Mohs for the Nose

It's interesting to notice the way people give you a quick look, and then carefully don't stare, when you have a large bandage across your nose.

Back in March, I noticed a small bump near the end of my nose. It didn't hurt, it didn't look especially ominous, it didn't get any bigger—but it didn't go away. Eventually I made an appointment to have a dermatologist look at it. They did a biopsy and told me it was skin cancer. Last week I went in to have it removed.

The procedure the doctor used is called Mohs surgery. They cut off a layer of skin and examine it for cancer cells. If they find any, they cut off a second layer. This is repeated until they take off a layer that is cancer-free. I was fortunate; all the cancer cells were removed in the first layer.

The only part that hurt was the shot to numb my nose. Still, it wasn't a lot of fun. There is something very personal about having someone come at your face with a sharp knife, even when you know it's for your own good.

As the final step in the surgery, the doctor made a U-shaped incision and pulled the skin down to cover the site. More accurately, he pushed the end of my nose up under the skin. He said cheerfully, "You know how, as you get older, the end of your nose sags? That is never going to happen to you."

Maybe I'll appreciate that eventually. Right at that moment, I really didn't care. By the time they finished securing everything with a fat white pressure bandage and a lot of tape, it felt as if someone had duct-taped the end of my nose to my eyebrows.

After two days, I was able to take that bandage off and graduate to a large band-aid. It's a challenge, by the way, to get a band-aid to fit your nose. After considerable trial and error, I figured out that trimming off about half of the sticky part to make a sort of band-aid butterfly worked reasonably well. I'm considering publishing a small pamphlet of my designs.

As you may be able to tell, I'm a firm believer in humor as a way of coping with stuff, like surgery, that isn't a lot of fun. Skin cancer, however, isn't really a laughing matter. It's the most common form of cancer in this country. One in five Americans will develop it. Forty to fifty percent of those who live past age 65 will get it. The good news is that it's almost always curable when it's detected early, and it can be prevented.

The three primary types of skin cancer are basal cell carcinoma, squamous cell carcinoma, and melanoma. Basal cell is by far the most common. It rarely spreads to surrounding organs or results in death, but it can damage surrounding tissue and can be disfiguring.

The second most common type is squamous cell, which is what I had. This type can spread, though only a small percentage of cases do. It does cause about 2500 deaths every year in the United States.

The third type, melanoma, is the nasty one. It represents only about three percent of skin cancer cases, but it causes over 75 percent of the deaths. The father of one of my friends died from melanoma a few years ago. Again, however, melanoma is nearly 100 percent curable with early detection and treatment.

Detection is one defense against skin cancer. It's a good idea, after age 40 or so, to see a dermatologist for an annual skin exam. This is especially important because many cancers are inconspicuous little spots that aren't nearly as obvious as the one that appeared on my nose. It's also a good idea to become familiar with your own skin. Know what moles, scars, and age spots you have. If you notice one changing, or you see a new spot that looks suspicious spot, don't wait. Call a dermatologist and have it checked. For some excellent information on what is suspicious, go to www.skincancer.org.

The second defense against skin cancer is prevention. Preventing skin cancer is based on one simple strategy: protect yourself from the sun. The basic tools for sun protection are simple:

Sunscreen. Use it, early and often. PF 15 at a minimum, 30 or better if you're going to be out in the sun for a long time. For women, it's a great idea to form the habit of using a daily moisturizer with sunscreen.

Long sleeves. If I'm out hiking or working in the yard, I've learned to wear a long-sleeved cotton shirt rather than a tee shirt or tank top. It's actually just as cool. Besides it keeps you from getting a tee-shirt tan that makes you look funny when you put on your swimsuit.

Hats. A baseball cap will shade your face. It doesn't protect the back of your neck, though—unless you want to wear it backwards and really look like a dork. Even then, it won't do a thing for your ears. What you need is a broad-brimmed hat. I was excited to find hats at www.tilley.com, where they are available in a variety of sizes—all the way down to 6 7/8 for people like me with kid-sized heads.

Shade. Stay in the shade as much as you can, and try to do most of your gardening and other outdoor activities in the morning and evening rather than the middle of the day. True, your neighbors might get annoyed when you mow your lawn at 6:00 a.m. But then they probably won't invite you to their 4th of July barbecue, which will give you another opportunity to stay out of the sun.

Protecting yourself from the sun doesn't mean regarding it as the enemy. The sun, after all, is so essential to life on this planet that many cultures over the ages have worshipped it as a god. Like many gods, it demands to be treated with respect. If you don't, there will be consequences. That's as plain as—well, the nose on my face.