Basal Cell Carcinoma Leads to Mohs Surgery

I was on my first lap around the fitness center track when dermatology resident Kevin Varghese, MD, called from The University of Kansas Hospital.

The biopsy was positive ¬– a small basal cell carcinoma on the right side of my face near the corner of my mouth. It caught my breath. About 20 years earlier I had a basal cell carcinoma on the left side of my face and hoped never to see another one.

Before calling, Dr. Varghese had already scheduled me for Mohs surgery with Atieh Jibbe, MD, Mohs and cosmetic surgeon at The University of Kansas Health System. Dr. Jibbe’s specialties include treating nonmelanoma and melanoma skin cancers, laser surgery and scar revision.

“During my dermatology residency, I was drawn to Mohs and the procedural and pathological aspect of dermatology,” she says. After a Mohs fellowship at Vanderbilt University Medical Center, Dr. Jibbe began her practice at the health system.

Surgery was scheduled for 7:45 a.m. Monday, February 17. It was so easy – all I had to do was be there.

Frederic Mohs, MD, developed his tissue-sparing method at the University of Wisconsin in 1936. Today, Mohs surgery is the gold standard for treating primary and recurring skin cancers. It has the highest cure rate and preserves more tissue compared to other cancer surgeries.

In 2007, as a writer for Marketing Communications at the health system, I learned about Mohs surgery from interviewing the hospital’s first Mohs surgeon.

But understanding Mohs is one thing; experiencing Mohs is something else altogether.

My wife and I arrived early at the Level 4 dermatology waiting room in the Medical Pavilion. Soon, Mohs nurse Lexie Brauer, RN, led us to one of the smoke-gray cubicles where patients and a spouse or friend can wait in relative privacy.

She then took me to the surgery suite directly across from our cubicle. She introduced me to Dr. Jibbe and dermatology resident Dana Sous, MD, who were chatting in the hall. Their friendly, easy-going manner immediately put me at ease.

As I waited in the operating chair, Lexie and I talked about her work and procedure details while she readied the instruments and draped me for surgery.

Having worked in general surgery a few years before joining Dr. Jibbe’s Mohs team, Lexie says she has found her place.

As we chatted prior to my procedure, Dr. Jibbe and Dr. Sous studied the basal cell carcinoma, noting its appearance and position on my face, to determine a surgery approach. No surgery is fun for a patient, but this surgery team enjoyed its work so much it was more a salon-like atmosphere.

For me, getting an anesthetic shot near the basal cell carcinoma on my face was the worst of it. Dr. Jibbe then used a red grease pencil to mark reference lines around the outer edge of the basal cell carcinoma. Called mapping, this crucial step ensures each skin layer slice aligns with the original.

The 2 surgeons answered questions I had asked beforehand, but when Dr. Jibbe began slicing the first tissue layer, I sat still and quiet. Making a circular cut just outside of the basal carcinoma border didn’t take long – maybe 20 minutes ¬– but I wasn’t timing it. And it didn’t hurt.

After the skin resection, Dr. Jibbe and Dr. Sous put a thick bandage over the surgery site. They examined the tissue under a microscope while I awaited the results in the cubicle.

“Mohs is used only for treating cutaneous – skin – cancers anywhere on the head and neck and on the trunk and extremities when appropriate,” says Dr. Jibbe. “These are commonly basal cell carcinoma, squamous cell carcinoma and early-stage melanoma.”

Using Mohs for melanoma requires more pathology training, says Dr. Jibbe, who is one of the few Mohs surgeons in Kansas trained to read melanoma Mohs slides.

Waiting was hard. We had no idea how long it would take or how many more slices they would need. After about 45 minutes, Lexie had great news: There was no cancer. No more slicing!

I sat back in the operating chair, and now Dr. Sous led the team. She enlarged the original incision, one of the last steps in Mohs. This helps prevent stretch marks and provides a normal appearance. Next, she sutured it with dissolving stitches and covered it with Vaseline® and another thick bandage. I looked like the walking wounded. But I would not have to return for her to remove the stitches.

Dr. Sous instructed me to leave the bandage on 48 hours before changing it. After that, I was to apply only Vaseline or any plain petroleum jelly.

After 48 hours, I removed the bandage. Where there had been an area slightly smaller than a deer tick, there now was a 2.5-inch curved line of stitches from just above the corner of my mouth down to my jawline. The raw surgery area was red and swollen.

After 2 weeks I no longer needed a bandage, or Vaseline, but could apply a bandage whenever we were out somewhere like the store or gym. Vitamin E cream helped speed healing and protected the stitches for a few weeks until they dissolved.

All the while, my beard was growing out and shaving without injury – maybe pulling out some stitches – was difficult at best. So, I let my beard grow, then shaved it into a Van Dyke, a combination mustache and goatee with clean-shaven cheeks. That camouflaged the surgery site perfectly. I haven’t had a beard in 30 years, but this was necessity. Whether I keep it remains to be seen.

From my patient perspective, Mohs surgery is a good option for smaller basal cell carcinomas on any part of the face, because it preserves as much tissue as possible to reduce scarring. The excellent teamwork of Dr. Jibbe, Dr. Sous and Lexie Brauer, RN, made the Mohs experience as pleasant and painless as possible. You might say I’ve looked at Mohs from both sides now.

Learn more about Mohs.