“Nose surgery?” I asked as the secretary was scheduling me for Head & Neck surgery.  “No, Mohs surgery,” she said, and she had to spell it several times before I got it right.  I jotted down the check-in appointment time of 4:30 p.m. for surgery at 5:00 p.m. and without delay I proceeded to Google “Mohs surgery“.  Google presented 162,000 hits (links) and of course, my reliable friend, Wikipedia, was on top.

Mohs Micrographic Surgery (MMS) was developed by Dr. Frederic E. Mohs (1910-2002) in 1936 to precisely remove skin cancer lesions while sparing healthy tissue and is the procedure of choice used by physicians today for anatomically important areas (eyelids, nose, ears, lips, etc.) where tissue sparing and low recurrence is important.

In my case about a year ago I started to notice a small, pin-point tenderness on the left side of the upper bridge of my nose near where the pads of my reading glasses rest and I noticed this most when I slipped on my sunglasses.  I could feel a dry raised tiny spot there that I attributed to wearing reading glasses.  Last spring my dermatologist finally got to see it and he treated it like my other precancerous skin lesions, called solar or actinic keratoses, with cryotherapy.  This initially worked, but after a few weeks I felt the tenderness again and I scheduled a return visit to my dermatologist, which had to be rescheduled after the completion of my summer jury duty on a murder case.  When I finally saw the dermatologist, he offered to freeze it again… or just cut it out.  “Well,” I said, “freezing didn’t work last time… maybe it would be better to just cut it out.”  And he did and sent it to the lab and I got the report back the next week that it was indeed squamous cell carcinoma, the second most common cancer of the skin, with more than 250,000 new cases diagnosed every year in the United States.  (Basal cell carcinoma is the most common.)

The image below shows the healed biopsy spot just before surgery.  The spot is the light circular area on the anatomically left side of the bridge of my nose, horizontally across from my pupils.

So last Thursday, Larry drove me to the hospital where I checked into the fourth floor Head and Neck Surgery Department for this outpatient procedure, which I was told usually takes one to three hours.  It is performed using local anesthesia and the patient guidebook said it would be okay to listen to an iPod during the procedure, and to bring a companion to drive me home afterward.

Being a “writer”, I thought I ought to avail all of my senses to savor the full experience, so I left my iPod at home.  I felt the smooth coolness of the rectangular cauterizing grounding pad applied by the friendly nurse to my upper left arm.  I was draped and felt the wet coolness of liquid and smelled the chemical odor of antiseptic solution as it was applied over my closed eyes, forehead, nose and upper cheeks.  I felt the sharp skin-prick and brief pain as the surgeon injected anesthetic into the bridge of my nose.  The surgeon and nurse then left me alone with my thoughts for about fifteen minutes while the anesthetic took hold.  I could barely hear questions and answers of the patient having a similar procedure in the next room, which helped me know what to expect.  I also heard the high pitched sound of what sounded like cauterizing equipment.

The surgeon returned and applied a drape with a small opening over my head.  We chatted and I told him that I was a retired RN.  I was pleasantly surprised when he informed me that his wife works as an administrative RN in the medical center where I had worked for 28 years.  As he mentioned names of people whom I had known and worked with, I drifted down memory lane while he scraped, cut, snipped, sliced and cauterized away.

The removed tissue was sent to the pathologist on duty and Larry was invited in to chat with me (he read to me an article in the latest Camping World magazine) while we waited for the surgeon to return with the pathologist’s report.  Meanwhile, the pathologist flattened, dyed, froze and cut thin horizontal sections (see You Tube frozen section technique) of the tissue using a microtome–cryostat.  The sections were placed on microscope slides, fixed, stained and examined to determine if the tissue margins were clear of tumor cells.  After about thirty minutes, the surgeon returned with good news (no more tissue needed to be removed) and closed the wound with ten small sutures and applied steri-strips.  I was given postoperative instructions, prophylactic antibiotic, narcotic pain reliever, a return date for suture removal and an instant cold pack to apply to prevent swelling during the return trip home.

One year ago in my “Sun safety” post, I documented my actinic keratosis on my left cheek and how it was treated with the antimetabolite Fluoroucil.  Development of actinic keratoses are associated with exposure to the sun.  As noted in this AOCD article on Actinic keratosis, sun damage to the skin accumulates over time and up to 80% of skin damage is thought to occur before the age of 18.  Left untreated, actinic keratoses can progress to squamous cell carcinomas.  Properly treated, the cure rate is 95% to 97%.

Having one squamous cell carcinoma is an indication that others may arise over time and it is important to be watchful and have dermatological examinations at least once a year.  Fortunately, my health care is provided by one of the largest and most respected health maintenance organizations (HMOs) in the United States.  I have affordable health care insurance, but some people are not so fortunate, which is one reason some believe that health care reform is the most important issue of our times.  It is also currently one of the most hotly debated national issues, as evidenced in this New York Times article of Sepember 18, 2009, “The Baucus Plan: A Winner’s Curse for Insurance Companies“, by Uwe E. Reinhardt.

“Every day is a gift…”

The recent death of Senator Edward M. Kennedy, whose passion in life was noted to be health care reform, has sharpened this debate, as evidenced in the August 26, 2009 New York Times article, “Kennedy Death Adds Volatile Element to Health Fight“, by Carl Hulse and Katharine Q. Seelye.  Mr. Kennedy wrote that health care was the great cause of his life and that he hoped that his words would inspire readers to take up the cause (page 506 of his recently released memoir, True Compass, Edward M. Kennedy, Twelve, Hachette Book Group, September, 2009, which is one of my fall reading books).  “Every day is a gift,” he was quoted as saying in the August 26, 2009 New York Times article, “After Diagnosis, Determined to Make a ‘Good Ending’“, by Mark Leibovich.

Although we are faced with increasing health concerns as we age, we are also determined to make each day count and enjoy celebrating life.  For example, last Friday Larry made (from scratch, his first, and so delicious) honey-raisin round challah and I learned how to blow the shofar to celebrate Rosh Hashanah (see the You Tube videos) , one of three annual new year celebrations that we observe.

Also seen on our table above are chopped Chinese roast duck and plum sauce, stir-fried Chinese broccoli (Gai lan) with oyster sauce, one fig (freshly picked from our Brown Turkey Fig tree) on a plate with three apples and nearby honey, peanuts, butter and baklava.

We continue to celebrate life and look forward to our fall and winter camping outings to the nearby mountains and desert.  So for us, and the “Snow Birds” beginning their seasonal migration to warmer, sunnier climes, this is a good time to review Sun Safety Action Steps…

And contemplate autumn sounds and sights.