The surgery went well. As far as cancers go, squamous cell carcinoma (a type of skin cancer) is usually pretty minor, but it was still good to have the surgery over and done with. Cancer is one of those words that draws your attention, or at least it draws my attention.

It all started late last winter when I noticed a scaly spot on my forehead. I didn’t think much about it at first. Due to my AFIB, I take Eliquis, a blood thinner. One of the results of blood thinners is scrapes, cuts and wounds sometimes heal a bit weirdly. The blood doesn’t clot quite the same way it does for a normal person and as a result, minor scrapes or cuts can take a while to heal. That’s what I thought was going on with this scrape.

Unfortunately, it didn’t disappear and I mentioned it to Cathy. She looked and recommended I consult a doctor, so I called the Warrenton Dermatology and Skin Therapy Center at the end of April. They were a bit backed up and scheduled an appointment for me on May 9th.

On May 9th, I arrived at the Center and explained why I was there. They examined the spot and thought it looked OK, but there was something right next to the spot that concerned them. After numbing my forehead, they took a biopsy and told me the results would be back in ten days to two weeks and they would call me.

10 days came and went, then 11, then 12, then 13 days and still no word. Finally on Day 14 I called them. The results had just arrived, but hadn’t yet been reviewed by a doctor. And… They couldn’t release the results until a doctor reviewed them.

The next day, May 23d, I received a call from Danielle at the center. The biopsy came back positive for squamous cell carcinoma. What? What did you say? Squamous Cell Carcinoma.

Danelle continued to speak, and after a few seconds, I started listening again. They recommended the removal of the cancer with Mohs Surgery. They could do it there, or if I wanted to go with another dermatologist, I could. Another dermatologist? Until two weeks ago, I didn’t know any dermatologists… I told them their office was fine. After consulting calendars, the first available date was Saturday, June 3rd – 8AM and 12 noon were available. Was there nothing in between? Well, no, Danelle informed me – the surgery could take one to four hours, I should wear comfortable clothes, and bring something to read or pass the time.

What!?!

It turns out the surgery, while relatively simple, can take some time. Here’s how Mohs surgery works (according to the Mayo Clinic):

You are given a local anesthetic. After the anesthetic takes effect, the surgeon uses a scalpel to remove the visible portion of the cancer. The surgeon also takes a thin layer of tissue underneath and around the cancer. A temporary bandage is placed where the skin was removed. This takes only a few minutes.

The tissue is then taken to the lab for analysis. This part of the procedure usually takes the longest time and you'll wait about an hour in a waiting room.

In the lab, the surgeon cuts the tissue sample into sections and looks at them with a microscope. If there is more cancer, your Mohs surgery continues. 

The surgeon removes an additional layer of tissue from the affected area. Again, you'll wait while the surgeon looks at the tissue in the lab.

This process continues until the last tissue sample removed is cancer-free. During the procedure, you may receive another shot of local anesthetic if necessary.

I chose the 8AM slot and the appointment was in the book. Of course after that, I did more research, and came to realize I was pretty lucky.

According to the Mayo Clinic, there are three major types of skin cancer – basal cell carcinoma, squamous cell carcinoma and melanoma. While squamous cell is considered relatively “mild”, if left untreated it can destroy nearby healthy tissue, spread to the lymph nodes or other organs, and may be fatal, although this is uncommon.

I also learned skin cancers are caused by many things, but most often are the result of overexposure to the sun. I guess my days of lifeguarding back in the early ‘70s may have had something to do with it. Not only did we not use any type of sunscreen, we used baby oil to tan more quickly. Whoops.

Time passed and I spoke with others. It turns out I’m actually a bit late to the skin cancer party. I learned numerous friends and acquaintances around my age have developed skin cancer. Many had the Mohs procedure, and all said it wasn’t a big deal.

On the 2nd of June, I made a big steak dinner with a salad. I mean, what the hell, if you are having a cancerous growth removed, it seemed a reasonable thing to do. A couple of glasses of wine, and a couple of hours of bad TV later, I went to bed and slept like a rock.

The next morning, after having some coffee and a small breakfast, I drove to the Center in Warrenton. On the way there, Taj Mahal and Keb’ Mo’ were singing “Waiting on the World to Change” on the radio and while I’m not sure why, it seemed to fit somehow.

I arrived at the center just before 8AM that Saturday. Doctor Dolan and his assistant, Amanda started their work just after 8:00. After Amanda put about 5 shots in my forehead to numb it, the Doctor came in. He was retired Navy, which for some strange reason gave me comfort. By 8:20, DR Dolan had taken the first cuttings and Amanda was cauterizing the one-inch wound. I recognized that peculiar smell of burning flesh from a previous surgery, but didn’t feel anything, as the anesthetic was still doing its job. Amanda escorted me to the waiting room where I did some reading while waiting for the results.

Thirty minutes later, Amanda came and gave me the good news. I was clear after the first pass. She said I was probably the easiest and shortest surgery the doctor would have all day. We went back to one of the rooms where the good doctor stitched me up. Seven or eight stitches I think but if you look at the picture, they’re big stitches. That’s fine with me. Just a little more character added to my forehead, and vitamin E should make it disappear over the course of the next year.

There was a headache for a day or two, and a slight black eye in my future, but that was alright. Things were OK, at least for now.

In 1964, actor John Wayne was diagnosed with lung cancer. Some people recommended he hide the diagnosis due to concerns about his image – they thought it might make him look weak. At the time, many public figures hid illnesses they had for image reasons. He chose the opposite path. During a press conference after the surgery the Duke said “They told me to withhold my cancer operation from the public because it would hurt my image. Isn’t there a good image in John Wayne beating cancer? Sure, I licked the Big C.”

Squamous Cell Carcinoma isn’t the “Big C”. We have friends and family who are dealing with, or have dealt with breast cancer, lung cancer, pancreatic cancer, brain cancer, prostate cancer, melanomas… there’s a lot of bad stuff falling into the “Big C” category. I know I’m quite lucky and this is fairly minor, so let’s just call it the “little c”.

One of the things for people to remember is that any cancer, even something relatively minor like my “little c” squamous cell carcinoma can kill you if left untreated. If you see something that doesn’t quite look right on your skin, have it checked out. If everything is fine, all you did was lose an hour of time. And if it turns out to be a cancer of some sort, you did the right thing and can have it treated.

No need to be macho. No need to be stoic. Just get the damned thing checked out.

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Addendum:

– If you live in the Warrenton/western DC suburbs area, I highly recommend the Warrenton Dermatology and Skin Therapy Center. They are great, and take care of you. You can find more about them here: https://www.warrentondermatology.com/