In January of 2004, I went to visit the dermatologist about a small wound--a tiny little red spot that occasionally formed a tiny little scab--which I'd had on my face for the previous eight weeks or so and which didn't seem to be healing. (Pictured is the spot in October, before it became a little more evident.)
Dr. Lee looked at it carefully, and decided that it was probably a form of sun damage, that it was probably not cancerous, and that the best thing to do would be to freeze it off and let it heal naturally.
And that seemed to work. She froze it with liquid nitrogen, which stung a little but didn't really hurt. This would eliminate the injury and leave minimal scarring, she said, assuming it wasn't cancerous. As she predicted, the spot blistered up for the next couple of days and then healed over the next week, and then went back to being invisible for a while.
Then, after about six months had passed, the wound reappeared, looking pretty much the same as before. In August I went back to Dr. Lee, and this time she decided it was time to to take a biopsy.
A week passed, and the biopsy came back positive; it was cancer after all. Fortunately, it turned out to be a form of cancer called basal cell carcinoma, which I'd never heard of; but this is apparently much better than melanoma, the other kind of skin cancer that everyone's afraid of. It seems that basal cell cancer generally doesn't spread to other parts of your body, but just works its way around under your skin and eats up the skin in that one area.
Dr. Lee scheduled me for Mohs surgery the following Wednesday. Mohs surgery is an outpatient process in which a small bit of skin is removed (under local anesthetic), then I am sent to the waiting room while the doctor examines the skin under a microscope for traces of cancer. If cancer is found, she calls me back in to remove some more, and the process repeats until all the traces of cancer are gone.
In my case, we did this four times, and by the end of the process she'd removed a considerably bigger piece of my face than we'd both anticipated. Instead of sewing me up with a few stitches, as I'd expected, she was handing me a plastic surgeon's business card and telling me that she'd made an appointment for me that afternoon. Yikes!
The new, open wound was astonishing to me. I couldn't get over how much it looked like movie makeup; I'd never seen anything like it anywhere in the real world before, let alone in the mirror. Now I suddenly had to deal with the prospect of having a large scar on my face for the rest of my life. It just isn't something that had occurred to me as a possibility before. Although I had expected a small scar from the surgery, a large, conspicuous scar is a completely different thing. And here was this enormous hole in my cheek, where there would never be healthy skin again.
The plastic surgeon that Dr. Lee had recommended had the improbable name of Dr. Gross, but he seemed to be a knowledgeable and experienced surgeon, and his concern for my situation was apparent. However, our consultation with him wasn't encouraging. Dr. Gross thought the only realistic prospect would be to apply a skin graft, say from behind my ear, which would leave a ring-shaped scar on my face. If I were thirty years older, he said, I'd have enough loose skin that he'd be able to slide my whole face over to cover the wound and leave very little noticeable scarring (a prospect which also weirded me out quite a bit); but since my face fit me pretty well already, he thought that wasn't a very good option.
I hestitantly asked what would happen if we were to simply let the wound heal naturally, and the surgeon sadly shook his head and showed me how he expected that the skin around the wound would pull in to close it, disfiguring my face by pulling my eye downwards.
But Dr. Gross wasn't able to do any work immediately, since he was about to go out of town for a week, so he referred me to his superior, Dr. Sherman, another plastic surgeon who would be available next week.
Dr. Sherman, as it turned out when we met with him, seemed to have much better confidence than his coworker in the human body's natural healing ability. He didn't think the skin graft idea was such a great one, and thought the slide-the-face-over technique would be my best bet for minimal scarring. Then he mentioned in passing that I could, believe it or not, just let the wound heal naturally and it would close up just fine. I pounced on that suggestion! Really? And it won't horribly disfigure my face? O.K., let's do that!
Over the next six weeks, I diligently kept the wound covered with an antibacterial ointment (Neosporin) and a bandage. And I always wore a hat when I went out into the sun.
And the wound gradually pulled itself closed, and it didn't pull my eye down or otherwise distort my face. I took each of the following pictures on successive weeks. Click on any of them for a close-up picture.
After six weeks had elapsed, I went back for a followup consultation with Dr. Sherman, who was so surprised and excited to see how well it had healed that he stepped into the hall to call to Dr. Gross: "Hey, you've got to come here and take a look at this!"
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