So I have a BCC
November 13, 2015 5:19 AM   Subscribe

Nothing particularly unusual in Australia. It’s been biopsied and confirmed. Specifically a “Mixed superficial and nodular basal cell carcinoma.” Mine’s too close to my lower left eyelid to have a simple removal. Here’s the thing. The BCC is completely invisible as far as I or anyone can comment. Previous question, related question.

It was only noticed when looking at another lesion on my left cheek that has been bothering me that’s turned out to be a actinic keratosis, also confirmed with a biopsy. That’s scheduled to be removed with cryotherapy in January. The keratosis could evolved into an SCC. SCC’s have a small but real chance to metastasise. I’m significantly immunocompromised to manage another chronic condition which complicates and exacerbates things. So it’s gotta go.

Based on the recommendation of my Dermatologist, I’ve met with a plastic surgeon to discuss the removal and repair of the BCC. He’s taken me through the likely plan and recommended excision with a flap repair. MOHs was also discussed and the view was it would lengthen the excision and delay the repair process given the location without much change to the space affected. He’s also said an overnight stay might be a good idea given the potential extent of the flap repair procedure. I’ll end up with two perpendicular, connected scars on my upper left face. And accordingly based on the consult, pale skin leaves pink scar lines.

BCC’s don’t seem to represent any existential risk. There’s a higher chance of recurrence given my immunosuppression, but that’s about it. An SCC would be worse news as it would require a change to my current treatments.

It’s a bit rhetorical as I’m not planning on not having the procedure. Still, It’s such a benign thing. Likely as benign as a cancer can be. Innocuous. This isn’t a big C. The long term untreated overwhelming likelihood once it became pronounced is a facial deformity. That’s going to happen anyway.

Friends have humorously suggested getting a face lift while I’m at it. Thank’s, no. But I’d appreciate other anecdotes or other strategies to stay positive about a procedure that won’t make a lick of difference to my overall health, well being, function or longevity; that is otherwise necessary yet leave significant scaring in a highly visible location.
posted by michswiss to Health & Fitness (7 answers total)
FWIW I have very pale skin and scar terribly. I routinely get raging keloids at my biopsy sites, for example. I recently had a mole removed from my jawline by a plastic surgeon. Initially the incision was about an inch long --it required several stitches. It was angry red and blossomed up a bruise the size of a golf ball.

But here I am about a month later. I've been diligent about putting Aquaphor or Vaseline on twice a day, and it's already faded to such an extent that it looks at worst like I had a pimple there that's still healing. No sign of a keloid, not angry red like my scars from gallbladder surgery or other biopsies, just a pink shadow. Given the speed which which it's healing, it may well disappear entirely in another month. And it's suuuper duper easy to cover up with concealer if I'm feeling shy about it.

The skin of the face heals a lot faster and smoother than other parts of the body, so you may well find yourself not actually disfigured like you're expecting. You will be OK!
posted by Andrhia at 5:44 AM on November 13, 2015 [3 favorites]

I am pale-skinned and had a BCC removed several years ago. It was very prominently located, high on a cheekbone, and it was large enough at the time to be obvious. I had MOHs surgery. The surgeon oriented the closure so that the scar would more or less align with the way my face naturally wrinkles when I smile. Now there's just a little linear divot in the skin, with no significant difference in color. It might become more obvious if I got too much sun, but that's a bad idea anyhow.

In your circumstance, I'd wonder whether the flap repair so close to an eyelid would pull that eyelid out of shape at all. That's what I'd ask the surgeon about. I wouldn't seriously contemplate skipping the surgery, because even if the health risks of doing so were relatively small, the BCC will (I think) eventually become a lot more prominent than the scar would be.
posted by jon1270 at 5:54 AM on November 13, 2015 [1 favorite]

Agree with the other posters that even though the BCC is highly unlikely to metastasize or impact your lifespan, it will grow locally and can cause greater tissue destruction, requiring a larger surgery later on if you were to opt against surgery now. If it was only superficial there would be other treatment options like imiquimod. But it's best for a nodular BCC to be surgically excised.

I do question as well whether mohs would not be better than standard excision. Yes, it takes longer (usually a full day), but you want to conserve as much tissue as you can around the eyelid.
posted by mossicle at 8:45 AM on November 13, 2015 [1 favorite]

I, too, have super pale skin and have keloid scars from a previous surgery on my chest. I had a BCC excised from just above my upper lip in about January. It was done by a dermatologist, but it was a fancy dermatologist near the studios in Burbank, so very concerned about appearances. The scar kind of dips down a bit into my lip. It is completely faded now and is just an indentation where the stitches were. NO ONE notices.
posted by kamikazegopher at 9:14 AM on November 13, 2015 [1 favorite]

Basal cell carcinoma can (rarely) metastasize. A family member had metastatic BCC and had flap surgery as well as much more extensive surgery and radiation. It was awful. My family member previously had local BCC. Perhaps knowing that, while rare, metastatic basal cell is a real possibility will help you make peace with your decision.
posted by harmonia at 11:06 AM on November 13, 2015 [1 favorite]

I had a large hairy nevus in the corner of my left eye, right up front. I am missing two eyelashes and otherwise there is no evidence that was there, or it was repaired. A good plastic surgeon makes that stuff happen.
posted by Oyéah at 2:54 PM on November 13, 2015 [2 favorites]

Response by poster: Thanks for all the reassurances about how well the face can heal.

I have to admit that the two 2mm biopsies healed extremely quickly and are completely unnoticeable now. I did the vaseline thing as well based on the advice from the assisting nurse.

I also almost immediately asked the surgeon about MOHs but hadn't asked the dermatologist before getting the referral. The surgeon's opinion was it might preserve ~ 0.5mm of extra tissue but that given the size and location, it would also almost certainly require a second procedure on a subsequent day to complete the flap repair. My understanding is the flap repair is essential precisely to prevent distortion of the lower eyelid. He also said he'd be able to use sedation in addition to a local anaesthetic to make the procedure more comfortable. I'm all for being more comfortable assuming the outcomes are essentially the same.

And hey, worst case is, I can make up some harrowing story about a sword fight to impress my nieces.
posted by michswiss at 4:32 PM on November 15, 2015

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