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.

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.

Base Image courtesy of Artistic Realism Fine Art / Artistic Realism Art Studio
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.

Image used with permission.
Courtesy of DermNet NZ

After further follow-ups by my specialist all appeared well as both skin cancers had disappeared with no visible defect caused by the treatment.

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.

So, where to from here? After my specialist confirmed that it was a nodular BCC by way of a biopsy, he suggested “Mohs surgery”.

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.

“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.

Image used with permission. Courtesy of DermNet NZ

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.

Image 1: Excision below with the two flaps marked in blue above	Image 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)

“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!

I hope this post makes a difference in someone’s life.

How much did it cost? A: Thank God I have private health insurance!

Update: Skin Cancer Nose No Boundaries - Part II

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References and links:

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.

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To be continued...

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Do Nurses Make The Worst Patients?

I can’t speak for all nurses, but the ones I’ve looked after have been nothing short of fantastic.

Naturally they have a better understanding of how and why things happen in a hospital, with most having a generous grin and bear it attitude when events don’t go according to plan.

Last but not least, they are quick to give thanks, without prompting, to those that help them during their stay in hospital.

For me, I take the same stance as the ones I’ve spoken about and cared for. But to be honest, I’ve had a few bad moments but this is a direct result of the ailing health system where health professionals do their best under worsening conditions and very tight budgets.

Short waiting times, excellent service, my body explored or punctured by foreign objects as little as possible, not having anything excised and a positive outcome, goes a long way to making my day in hospital as a patient a tip top day.

To date, most of my encounters have been bloody fantastic. But I can tell you here and now that on a very bad day I can be the world’s worst patient due to my own shortcomings and anal fixations. Some of which are mentioned here:

1. Being the biggest chicken in the world.
2. Extremely low pain threshold.
3. An aversion to having needles stuck in me.
4. A critical eye for things being done just right.
5. Growing distaste for having pieces of me removed.
6. Lacking the patience of a saint.
7. Being a nurse I know too much.
8. Always thinking the worst will happen.

Now, without further ado and with nothing better to do than to wallow in my own self-pity, moments of fleeting agony and extreme boredom I will now divert your attention from the above by reminding you to take care of your skin when going out into the sun.

Why? Well, it’s a long story but here goes!

I’m at home on my “Pat Malone” feeling sorry for myself after a recurring superficial nodular basal cell carcinoma (BCC) was surgically removed from my nose on Monday 12 January, 2009.

The BCC, as it’s known, was without a doubt caused by spending decades under the hot Aussie sun without adequate protection.

Thanking God for small and large mercies, I’m extremely happy to announce that I behaved myself quite admirably during the procedure and far removed from being the nurse’s and medical practitioner’s worst nightmare like I have been in the past.

Why? Ten milligrams of oral valium (diazepam) sorted this chicken out, well and truly. Mind you, my preference for excellent pain relief and sedation is “morphine” and “midazolam”.

I will explain the procedure known as “Mohs surgery” in my next post. Why, you may ask? In an attempt to get the message across that sun protection should start from the day someone is born.

“Be warned, the images of my nose will not be to everyone's liking.”

But they will show you the marvellous way my specialist doctor went about re-constructing my poor old nose.

To put you in the picture even further, I’ve had more pieces of me removed than Tom Cruise has had Aussie lamb roasts.

Somewhere, there’s just got to be a room full of little pieces of me. I wonder how they’re going in all that formaldehyde solution? Poor little devils!

The Aussie sun has played havoc with me and I have been paying the price since the age of 27. My worst experience with cancer occurred back in the early 90’s. After my wife located a pigmented lesion on my back I went off to seek advise at a Medical Centre. The doctor informed me that it was most probably a reaction to a insect bite.

Leaving there relieved but still not satisfied I sought a second opinion. This time the advise came back that it was a “melanoma”. It was successfully removed and as you can see I’m still here after having avoided kicking the bucket.

One last thing before I go,

Slip on sun protective clothing, slop on SPF30+ sunscreen and reapply every 2 hours, slap on a broad-brimmed hat, seek shade and slide on wrap-around glasses

whenever you go out into the sun, get your skin checked regularly by a skin specialist and remember the next time you go into hospital:

Give a smile to the hard working nurses and doctors! You never know, they may even smile back!

To be continued…

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A funeral for a friend

One of many that have helped me throughout my life has sadly kicked the bucket. Short in stature, he will long be remembered for standing tall amongst giants, countless selfless acts and living an unusually long life.

Although staying in the shadows with a handful of combatants for most of his life, he will be sorely missed. Not just by me but by others who were struck by his rugged good looks and his dogged determination to go above and beyond the call of duty.

To put you in the picture, he appeared shortly after I was born and remained a loyal and constant friend to the end. We tasted life together through thick and thin. Never a day went by where we weren’t together. Oh! The memories we shared together!

Known to bite off more than he could chew, he kept this reputation going even when he realised he might soon be waiting in line at the pearly gates.

Never one to complain, no one would have ever dreamt that the end was near for this gallant little Aussie trooper.

But I had known for sometime that he was on shaky ground and that he could be uprooted at any time with a wayward blow.

Alas, this came to fruition a few nights back. Following in his footsteps, I tried to bite off more than I could chew. The instant I did, I knew something had gone drastically wrong for my dear old friend.

Running into the bathroom I gave out a prolonged yell of horror and anguish as I saw his life slipping away in my wide open mouthed reflection in the mirror.

Hanging on by a fleshy thread, his lifeless body was pulled free with a single and well meant tug. Holding him gently between my fingers I realised his fight for life was finally over and he was gone.

I can still recall his last frantic words: “Pull the other one!”, made just as I gingerly yanked him from his precarious predicament. What else was there to do? Oh! The horror of it all.

Babe’s Final Resting Place

The void left in my life by his passing will never be filled. The gap too wide to mend will remain forever. A silent reminder of the lifelong friend I lost.

To be continued…

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