So, after a recent checkup, as the doctor leaves the room for his next patient, I say, "Hey, Doc, by the way, what are these scaly patches?" "Hmmm. Actinic Keratosis. Pre-cancerous. We'll get you a referral to a dermatologist to take care of them."
So, I go the the dermatologist who looks at them and says, "It's nothing serious, we'll just burn them off with a little liquid nitrogen" (Yes, it does feel like a minor burn, maybe more of a stinging sensation for a bit). "Let's have a look at the rest of you first, though." Many nevi on the back and a large beige-colored freckle on the earlobe. "OK, we'll biopsy two of the nevi and the earlobe, then burn off the other ones. The report will be back in about a week or so."
A week later, the report is back. Bottom line: "The two on your back are "anomolous nevi" and are pre-cancerous, so we'll remove them later this summer" (The Doctor is great with child, due any time now. August will be a good time to do this.). "The one on your ear is a melanoma, in situ, Stage 0. That means it hasn't spread from anywhere else, and will be completely cured with Mohs Surgery. We'll call the surgeon and take care of the referral. Here's his number; schedule it as soon as you can."
They can't schedule it fast enough as far as I'm concerned! A week and a half is the best they can do, but promise it's well within time.
Basically, Mohs surgery is used for cosmetic areas such as the face. The tumor is taken in layers. and each layer taken is checked while you wait (uh, 45 minutes or more, depending on how busy they are), until it's all gone. Then they take a little extra for good measure. The really thorough surgeons, like mine, send the final piece out for an independent evaluation by a board-certified cytologist. I like that.
Now for all the gory details. Literally!
OK, this first part isn't gory. Here's my ear, just before surgery. A lot of the tumor is already gone, from the biopsy, but the inner circle shows the original size of it. The outer circle shows the "margin" the surgeon wants to take out to be sure there is no melanoma left. Notice how it goes around to the back side of the earlobe. Also note the whiskers of my beard. More about them later.
There is more work to be done yet. The area has to be cleaned and then swabbed with Betadine, and then a local anesthetic is injected all around the area. It's not quite as bad as dental anesthesia, but you do feel the pinpricks until things numb up. Still, when it's all numb ("profound" I think is the word Dentists use), you can't feel a thing. Well, you can feel pressure, but no pain. I like that.Now on to the gory stuff!