While New Zealand was reeling from a quake of 6.3 today my world was shook slightly when the consultant said I had a basal cell carcinoma on my chest and that it would need to be cut out. He then went in to some detail about how that would happen. Those of you who know me well can probably guess at what happened next.
Well, you’d be wrong. I wasn’t sure what was worse – the fact that I have cancerous cells growing in my chest or that they would have to be cut out. Still, on the plus side cuts heal and chicks dig scars.
From the NHS:
BASAL CELL CARCINOMA (BCC)
A basal cell carcinoma or rodent ulcer is a low grade skin cancer. If left untreated it slowly invades the area in which it grows destroying the surrounding structures including eyes, nose and so on. For this reason it must be removed. The majority of basal cell carcinomas, once completely removed give no further trouble. In order to ensure complete removal a margin of apparently normal skin is removed with the ulcer. The removed tissue is examined under the microscope. If there is any sign that there is residual basal cell carcinoma left behind a wider excision must be carried out removing involved tissue around the ulcer. This tissue is likewise examined under the microscope, to confirm that the basal cell carcinoma is cleared.
Removing the ulcer will leave a defect in the skin. This defect must be closed. There are various techniques for achieving this. Ask your surgeon to explain exactly which technique he plans to use. Small defects can be closed directly by shaping the wound into an ellipse and drawing the edges together to close the wound as a straight line.
Larger defects will require a flap or a skin graft. A local flap is a trapdoor like portion of skin lifted from the adjacent area and dropped into the defect. The flap is designed to use skin from an area of laxity where closing the defect thus created is done by simply drawing the edges together.
Skin grafts are required for defects which are unsuitable for flaps. Skin is taken from another area as a small sheet and laid into the defect. We frequently take full thickness skin grafts from behind or in front of the ear or low down on the neck. The defect created by lifting the skin is closed by drawing the edges together.
All wounds created by any of these techniques are held together by stitches until they heal. Stitches are removed either by your general practitioner or for more complex wounds in the plastic surgery dressing clinic.
In deciding on the best technique for removing a basal cell carcinoma we consider the size and position of the ulcer and the laxity of skin. Since basal cell carcinomas frequently occur on the face we always take cosmetic factors into consideration, hiding the surgery as far as possible. It is not possible to do surgery without leaving scars. Your scars will start off red and noticeable, with time they will improve. Some people’s scars fade better than others – no scars vanish completely. Sometimes it is not possible to avoid the surgery causing some change in shape of the facial structures.
In any operation infection or bleeding can cause problems. Simple infections will settle on a course of antibiotics. Infections caught early are easier to settle. If you notice increasing redness of the wound and it is painful make sure one of the doctors checks on it. Some wounds bleed some time after theatre. It is possible to lose a skin graft if a blood clot collects beneath it. Most often applying pressure for 5-10 minutes will settle the bleeding. If this is not the case you will need to re-attend the plastic surgery unit for a dressing change and occasionally for the bleeding to be stopped in theatre.
Basal cell carcinomas do not spread around the body. They can, however, recur. Recurrences appear beside the original ulcer frequently as nodules around the scar. You must always be on the look out for recurrences as these must be removed. Recurrences usually occur within the first few years but can in fact occur at any time, even years later. You will initially be followed up in the plastic surgery out patient clinic, but even after you have been discharged you must keep an eye open for recurrences or the development of new ulcers elsewhere. If there are any concerning changes either check with your general practitioner or contact the plastic surgery department Look out for redness, nodules, thickened skin, ulcers, bleeding or any progressive change.
Basal cell carcinomas are thought to be related to sun exposure. If you have developed a basal cell carcinoma you probably have susceptible skin and should be careful about sun exposure. Don’t stop living altogether, do continue to garden or whatever you did previously, but be sensible. Avoid being outdoors around midday when the sun is at its hottest. Cover up – use a hat and long cotton sleeves. Above all do not bum. Advise your family to do the same.
I will take their advice and not stop living altogether…