Will it hurt?
July 27, 2012 10:46 AM   Subscribe

Having a potentially cancerous skin growth removed by a plastic surgeon. What should I expect?

There is what appears to be basal cell carcinoma on my jaw, and my doctor has referred me to a plastic surgeon to remove it entirely, repair any cosmetic damage from the surgery, and send the growth to a lab for analysis.

My doctor said it could be something else, too, but that it certainly could be a common skin cancer like squaomous or basal. Maybe I shouldn't worry yet, but that's almost impossible.

I've never had any kind of cancer, never seen a plastic surgeon, never been to a doctor for anything serious. I guess I'm wondering if anybody here has been through something similar, and what your experience was like. I have only a vague idea of what to expect and what questions to ask.
posted by swift to Health & Fitness (16 answers total)
Best answer: I had one removed from my cheek at the Cleveland Clinic, by a plastic surgeon. They did not initially assume it was cancerous, so I ended up having 2 surgeries. For the first I was awake, local anesthetic, quick and easy. When I went in for a followup appointment the surgeon pulled up the lab report, read it over and said in surprise, "Oh, it was cancer!" They scheduled another surgery to take out a bigger chunk of my face (Mohs), and for that I was unconscious. I had almost no pain at all through the whole process, and the scar is not very noticeable.

If it turns out to be cancer, they'll tell you to wear heavy-duty sunscreen whenever you expect to be outside for more than 15 minutes (except in winter) and to see a dermatologist annually for a skin check (strip and let them look at you).

Cancer is a scary word, but as a friend told me when my basal cell carcinoma was first diagnosed, if you have to have cancer, this is the kind you want.
posted by jon1270 at 10:56 AM on July 27, 2012 [3 favorites]

Best answer: They're going to numb up the spot with a shot of numbing juice, then carve it out of your face. They'll drop the sample into a jar of liquid. And then they'll likely finish up by going over the open wound area (my assumption is that this is small) with a hand cautery tool.

The shot will feel like a shot. The carving won't feel like anything because the area will be numb. The cauterizing part will be unpleasant (because burning flesh is stinky), but it's very unlikely you'll feel anything.

It'll hurt once the numbing agent wears off, though, because you'll have a face crater. Just care for it as you would any other wound (keep it clean, follow their aftercare instructions) and it'll heal up in a few days.

You'll probably get a phone call within a week with the biopsy results. My family has had some pretty weird-ass things cut out of us (moles, warts, skin tags, all sorts of delightful stuff), all have been biopsied, and all have (so far, fingers crossed) been negative, so I can't tell you exactly what the next steps are if it's positive, but it probably won't be a huge deal considering this is your first thing. (Maybe go in to get a more aggressively-sized area removed.)

Skin cancer is nothing to take lightly, of course, but it's not like it's lung cancer. The treatment for early-stage stuff is generally very minimally invasive and very successful. Good luck!
posted by phunniemee at 10:59 AM on July 27, 2012

Best answer: I had a very large mole on my neck that I was born with. It always got caught on combs when I had my hair cut and sometimes bled when that happened. At some point, it began getting larger and darker, so it was removed and biopsied. I had a PA for the surgery who had worked with a cosmetic surgeon. He cut a football or eye shape out in a direction such that the remaining straight line scar blends in with normal creases in my neck/throat. It turned out to not be cancerous. It ended up being a very minor issue.

I also had surgery on my face for a cyst. That was also a positive experience with minimal scarring. The main thing was I could not laugh, could barely talk, could not lift weights (because I could not grimace) and had to eat a soft diet for a few days. The stitches were very near the corner of my mouth, so that was the reason for the restrictions.
posted by Michele in California at 11:00 AM on July 27, 2012

Best answer: I know someone who had about 100 growths removed from her face. It shouldn't hurt too much. They'll numb you and most likely you'll be awake. It will be very fast.

They'll biopsy it, and then call you with the results.

You might be worried about a scar, discuss that with your surgeon. (S)he may recommend medications to prevent scarring.

Try not to play the most awful scenarios in your head.

When visting with your doctor see if you can bring someone with you to advocate for you, to write down what the doctor says and to prompt you to ask questions. When you're freaking out, you're not at the top of your game.

Keep a pad around and as things occur to you, write it down. Take it to the doctor with you and ask about everything.

My friend had no further problems with her skin cancer and although she lives in Phoenix, she covers up to prevent recurrences. It's been 20 years.
posted by Ruthless Bunny at 11:01 AM on July 27, 2012

Best answer: swift, my recent thread might also be of some use to you.
posted by thrasher at 11:15 AM on July 27, 2012

Best answer: I have dealt with suspicious growths all over my body, but about two months ago, I suddenly got a very weird thing growing on my lower eyelid. I promptly made an appointment with an oculo-facial plastic surgeon for removal. I was concerned that it was on my face and, specifically, on an eyelid; that's why I went to a specialist. All he does is eyelids and the immediate surrounding area.

A biopsy is simply removal of the growth for evaluation. The surgeon will remove the growth, either by punching it out, or by using a scalpel to slice it off. They will give you a local anesthetic via injection to numb the area. You shouldn't feel anything beyond a bit of pressure (maybe). They will either cauterize the site or maybe give you some very fine stitches, depending on the site. They will probably take the whole thing, but that's a question for the doctor.

Once the pathologist has examined it, and determined if it's cancer, you may need to see a Mohs surgeon to have very small pieces of tissue removed and examined under a microscope until the malignant tissue is all gone. You may or may not be closed up then; you may need to see a plastic surgeon in his/her office to get closed up.

If it's not cancerous, which I am rooting for, that's it--you're done. But, keep an eye on the site for re-growth, re-pigmentation, or anything suspicious.

Your wound will probably be itchy as you recover. You will want to follow carefully the instructions given to you because it is on your face and you will want to keep scarring to a minimum. So--don't pick, don't scratch, don't do anything to compromise the wound's recovery. Ask the surgeon about scar management, especially if you tend to get keloids.

I know it's hard to not worry, especially when the site is on your face. But, you're seeing a plastic surgeon, and you're being proactive about it. Ask about how often you need to see a dermatologist, too--I go every year for a yearly check because I am at high risk for skin cancer (suspicious moles, pale skin, pale eyes, etc).
posted by FergieBelle at 11:27 AM on July 27, 2012

Best answer: I had what turned out to be basal cell carcinoma on my right cheek. I was referred to a plastic surgeon to have it removed as it was on my face (which is why you were referred to one as well.)

They did a biopsy of it (which basically removed almost all of it at that point as it was not too large to begin with (I had caught it early. Early detection is key!)). It was determined to be basal cell carcinoma (which, if you have to have skin cancer, is the best kind to get.).

They had me come back in for mohs surgery, to remove the rest of it, which, depending what they find, can take several hours to do! (So bring a book and have someone come with you to drive you there and back.) I was lucky, as they got all of it after the first round. They will give you a local anesthetic, and you will be awake for the procedure (I was chatting with the doctor while she did the procedure!).

I did end up with stitches. They sent me home with instructions on how to care for the wound and I had a follow-up appt to have them check on it and have the stitches removed. As I am very fair-skinned I have to go back to see them every 6 months to have a "body check" to see if any more develop.

I don't remember any extreme pain after the surgery (they did give me pain pills for that though). I do remember not being able to bend over or lift anything heavy while I had the stitches, and the worst part was sleeping at night, as I sleep on my right side and I couldn't sleep on it for two weeks while my wound healed! Once the stitches came out I did have to massage the area daily in order to break up the scar tissue beneath the skin and "smooth out" the minor scar on my cheek.

As long as you go to a good plastic surgeon you'll be fine. Good luck!!
posted by Hanuman1960 at 11:50 AM on July 27, 2012

Best answer: Both my husband and I have had suspicious moles lopped off, and in all cases they were nothing. They inject the numbing stuff, lop it off, stitch up the space, and off you go. I personally have always opted just to have the whole thing removed (rather than take a biopsy and only remove if there's cancerous cells), which they do if it's up to a certain size, I think. I have one slightly noticeable unnecessary scar on my shoulder where I had a bigger one all off at once, but whatever, it was a noticeable mole before that, I don't think anybody cares. (They could have plastic-surgeoned it up but I did not care that much about having a scar on my shoulder.) They heal pretty quickly because they're neatly-done incisions by a surgeon, not like haphazardly cutting yourself and ending up with stitches. Bigger ones look a little cratery and OMG HOW WILL THAT EVER HEAL NORMAL but they heal normal, I promise.

If you can have someone accompany you, do that. You may not react well to the injected anesthesia (it makes me feel nauseated when I start metabolizing it ... after the surgery is over, but before I make it home). It's not a big deal, I can make it home by myself, but it's nicer when I can just slump in the car afterwards and let someone else drive.

I had one mole lopped off when I was under anesthesia for abdominal surgery and I thought, this is a great idea! Two surgeries, one anesthetic! Excellent painkillers! But it was NOT a great idea because it turns out to be hard to care for awkwardly-placed mole removals while recovering from abdominal surgery.
posted by Eyebrows McGee at 12:15 PM on July 27, 2012

Response by poster: Thanks for all the responses so far. There's a lot of great information, but the best part is hearing firsthand that it's probably not that big a deal (knock on wood).

My initial appointment with the plastic surgeon is on 7/31, and my wife will be able to come along (and drive me home). If this thread is still open then, I'll try to remember to update it.
posted by swift at 12:43 PM on July 27, 2012

Best answer: I had Weird Spot cut out of, not my face, but the side of my calf, by a plastic surgeon a couple of years ago. I just wanted to add that, while I did not get the plain white-ish scar I'd hoped for, the size and color of the resulting scar-spot is STILL fading and improving in appearance to this day, so if it doesn't look as good as you'd hoped a few months afterwards, don't despair.

Best of luck!
posted by Occula at 2:20 PM on July 27, 2012

Best answer: I've had surgery for basal cell on my chest and and shoulder, and a rather larger surgery on my forearm for melanoma on my forearm, just in the past three months. (I'm going through a rather rough patch personally.)

I bought something called ScarAway for my forearm -- they are silicone strips that you wear over your scar once the wound has healed (not before!). They're supposed to reduce the appearance of the scar. My doctor dismissed the notion of using vitamin e oil or any of the scar creams.

It seems to work, but mostly because it protects the scar from the sun (which will turn it very purple).

Actually, that's what I want to emphasize for you -- protect your scar from the sun. It has no melanin to help.

Good luck!
posted by book 'em, danno at 6:53 PM on July 27, 2012 [1 favorite]

Best answer: Also Basal Cell here and also had Mohs 2 of the 3 times I've had BCC. The scarring on my forehead is minimal - the nose was trickier because there's just not that much skin to pull there.

None of it really hurt - just a little overwhelming seeing the hole in my face when they showed it to me. On my forehead I had stitches for a week, came back in, and they just snipped them out.
posted by getawaysticks at 8:03 AM on July 31, 2012

Response by poster: Saw the plastic surgeon today, who took a biopsy and gave me a stitch. Next appointment is in a week.
posted by swift at 1:33 PM on July 31, 2012

Response by poster: ... and as predicted, it is indeed basal cell carcinoma. I have cancer!

It's a good-sized one, he said, (around 2 cm diameter) and will require a pretty long incision. You can't just cut around the perimeter, because you can't stitch a circle back together.

Luckily though, the scar will be under my jawline. The procedure will probably take place later this month, at a hospital. There will be a little novocaine, and they'll examine the extracted tissue to make sure all the cancer cells have been removed.

Thanks again for everyone who answered -- it really has made all the difference.
posted by swift at 11:08 AM on August 7, 2012

Hey, thanks for the update--good luck! I'm sure everything will be just fine.
posted by phunniemee at 11:31 AM on August 7, 2012

Response by poster: I had the surgery today. It went well -- the surgeon did the excision and sewed me up immediately because "99 times out of a hundred" he gets it on the first try.

It hurt a little but not too much. Kind of uncomfortable and intense having surgery on one's neck, though. The worst part was waiting on the table, prepped and immobile, while the sample was analyzed. I really just wanted a drink of water.

The whole thing took a little over an hour.

Now I have a big bandage for the next few days, and can't turn my head very well because of it.

But I don't have skin cancer, and that's wonderful.
posted by swift at 10:51 AM on August 22, 2012 [2 favorites]

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