a teacher but unfortunately I don't have the patience of a saint!- at least you are honest, lol, I don't know how do you do then with patience, lol.
Have you had your skin checked recently?
Peter no I did not, but I think I will. After reading your post both me and my husband started to look at the suspicious stuff on our skin, lol. I think it is time to get check!
Thanks Peter this post does really makes you aware of stuff. I never thought that skin cancer can be that dangerous!
Anna :)
LOL on the toes, Peter. :D Am swinging by to wish you a FANTASTIC week.
My life has picked up speed. A magazine requested to see some of my photos. :D I was busy getting the submission ready.
Keep your fingers crossed for me. :D
Hugs, JJ
Hi Peter!
"I wish I had stayed out of the sun when I was just a lad. That spilt milk saying echoes in the back of my mind everytime I go to the skin specialist."
I hear you!
"Yes, PDT can't be used on certain types of skin cancers. If you click on one of the links about PDT it will explain which cancers can and can't be treated."
I will, Pete!
"All I can say when it comes to having your skin checked, is to have it done by a skin specialist and nothing less, Ok!"
Ok, don't worry :)!
"All's well, with my poor old nose looking far better than before. Just a little numb and tender at the moment but that is expected."
As long as it is healthy :D!
"The numbness will probably be there for sometime as the nerves have to sought themselves out."
I can imagine. You don't play with it, do you? You are leaving it alone, hopefully?
Hi Bob and thank you! I believe Australia has the highest rate due to our fair skin, the hole in the ozone layer and the love of the sun.
Take Care,
Peter
Hi Anna. If not on the road certainly on a hot tin roof or the bonnet of my car.
I'm going stir crazy with this heat! Staying indoors and enjoying the cool winds during the night if and when they come. Yes, I've turned into a night owl!
Yeap! Things are fine now, now that my nose is beginning to settle down a little.
Realising the negatives of air conditioning, I'd take that over what we're going through now.
Plenty of moisturiser in our place, I can tell you!
All the very best when the two of you go and get your skin checked.
Take Care,
Peter
Hi JJ! You can rest assured that I will keep my fingers crossed for you. It will be great to know someone famous!
Take Care,
Peter
Hi Max. As always it's great to hear back from you. Live long and prosper.
Take Care,
Peter
Cancer in all its forms is very upsetting--an ugly and insidious disease--and I'm sorry you have had to deal with another occurrence. Hopefully your photos will dissuade some people from hanging out in the sun! And I'm SO glad these two were not melanoma.
Thanks for your courage and candor in sharing these photos and your story, Peter.
Hi Lynda Lehmann and thank you again for your kind words.
Yes, lets hope the words and images here do save someone.
Take Care,
Peter
Peter,
Just checking in to see how the nose is coming along. Hopefully it's all healed up nicely by now.
You take care and find a good hat!
Hi Janeywan and thank you for asking how my nose is going. Yes, it has healed up nicely. Although totally numb in the beginning, some feeling is coming back. This is expected and it will take sometime to get full sensation back.
I have plenty of hats and plenty of zinc cream to last me and my nose a life time.
Take Care,
Peter
Hey Peter are you okay? How is your nose, and how is the weather, still hot? Anna :)
Hey Peter I will respond to your comments later on my blog. But I thought I let you know about the comment box. The comment box is working fine, it is just me. It is easier for me to comment back using the original comment box not emmbedded. However, when I change to full page or pop up, because of the code, it leaves a white form inactive box, and I don't want to remove from the code. I probably will go back to the embedded again, lol. Just deciding which format is good for everyone.
Hey Peter cannot wait to see the blog makeover!
Lastly, tt is terrible about the fires, us to been watching on tv.
Anna :)
Hi Anna and thank you heaps for asking how my nose is going.
I can tell you that my doctor has done a fantastic job as my nose hasn't fallen off yet, well, for the moment anyway!
It's pouring cats and dogs in Sydney at the moment, thank God!
Just hope our southern state of Victoria gets the same treatment.
Take Care,
Peter
Hi Anna! I must have replied to your earlier comment at the same time you were commenting.
Thank you for the feedback. I'll keep your thoughts in mind when I see how the commenting goes on my new template.
A lot of hair pulling and grinding of the teeth at the moment but I hope to have it out soon. Just have to stop watching the fires on TV.
Take Care,
Peter
Hi Peter
My story is very similar. Had a BCC growing near the tip of my nose. First I underwent PDT, but, 18 months later, the rodent nodule was back. The dermatologist recommended having it removed post haste. So I also had the excision, frozen section pathology and bilobed reconstruction on 11 Feb. An interesting point here is that I take a daily aspirin for my heart, and never thought to mention this to the doctor (I mean, after all, what is a little aspirin?) Big mistake! There was quite a lot of bleeding, both during and post surgery.
The stiches were removed six days later and things looked very ugly under the dressing. Lumps and bumps and allsorts - somewhat like the surface of the moon!
However, the plastic surgeon kept muttering: "beautiful, beautiful" as he was removing the stitches, so I still had some hope!
He also recommended massage and the use of a silicone-based cream (Kelo-cote) applied once a day for a period of six months.
I must say, things are looking a bit better, but there are still quite a few raised scars and ridges.
My message to anyone who reads this - particularly the younger ones - wear your little sunhats and apply loads of sunblock!
Keep well and thanks for a very informative site. I'm glad I only read it AFTER my surgery, though!
Hi Ann from South Africa! Great to hear from you! I see we have a lot in common as we've both been through the same type of war together even though so far apart.
It's a great pity PDT didn't work for us and that we had to go through the pain of surgery.
The worry of what it would be like afterwards was of great concern to me, as it would have been for you. But I shouldn't have worried as things are looking up for my poor old nose.
Sorry to hear about the aspirin experience but still you came through it ok.
My referring doctor and surgeon both said the same thing after my surgery. They do love their work don't they. Can't blame them really when so do such awesome near miracle reconstruction.
I was dreading having a graft, as I believe the results are not as good as the flaps.
The same goes for me, as my nose, although not the same will soon be after the cushioning (raised skin at the cancer site) appearance fades.
If only, if only we had our life to live over again we'd be clean skins!
Thank you heaps for your comment. Keep well and take care, Peter.
Peter-
I just wanted to let you know that I have a spot in the crease of my nose where it meets my face that looks almost identical to the nodular BCC you had removed.. I'm making an appointment with my dermatologist this week.
Thank you so much for making this post.. if you hadn't put the picture up I would have dismissed it as a blackhead and never thought twice about
Hi Anonymous and welcome! I'm hoping it's not anything that requires excision. You are doing the right thing seeing a dermatologist and I congratulate you on having it checked out.
Please let me know how you get on and if there is anything else I can do please let me know.
Take Care,
Peter
I will keep you posted! =)
Hi Anonymous! You're certainly on the ball and good luck!
Take Care,
Peter
Do you have an email address that I might reach you at?
Hi Anonymous! I can be contacted at stvincentsmalenurses(at)gmail(dot)com, Take Care, Peter
Hi Peter,
Thank you for your story. I am having surgery on a recurrent BCC on the side of my nose, and your information told me more than any doctor! I am having Mohs surgery, but until they are "in there" they won't know which reconstruction. Best case scenario is the bilobed flap, so I am hoping! Did you have the excision and flap surgery on the same day? I have my choice of the Mohs surgeon doing the flap reconstruction, or waiting until the next day and having a plastic surgeon do it under general anesthesia. I'm not sure which would be better.
Thanks again for the info. Your nose looks really good.
Ruth
Hi Anonymous. Sorry to hear about your bad news. For me, the bilobed flap repair was done immediately after the Mohs surgery by the Mohs surgeon.
Prior to this, I had been given some oral sedation after which the site was injected with a local anaesthetic.
It didn't take long as I was in at 7am and out sometime after lunch.
I had been to this specialist centre before for Mohs surgery to my ear and I must say, I trust their work.
Sorry, but I really can't advise you one way or the other in regards to who should do the repair. Obviously you have spoken at length with your Mohs surgeon. Perhaps you could do the same with the plastic surgeon.
Seeing pictures of both their work, would certainly help me make my mind up.
My nose is fine now, with one of my friends just yesterday saying he could hardly notice anything different with it.
Ruth, I wish you all the best!
Take Care,
Peter
I also recently had cancer taken from my nose area and had a flap under my nose. Your nose looks a lot better then mine. Thanks for sharing.
Hi Anonymous and welcome! My heart goes out to you, as I understand what you went through. I hope your scars will diminish with time, as mine have. Although it will never be the same, I am very grateful for the skill of my two doctors whom I trust with my life and my poor old nose.
Take Care,
Peter
Hi Peter, this Monday a BCC (diameter 3 mm) has been removed from my nose. I asked for Photodynamic Therapy (PDT), because of the excellent esthetic results, but all 6 doctors I turned to said, micrographic surgery (excision in toto) would be better. Photodynamic Therapy, they said, is for therapy after a biopsy and not for a combination of therapy and diagnosis instead of a biopsy. After the surgery the micrographic control showed that the BCC was only 0,6 mm thick and lay "on top of the skin". So curettage or PDT would have been sufficient. Now I have to live with one nostril smaller than the other, although I favoured a less invasive method. Wolfgang
Hi Wolfgang and welcome! Sorry to hear about your nose. You've certainly done your homework going on the fact you consulted six doctors and it's a shame it didn't work out the way you wanted it to.
As for me, I was scared witless when I found out about what was going on with my poor old nose. The number of procedures and treatments has taken its toll but I'm happy to say, I survived it all and my nose, although not the same as before, is almost as it once was.
My Mohs surgery involved two excisions after getting the biopsy results and I'm very thankful for the work that was done and the good result.
All I can say is when it comes to facial surgery, is that everyone should see a specialist and at the same time to ask to see pictures of their work.
As for sun protection for the nose, forget 30+, zinc cream is the only way to go.
If you need to talk about this more, feel free to contact me via the email address at the bottom of my page.
Take Care,
Peter
Thank you for sharing this experience with us - it is not every day that you can read about this type of thing and it will hopefully help others who are in the same situation or even better people like me to either spend less time in the mid-day sun and/or slap on much more sun screen!
Thanks for the informative one.
Hi Shankha and welcome! I'm glad you found my story helpful.
Take Care,
Peter
Hi Russell and welcome! Sharing my story here has been both painful and insightful for a lot of people. I am amazed how many have found it and I hope they have gotten something out of it as skin cancer crosses all boundaries.
Hopefully one day, it will be a thing of the past.
Take Care,
Peter
Nice blog, very interesting.
Hi Freddie and welcome! Your list of blogs is very impressive and must keep you very, very busy. Thank you for dropping by!
Take Care,
Peter
Hi Peter,
My name is Alice. About a year and half ago, a lesion starting forming on the right side of my nose.
I went to the dermatologist who initially thought it was type of wart. We removed it at first by freezing. The sample was sent to pathologists which confirmed that it was not cancerous.
However, since then it has come back repeatedly. Since June 2008 right through to now, I have frozen the lesion, then had a shave biopsy, used various creams eg. Aldera, had it lasered and more recently used DCP cream in which activates my immune system and reacts to the area where the cream is applied. The cream causes major blistering to the area and is suppose to dry and scab off.
At first I thought it was working becuase the area where the lesion was, was smooth and flat. But soon after, the lesion appeared, but much much more raised and spread.
Due to its persistent nature, my dermatologist now believe that it may be a type of birth mark in which can occur later in life, and if not removed properly can reoccur.
So after almost a year and half of attempts, my dermatologist has recommended that I see a plastic surgeon to perform excision and flap repair - The procedure that you had.
So, what I would like to know is, do you have any scars at the moment. Can you upload a current picture.
I have booked myself in for a plastic surgeon in November, but was wondering if you know a good surgeon who you know can do a good job.
Hope you can shed some light.
Hi Alice and welcome! You certainly have come through the wars. By the way, you would think that with all the biopsy's etc that you have had, they'd be able to tell you what it was.
I have posted a recent photo of my nose on my blog and although there is some nose disfigurement, I'm happy with the result. Now, if I used makeup, you might not see the defect at all!
My operation was done by a Mohs surgeon and not a plastic surgeon. It was done under a local anasthetic and not a GA. A day only procedure and I was home by the afternoon.
My local skin specialist referred me to the doctor concerned and a link to this practice is in my latest post. Wishing you all the best.
Take Care,
Peter
Hi
I had the same operation last Thursday, and I am waiting for the stitches to be removed. My face looks like I have done 10 rounds in the boxing ring. I never thought as myself as being a vain person, but I am totally devastated and overwhelmed with emotion. I have a wonderfully supportive family, but find myself apologising for the way I look all the time. Your website has made me feel loads better though, Thank you.
Jane UK
Hi Jane. My terrible thoughts of what was behind the dressing vanished once I looked in the doctor's mirror after the stitches were removed.
Finally I could see that my nose, even though swollen and sore, would be almost back to normal once the healing process was completed; as you can see in my latest article.
If you click on "Home" at the top of the page you will see the final result of what my nose now looks like.
Jane, as your wonderful family has probably already told you, there is no need to apologise. Hopefully, messages like yours and mine, will make others think twice before going out into the sun unprotected.
Thank you for your heart warming comment and get well soon!
Take Care,
Peter
Peter I was cruising around your site and saw this what a horrible scare I hope everything continues to be alright. I surely understand the horror in that experience for you.
Blessings and friendship
Dorothy from grammology
grammology.com
Hi Dorothy! Yes, it was a horrible scare but I recovered fairly well. It's an ongoing problem with me, as I have very fair skin and as a result of sun damage during my early days, the fight is ongoing, sad to say.
Blessings to you and your family, my friend!
Take Care,
Peter
hi Peter, i also had a skin cancer removed on my nose. did they tell you how deep it was?
Florida
Hi Anonymous and welcome! My doctor never told me how deep it was except to say it required a second excision as can be seen in image one.
Take Care,
Peter
Here is a link to more information about the genetics of Skin Cancer that was prepared by our genetic counselor and which has links to some useful resource for those dealing with this condition: http://www.accessdna.com/condition/Skin_Cancer/671. There is also a number listed for anyone who wants to speak to a genetic counselor by phone. I hope it helps. Thanks, AccessDNA
Hi Shashank and welcome. Back from the link you mentioned and I am amazed on how much information you have there. If only I had this information when I was young, then I wouldn't have the trouble I'm having now.
Take Care,
Peter
Hi I have recently had the same procedure but the scar goes from the side of my nose level with my eye, in two loops, to the tip, I have got two lumps where the skin was turned around to cover the gap. Do these lumps disappear in time and how how long were you away from work.
Hi Anonymous and welcome. The only thing I can suggest is that you go back to your surgeon and have him/her review the site.
For me, it was about six months for things to settle down - that is, to get back full feeling. I have slight cushioning to the site but it is now hardly noticeable.
As for how long I was off work for, silly me took annual leave to have this done. But I could have gone back to work straight after having the stitches removed.
Now, if you look in my right sidebar under the heading "2009", you will be able to see how my nose looks now by clicking on the words, "Skin Cancer Part Two."
That will take you to my update on my poor old nose. I hope this helps.
Take Care,
Peter
As a fellow treatee of the same issue, with a similar surgical technique, I found the post very informative, especially the photos.
Mine was last week - 4 days ago and skin is already settling down. Done with local anaesthetic in the surgery, by an experienced GP with good knife skills.
Have had many small skin cancers removed. One issue/ area that should not be forgotten is the knuckles and top of the hand - areas exposed if you drive a lot, car or truck. Many Australians in rural areas do protect the face and back BUT rarely that area, and they drive A LOT. R arm is also another area - the old arm out the window syndrome, less so now with a/c!
early detection and treatment is vital......have a look, take action!
Hi Peter H and welcome. Great to see a new face here!
Sorry to hear about your experiences with skin cancer but I am heartened that you are on the mend.
Skin cancers! The same goes for me and I have lost count of how many I've had cut and frozen off.
As for my nose, my skin specialist referred me to a Mohs surgeon and probably just as well, as I am a very nervous patient and have been known to jump about a bit when under the knife.
You're spot on about the areas you spoke of, with people tending to forget to take measures when driving for long periods in the sun.
Being an old fellow myself the one promising thing I see now is the use of rash shirts etc by the younger folk.
Just as well really as the number of young people affected by melanomas is increasing.
Now, if you want to see what my nose looked like well after the operation, just look in the 2009 folder in my right sidebar and click on, "Skin Cancer Part Two." Not bad considering what it went through. All the best!
Take Care,
Peter
Hi Peter,
I developed a small flat red spot on the bridge of my nose around Dec 2009. I started becoming concerned and made an appt. with a Dermatologist/Plastic Surgeon who felt it should be removed and sent to pathology. I will get the results this Thur. May 6, 2010 and am very nervous. He said he wasn't sure if it was basal cell or squamous cell which is all I know right now. I still have steri strips on so I don't know how much was removed or how deep it is. Am I on the right track?
Hi Grace. Hoping that on the 6th, you receive good news. Now, your doctor has done the right thing by taking a biopsy.
I have heard of some cases where the suspect item has been frozen only to come back again revealing its true form, so having a biopsy is the best thing for you.
In the past my biopsy sites including the ones to my nose have healed well with no scaring at all and I am sure yours will be the same.
For me, the ones to my nose only involved one stitch and that was done just to close the very small site and to prevent further bleeding.
Yes, I worry to, as I wait for results but I must say I have become quite matter of fact about them as I have had so many taken. Fair skin is my curse unfortunately.
The good news for me as it is for you, is that you and I did something about the suspect lesion early. Yes, you are on the right track!
Take Care,
Peter
Hello Peter,
I had a bilobed flap repair on my nose just recently (16th April this year) and it appears to be healing well, but the colour/texture doesn't feel the same as the rest of my nose and the new skin feels numb - is that normal? I'm also concerned about the scarring as it seems quite deep to me. I am an out-patient though and no doubt it will be checked out soon.
I would appreciated your comments,
Cheers, Tony.
Hi Tony and welcome. I had the same experiences as you with my flap repair. My doctor said it was quite normal.
It took some months to get full feeling back as it takes a while for the nerves to sort themselves out. The redness and swelling also took sometime to subside.
For me, they recommended after the sutures came out to gently massage the site to reduce the swelling, which I did of course. Yes, it did help.
As for you, check with your doctor first about this technique before doing this.
I do have some scaring and cushioning to the site but it is hardly noticeable now.
I'd imagine the scarring seems quite deep to you as your nose must still be very swollen, give it time and you'll see the improvements.
Now, if you have any concerns about your nose, don't hesitate to contact your doctor.
Take Care,
Peter
Thank you most kindly Peter... I see the doctor tomorrow and I'll mention that, cheers. ~T
Hi Peter
I've read your blog with interest as your story mirrors my own. Three years ago I had a BCC removed from the bridge of my nose via a similar procedure involving a rotated skin flap. While I can see the scarring, noone else really notices. Trouble is I've just been diagnosed with a large BCC on the tip of my nose and, due to the previous scarring, surgery to remove it will require a skin graft. I've seen the plastic surgeon who is not confident of a great result (ie/ I'll be scarred with a large pale divet on the end of my nose and nasal contouring will be affected). I was also referred to a cancer unit to investigate radiation treatment as an option and have seen the oncologist today. He agrees the plastic surgery results would not be great (and he thinks there is another BCC on the other side of my nose) and beleives I would be a good candidate for radiotherapy.
I'm just confused now. I'm 48 and concerned about future side effects from radiotherapy, but I'm still vain enough to want my nose to continue looking like a nose. In your experience have you ever heard of anyone receiving radiotherapy for a BCC and the success of this treatment? The oncologist says it has a success rate of more than 90%. The plastic surgeon says the success rate is much lower.
I've been Googling for more information but have not found much to go on yet.
As your own account was so detailed and thorough, I thought you may be able to point me in the right direction for getting more information.
Many thanks
Judi
Hi Judi and welcome. I'm no expert but have they considered PDT, photodynamic therapy, or Mohs surgery as a treatment?
As for radiotherapy, I am aware that it is used but I don't know of anyone that has had it done, but with more than a 90% success rate, that would be enough for me to have it done, especially if the advice was coming from an oncologist.
Please let me know how you get on, as it may help me in the future.
Take Care,
Peter
Hi again Peter. Thought I'd let you know how I got on with this latest BCC. In the end I opted not to go with the radiotherapy, after consulting with yet another surgeon and also with my dentist who warned of the potential risk to my teeth. I did ask about Mohs surgery but was told this was not recommended in my case. In the end I went for the surgery (last Friday) which has involved a skin graft from a donor site on my forehead, now attached to the tip of my nose. The bandages are still on so I have no idea of the outcome, but I remain hopeful it won't be too bad.
Just on a side note, in the period during which I was seeking opinions from various specialists, two felt they had discovered an additional two BCCs on my nose. I had biopsies and was told at that stage to expect my entire nose would need to be re-skinned with a trunk like structure they would re-create from my forehead. I was devastated. If you Google this op you will see why. But as it turned out the other two biopsies were clear - so only one BCC to contend with not three.
This showed me that even the experts can get it wrong sometimes so I didn't feel as stupid for not realising the original blemish on my nose was a BCC. It is bad enough having to go through the surgery, let alone feel guilty for not wearing a hat so much when I was younger....
Hope all goes well for your nose story, with no re-occurance of these nasty BCCs!
Judi
Hi Judi. To pinch a phrase from my grandmother, "You have been put through the ringer." Good news about there only being one BCC though.
Yes, doctors aren't perfect as I found out when one of them told me many years ago, that a spot on my back was just an insect bite. Turned out to be a melanoma.
Although I hate having biopsies, they are the only way to make sure if something is truly suspicious. No need to tell you that one!
I wish you a speedy recovery and a life free from any more hassles.
Take Care,
Peter
OMG i am so scared now. I have had a lesion on my nose for about five months now, I saw doc at month two and the ointment he gave me seemed to make it grow larger. The dryer i can keep it, the better it seems to be, but now with this heat wave we are having in Ontario CA, it seems to be growing again. Saw doc again today, he has referred me to a specialist. I am so afraid now i am going to have to go thru all that you did peter,, Not sure if i am mentally or finacially ready....pray for me.
Hi Anom. Sounds like you need a skin specialist to take a biopsy of the site to determine for sure what it is. Try not to worry until you get the results. Easier said than done though, hey.
I worry over these things like you but in good hands you will come through okay. Yes, I will pray fro you and please let me know how things turn out.
Take Care,
Peter
Hi Peter,
I would like to thank you for all the information you have shared with so many people.
I was trying to find out info about skin flaps when I first found your blog and I was able to know so much from your experiences....much more than what I had been told by my doctor so thank you very much.
I had a lump on my nose that I had actually had for more than 15 years but just thought that it was an overgrowth of cells under my skin.
I am from Australia but have lived in Japan for a long time and decided to have it looked at 2 years ago.
A biopsy was done and I was told that it wasn't anything to worry about so was relieved but I went to a plastic surgeon in May to have it removed out of vanity(??)
The surgeon was able to sew the skin together so I was so glad that I didn't need a skin graft but was told a week later that it was cancer so I was really shocked.
I then had the whole thing cut out and the wound was left open for a week until they got the results back and was relieved to hear that they had removed all the cancer cells. If there were cancer cells remaining they would have cut more away and then sent it away again and would have repeated that process until it was clear so I was really freaking out when I first heard about that.
Luckily all the cancer had been removed and a skin flap was performed a week later and then after 3 weeks I had another operation to "fix" the big lump that had been left.
I am once again stitched up and look like I have 2 big pieces of masking tape on my face once again and have actually been asked by 3 people if I had been punched!!
I also had something removed from my leg and it was also a BCC and after looking at your pictures once again I realize that I may have 2 small ones on the other side of my nose!! I mentioned this to the doctor but she said she will remove them if they get bigger so I'm not really happy with that response and will try and see someone else about it.
My right nostril is now bigger and kind of pointing up where the skin was pulled up from my face. After the stitches come out I've to keep tape on the scars for 3 or 4 months so hopefully I'll be beautiful again by Christmas!!! If not then I'll just keep the tape on for the rest of my life.....
Sorry for writing a novel but once again thank you for all the information that I was able to get from you before my 2nd operation and for showing pictures too. I really appreciate it.
I'm sure this is just the beginning of the merry go round for me but I hope it will not be too rough a ride and hope that you will be OK and stay healthy.
Kindest regards
Jackie
Hi Jackie! There's no need to say sorry, far from it, it should be me giving you one big pat on the back for being so honest and open with someone you don't know from a bar of soap! So, thank you ten times over. You really made my day!
Fifteen years in Japan! I haven't even been overseas unless you count Tasmania as being OS. The stories you must have up your sleeve, you should really start your own blog to share them.
Now, you have certainly gone through a rough patch, and I hope with all my heart that things get better for you, especially your wish to be beautiful again by Christmas.
Why wait till then, I can tell you're already beautiful, inside and out.
Take Care,
Peter
Peter,
Thanks so much for sharing your experience. Three weeks ago, I had two basal cells removed from my nose with Mohs surgery. Each had been there for a very brief time and barely showed on the surface. Unfortunately, they were far deeper than anticipated. I had plastic surgery the next day and, like you, a nasal flap was used to repair the damage.
It's now three weeks post surgery and I am far from happy with the results. I know it's too early to be concerned, but I am. I have both horizontal and vertical scars on my nose and the area around the scars is lumpy. One nostral looks slightly different than the other. Much of hy nose is numb. Does your nose look as it did before the surgery? Is it still numb? I wasn't able to locate the current picture of your nose on the website. Could you possibly email it to me at levpers@msn.com.
Any info you can share with me will really be appreciated.
Laurie
Hi Laurie. As you say, three weeks is far too early to tell how your nose will end up looking like. Two procedures on the nose at once will obviously take sometime to heal properly and for the swelling to go down.
Yes, my nose was numb for a number of months, but that is normal for such a procedure. I now have full feeling back after the nerves repaired themselves, and, all up I'm very happy with the results.
Yes, my nose is not as it was but with the amount of sun related skin damage that I have, I'll take the good with the bad.
I sent an email to you with the details of how to access my post on how my nose looks now.
I had very good doctors and they were only to happy to address my concerns, even relating this to me on the phone.
Take Care,
Peter
Hi Peter,
Thanks for your comments to my blog and thank you for this post. It was one of the ones I looked at when I found out I had BCC on the nose. That was last May, (right after I visited your lovely city for the first time--and what a shock to come back to this diagnosis!) and after Mohs, things went well and my scar is small.
Your nose looks great now, and I hope you are doing well.
Wishing you all the best.
Camille
Hi Camille. Welcome back! Like your story and mine, its good for others to read about our experiences, as it lessens the fear of what is to come if ever it happens to them. Don't you think? Well, I could be wrong.
Did you like Australia? Just as well you weren't here late Dec and Jan, Queensland that is, with the floods and all. Yes, if it doesn't rain it pours. As for me, I'm having further Mohs surgery to my nose late March, 2011.
Take Care,
Peter
Peter- I too had the same thing done this year- 1/11/2011. I do not have feeling completely at this time but I feel a lot of scar tissue-- did you experience that- and did it go away- I am very worried- as one my nostrils looks different now due to the scar tissue and its a huge knot like area- hoping in time this will all go away. Thanks - B
Hi B and welcome! I didn't recover full feeling until the nerves in my nose had mended. This took months and I'd imagine this will be the same for you.
The swelling and scars on my nose also took sometime to subside. I had a raised area, known as cushioning, and this also subsided although not gone for good, but you can hardly notice it unless you get up close.
My doctor suggested massaging the area gently after the site cleared which helped.
Next time you see your surgeon ask him/her about it and express your concerns at the same time.
So you don't forget anything, write all your questions down before seeing the surgeon.
If not seeing the surgeon again, best make an appointment to get things checked up. I hope this has helped. Wishing you all the best!
Take Care,
Peter
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