I had Mohs on the rim of my nose at the end of July/09.... it is end Sept. now...... I basically went ahead with it because, compared to the other option, it was a surer cure, even if it was more disfiguring.  I had plastic surgery the following evening.... am still healing from that.... they took cartillage from just inside the ear, and stuffed it into the hole from the Mohs.... but i think that they may have to adjust the cartillage, and remove some of it... because it is "mounded" a bit.  I am scheduled for dermabrasion in early October, to sand down the scar lines.... but was told that if the cartillage needs "tweaking", they will reschedule to do that, instead.

I must say that i had minimal discomfort from all of this.... it's just been pretty unsightly at the beginning.... just now i've begun to go out without bandage.  If I wear makeup, it still looks funny.  My 21 year old son has teased me!  (Nice guy!).  Good luck with your process... have patience.... you did what was really necessary!

what is PDT

What is PDT

I had MOHs for basil cell small on right nostril towards center. I was very anxious for 2 weeks before. Needed Xanax & Valium that morning. That said the Numbing was not a big deal and even ending up with THREE layer removed was minor. Each time took less than 10 minutes,and pathology was very fast, I between taking about 25 minutes, we had been advised typically it can be 45-90 minutes wait in between for results. Then the repair...idid not look at would, I had been advised not agood idea. Doctor offered skin graft patch quick option, but recommended v-shaped incision on nose, using nose's own skin for any graft, maybe down to in between tip, only if needed. The numbing for this was a good 15 minutes, I was poked about 30 times for this and about 60 altogether that day! I can't explain why, but I was OK with that. Then I has to wait in chair for about 25 minutes nurse said for Epiniphrin(sp?) to work, apparently this reduces bleeding. I was fully awake talking to them for the next...60-80 minutes, with a LOT going on (my eyes were covered at all times). Poor wife in waiting room now 3 hours, said this was another 2hours beginning to end. I did not feel any pain except a few times, doc shot me up again when I said anything. A few of the MANY elecocuterizations I felt a little,,lots of pulling and fingers and the weird sound of the suture device and interesting cutting sounds. In the end I asked to see. At this point I was a bit SHOCKED, incision center of nose from just below eyes to under the tip in between nostrils! Maybe 20+ sutures. Not so red at that time. Looked very bad! I had HUGE. 6 layer pressure bandage on, almost comical. I took Vicodin for THREE days, did not go to bathroom for 4 days(which resulted in another issue when I finally went that I will not go into), I was also taking stool softeners, should have taken much more! Bandage off after 2 days. Looked like horror movie, had to take Xanax to remain calm, felt regret, ,anger. Pain. 8 500mg Tylenol for the next 4 days, still 3 as of days 10. Stitches out day 8. You have to self care day 2-8, nasty. Nurse cleaned lots of stuff off and 2 scabs to get to stitches. Upper portion incision looked 50% better, but towards tip, nurse said "wound not closed there"' put 2 seri-strips and glue on upper portion, script for stronger antibiotic ointment to use, no bandage? Gross. Very red along entire incision and tip is almost to tender/sore to touch. Nurse advised all is A-OK. Some patients are more red than others. They were surprised I did not have raccoon eyes or very much swelling? Only the slightest improvement days 8-11 now. Soreness at tip worries me a lot! Every day it is the slightest biti less, which is good. sadly I joined the unemployed a few months ago after 22 years at same job, if I was working, l would NOT have been able to go to work week #1, and it would be hard to due my job week #2, for me. Looking at wound every day in center of face is traumatic to me. It is about 70% better than a week ago, but still very red, tip still sore. sleeping without strong meds is a miracle. 4 hours sleep per night the past 10 days has not helped. I wanted to get rid of the cancer 99.9% and I did. In hindsight , at this time, 11 days post surgery, I am not sure I made the best choices for my overall physical & mental health. I should have just done scrape & burn, or chrmo cream. At this point the "repair" was 20X worse than the Mohs itself. I do not doubt my very skilled and eccellent bedside manner doctor did what he felt bestd. I was just mot preparred for the recovery trauma. I leave it open that I might reconsider in just a few more weeks. The not closed wound on tip has mostly sealed in just a few days, they advised 1-2 weeks possible. I am still using antibiotic oniony,ent, I also used Betadine first few days and tried Silvadine last night, which seemed to work well. ointment burns a bit, seems to trigger pain to itch? Nurse was not impressed with the original CVS triple antibiotic cream I was using. As a worrier, I can't help but think there is an infection in tip, or...I am going to need add'l surgery or lose tip, or worse. (like isaid, worrier) My wife wants me to post everyday sequence so those going into this have wide open eyes. So that you can see, without my interpretation, how actually amazing the healing has been in a relatively short time, considering how bad it looked. If the tip was not so sore and the redness not so red, I might feel better. But it is not. Looking and worse feeling disfigured to do the right thing is very hard. I know many seem to cope better, I am only speaking for myself. Thank Yoou to those others who posted comments about their own experience and feelings.

Day #15 now, I have to admit that the healing is beyond amazing.  I am on my seconds fresh pineapple (maybe does some good?).  The redness is still present along the long incision and at the tip, though...each day it dminishes slightly.  I have also had mixed days with some yellow, purple, and redder too.  I tried to stay calm during these, as they only lasted 12-24 hours, so I only thought the bruise is changing.  MY right nostril is tigher (cancer removal wound was on right).  I can breath, but right is "narrower, tighter.  Maybe its still swelling?  I can't help think that the TENDERNESS of the tip is something wrong, though they keep reassuring me that "that is normal".  Each day it seems, though minimal, that the tender area shrinks a tiny bit towards the center.  After day #12, the incision line that was not so tender, now is, and I feel much more "pulling" than previously.  I assume both are related to nerve healing and feeling returning. 

 

There is no question that it appears Standard Operating Procedure is to send the patient home with a post op sheet (generally basic vague instructions), call if there is a concern.  This is only my 2nd major surgery in 50 years and I was not prepared to be my own would care specialist.  Maybe I need more medical directions and reassuring than most?  Based on the MULTIPLE unusual sights and sensations I have experience in just 14 days, I think that it would take 5 pages to just summarize post op care.  I am sure each patient is different, but that is no excuse for what seems to be "you are mostly on your own".  This is likely a common complaint for most surgical patients.

 

Thank heaven that the ITCHING has subsided 75% (still comes and goes).  On day #14, in the tip area, I had 4 short bursts of intense pain during the day (took 1000mg tylenol).  Again, I attribute this to healing, though during the pain I had other thoughts.  The scabbing is from just above the tip to the tip, it is minimal, but visually annoying.  I got mixed messages from post op care, one saying "let it dry out" the other two saying "keep it moist".  I have opted for the MOIST choice most the time, alternating from putting the antibiotic ointment on 2X/day to cleaning it with Qtip, or pad with 50% peroxide/water and letting it air out a few hours.  I have also used Betadine/Providone (OTC fro CVS) 3X the past 2 weeks, and some Silvadine cream I have 2X. (I mentioned both to doctor who seems unconcerned.  I also had to take OTC decongestants 3X/day the past 2 weeks and my BP shot up to 148 (not a shock).  I still use my nose spray sparingly.

 

The nostrils do not seem perfectly even, maybe this will equal out. (or maybe its not a valid expectation).  The incision between the nostrils (gross) has also healed to almost not visable.  I get scared any time I touch any part of the nose, adding to my medical insanity.  I have also sneezed about 8 times the past 2 weeks, without incident, never holding it in.  I also lost 8 pounds during the 2 weeks, though 3 came back the past 2 days.  My energy is bordering on cronic fatigue (now I know what others mean about this).  My sleep pattern is very disturbed and I continue to use the Ambien or OTC PM before bed to help (and it does!).  The only down side, is that while the actual Mohs 3 layers was easy, nothing to fret about, the repair and recovery has me now in a mindset, NEVER to do this again (wife says never is a long time).  Meaning when another skin cancer is found, its scrape & burn, freeze, or chemo cream for weeks or months.  I suppose it's fair to say the location of the skin cancer would effect my next decision (I.E. not on the face).

 

PS, my digestive system is still out of wack too.  The anxiety and Vacdin for a week cause constipation.  This has continued in week#2, still using PTC stool softenres 2-3X/day.  MY backside is still recovering from the extreme episode on Day #4. 

 

Another huge issue for those of you in Winter in cold weather...if possible this is NOT an optimum time for sugery.  Even short exposure to the cold on my nose, causes discomfort and concern, and warming up that area (or my damaged nerves) seems to take HOURS after just a few minutes cold exposure.  I now can cover my nose with a scarf (though still hurts when ANY pressure is applied, though I could not do this until about 2 days ago.  Maybe I should have waited for Spring? 

 

The entire recovery trauma has also set my general anxiety issues back about 5 years.  this is not good, not the surgeons fault, though many peers think that I was not prepared for the post procedure issues.  Without question I would have been out of work for 2 weeks, and still very fatigued and mentally not all there for week 3.  I do not know if it is a vanity, medical phobia or reasonable concerns looking in the mirror.  I see the surgeon in another week, though as I understand normally, you are just DONE until 6M dermatological check up.  I still leave it open to change my positions down the road. 

I had Mohs surgery 13 days ago and the part that is not healing properly is closer to the tip of my nose. I keep an  ice pack in the freezer and have continued to apply it ever since I came home.  I had 3 internal stitches and 8 external stitches, which were removed after a week.  I was told by my Dr. that the skin on the tip of the nose is thicker and heals differently than the skin higher up, between the eyes on the septum.  I also was not prepared for the swelling and thick appearance of the area around the incision.  I have a follow up appt. in 5 weeks.  My Dr. mentioned something about steriods in case the swelling is not going down. I have also read info on dermabrasion to take down the thickness of the scar.  I asked

 my Dr. if I could massage the area and I was told NO. Not until 6 weeks post op. Same for topical ointments like Mederma and such.