Skin Cancer - Lindsey's Personal Story

***This is a guest blog post from Lindsey Macomber Callahan, Skin Cancer Survivor***

"Mohs surgery, also known as chemosurgery, developed in 1938 by a general surgeon, Frederic E. Mohs, is microscopically controlled surgery used to treat common types of skin cancer. During the surgery, after each removal of tissue and while the patient waits, the tissue is examined for cancer cells. That examination informs the decision for additional tissue removal."

Read on to hear about Lindsey's experience at Massachusetts Eye and Ear in Boston. Some photos are fairly graphic, so please stop reading if you are sensitive to blood/swelling. ;)

It has been exactly one year since I had Mohs surgery to remove a Basal cell carcinoma from my upper lip. Time flies! One year ago I thought my face was going to be ruined forever and my lip would never the same. Though that may sound dramatic, it is SCARY to find out you need to get invasive surgery on your face… less than three months before your wedding. Yeah, that timing wasn’t ideal. I write this blog post with the hopes that someone else out there searching Google furiously for “before and after Mohs surgery pictures” can find it, look at all the photos, and know that everything will soon be okay. The power of SEO! There is a lot of scary stuff on the Internet, and before my surgery, everyone tried to remind me that those with good or normal experiences don't typically feel compelled to write about them. Since my experience was profoundly positive, I want to get my story out! Read on for details about my surgery and recovery, and why having a great plastic surgeon is a total game changer. 

When I was told I had skin cancer on my face in January of 2016, I was shocked to say the least. I had gone to the dermatologist after noticing a white line on my face that resembled a scar. At first, I thought I had scratched myself while exercising or sleeping and thought nothing of it. However, a few months later, it had not gone away and I hated how it looked. To be completely honest, at that point I thought it was a pimple or blocked pore and I just wanted it off my face since my wedding was quickly approaching. Oh, how wrong I was. Fast forward to the day of my appointment: literally seconds after looking at my face, my dermatologist announced that I "definitely had cancer" and would "need Mohs surgery as soon as possible". Let’s just say his bedside manner wasn’t the best! I left the office ten minutes later in tears, confused and scared, and with a referral to see the best Mohs surgeon at Massachusetts Eye and Ear in Boston, MA. When I got home, I did what everyone told me NOT to do… Googled the hell out of it!

What I learned: Mohs micrographic surgery is the leading treatment today for skin cancer on the face and neck. Mohs surgery is an outpatient procedure, and due to it's unique nature, is performed with local anesthesia so that the patient can remain awake. Until the skin is opened and cells are examined under a microscope, it is really hard to know how far the cancer has spread. My surgeon compared a Basal cell carcinoma spreading to a tree and it's roots. What you see on the surface may be very different than what has spread under the skin. For reference, my wound ended up being about four times larger than the original spot. Mohs surgery is an extremely precise and slow procedure, split up into sections called "levels". Each level involves the surgeon repeatedly removing the smallest piece of skin/cancer cells possible to minimize scarring.

A complete level consists of:

• Local anesthesia is administered
• Horizontal pieces of tissue are cut from the bottom layer of your skin
• The spot is cauterized but left open. Gauze will cover the open wound.
• The surgeon leaves the room and examines the cells under a microscope, testing the margins for cancer cells. A tumor map is drawn with the results.
• A decision is made: are margins clear, or is there still cancer present? If margins are clear, you are done, and the wound can be closed. If the margins are not clear, start back at step A.

I personally had to go through three rounds of surgery before the surgeon determined the margins were clear. The worst part was simply not knowing - would it be one round, or would it be five? There is no way to know how deep and/or wide the cancer has spread under the skin, but rest assured that Mohs surgery was created to take the LEAST possible number of healthy cells, resulting in the smallest possible scar. The surgeon will never take more than he/she should.

Okay - it's timeline/picture time! Here is how my Mohs experience played out:

August 2015: I begin to notice a faint white line on my face. A lot of people have asked what it looked like before the surgery - and how I knew something was going on. 

August 2015 - December 2015: I spend entirely too much time outside without realizing the spot on my face was cancer. I notice by Christmas that the spot has nearly doubled in size.

December 29, 2015: Visit the dermatologist, who highly suspects the spot is Basal cell carcinoma. A punch biopsy is performed. A week later, I receive the report that it is indeed Basal cell. Photo below is 2 weeks post-biopsy.

January 26, 2016: Mohs surgery day:

11:00am: Arrive and get comfy. I could still drink water, so I brought a few cans of seltzer with a straw along. I am connected to a cauterizing machine to stop the bleeding between levels. One thing to note about the cauterizing process: if your cancer is close to your nose, you’ll smell the skin burning. While it doesn’t hurt whatsoever, this is a weird smell/sensation. I was a little freaked out by it.

11:30am: The surgeon comes in to draw a circle around the visible cancer cells. I stop looking at photos and in the mirror at this point. If I had seen how large the spot already looked when circled, I likely would have freaked out. Next, they begin to administer the local anesthetic. Unfortunately, this part HURTS. I have to be honest here because I wish I knew how bad it would be - I was so worried about the procedure itself I forgot that I'd need to be numbed for it. Because time passes between levels while the surgeon tests the cancer cells, additional anesthesia has to be administered each round. Between the surgery itself and the work my plastic surgeon did to close the wound, I had approximately 30 needles in my lip and nose. Not fun!

11:45am: The procedure (aka, the actual “cutting”) begins. The cutting process is fast, but the examination of the cancer cells is not. I listen to music in between each round to keep my anxiety down. After the first stage I got a little bit panicky. Luckily my wife calmed me down and set me up with some headphones. Thank you Chrissy!

1:45pm: Three rounds of surgery pass. Each round takes about 30-45 minutes. After the third round, I'm told that all of the cancer is gone! They remove the dressing so that they can take a photo of it for reference. They offered to give me a mirror to see how big the open wound was, but I said no. My wife took a couple photos for me to see later, but I was in no mental state to see that large of a hole on my face. I’m glad I made the decision not to look.

2:00pm: I walk next door to plastic surgeon's office to get the wound closed and spend the next two hours in blissful ignorance. I was told the spot was the "size of a pea" and that it would heal nicely. Guys… it was a lot bigger than a pea! I had NO CLUE just how much they had removed, but I’m glad I didn’t know the truth so I could stay mostly calm.

4:00pm: My face is stitched up and I finally muster up the courage to take a look at the plastic surgeon's work in a mirror. I was shocked at how many stitches I saw, but pleased my lip was mostly still in tact. Because the size of the cancer was unknown, one of the risks was the surgeon needing to cut into and/or under my lip. That didn’t happen. I received over 30 stitches, but that included both internal and external stitches. They were very tiny and took quite a while.

5:00pm: I head home to relax. The swelling starts around 6:00pm, and comes on FAST. By the time I go to bed, it is extremely swollen. The only way I can describe the swelling is that my lip felt like it was so swollen/full that it was going to burst. It was super uncomfortable in a "that feels gross" kinda way, but not necessarily painful. All I wanted to do was sleep.

The next morning: I wake up to a lip that is FAR larger than I ever anticipated. I’m also in a good amount of pain. Note: Day 2 was definitely the worst. I had originally hoped to be able to work remotely and that absolutely did not happen. I slept almost the entire day, exhausted from the surgery.

After day 3, which I talk about below, things got considerably better! On day 4, I went into work with my stitches. After day 5, it was smooth sailing… and by smooth sailing I mean I attempted french fries and bloody mary's :)

Here are some additional photos of how it healed over the past year:

The Day Stitches Came Out - 

One Week Later - 

One Month Later; My Bachelorette Party -

Three Months Later; My Wedding 4/16/16 -

Nine Months Later - 

One Year Later; Collage - 

Here are the answers to some of the common questions I get:

What hospital did I go to and who was on my care team? My team of doctors could not have been more amazing. Dr. Molly Yancovitz completed the Mohs surgery, and Dr. Robin Lindsay was my plastic surgeon. Both operate out of Mass Eye and Ear and are outstanding. Their offices are right down the hall from each other, so I could leave the surgery and simply walk through a back door into Dr. Lindsay's office for the repair. I know some people have to drive to a separate office for plastic surgery, so this was a perk. I am so happy I took the advice to see a plastic surgeon to close the wound. While Dr. Yancovitz could have done the repair herself, she strongly suggested I see Dr. Lindsay and I believe it made all the difference in the way my scar has healed.

What did I do for the pain? I only took Advil and that ended up being just fine. They didn't prescribe anything stronger than that, and because I was sleeping most of day 2 and some of day 3, I didn't really need it. I also received an adorable gift from my sister that reminded me of our childhood: the BooBooBear. It is a soft ice pack that you can bite on/place in your mouth. This thing saved me! I would fall asleep with it on my face or in my mouth.

How long did I wait until I went out in public? I was out in public by the end of day 3. I woke up that morning and took a shower, put on mascara and braided my hair. That made me feel a hell of a lot better. My first trip out of the house was to get an iced coffee down the street. Nothing can keep me from my iced coffee! My lip was still significantly swollen and a bit bruised, but I wasn’t terribly embarrassed. By the Sunday after my surgery (which was day 6), I felt good enough to go out with my wife to get brunch in the South End.

What did I eat? It is super difficult to eat for the first few days, and honestly, I barely wanted to. This is rare for me! I think I had a smoothie or two, and attempted mac and cheese. Once again, since I was sleeping so much, I barely noticed. Day 2 was definitely a blur.

How long did I wait until I started to exercise again? This was one of the more frustrating parts of the recovery. The surgeon didn't want me exercising too soon, for fear of my blood pressure rising and me bleeding through the wound. I took a solid 10 days off and then I slowly did some light lifting/kettlebell work. It wasn't until day 14 that I went back to intense exercise like Barry's Bootcamp.

How has my scar healed? I am amazed at how well it looks after one year. Some days it is virtually invisible. Occasionally if I'm cold, it might appear a little purple, but it is nothing a bit of bronzer can't fix. I never “cover” it with makeup or concealer, I just don’t really care that much! Like I mentioned at the beginning of the post, my wedding was a little less than three months after my surgery. I will say that I felt extremely confident about how the scarring looked by April. With some makeup and a spray tan, it was barely noticeable!

Overall, I am extremely thankful that I caught the skin cancer before it spread any further and that I had the resources and opportunity to visit one of the best hospitals in the country to get it removed. My entire Mohs experience was quite positive. I wish I could go back in time a year to tell my anxious self to calm down, because everything turned out just fine. I now go to the dermatologist quarterly, and am extremely aware of any changes in my skin. My odds of getting skin cancer again are now much higher, but with proper prevention, derm visits and lots of SPF, I can remain proactive instead of reactive!

If you made it this far: please leave any questions in the comments! If this post helps even one person, it was worth writing. Good luck! :)

Lindsey