Last week I had my appointment with the Ophthalmologist who will be my Oculoplastics surgeon directly following the Mohs surgery. I wasn’t quite sure what to expect when I came to his office for the pre-op consult and examination. He examined my eyes closely with a numbing yellow dye and a split scope then took a ton of measurements of my face from my eye up to my hairline, from my eyelid to the area of the lesion, and across the bridge of my nose. He then took a lot of photographs of my face, especially of the area where the cancer lives.
Dr. J as I will refer to him explained the difficulty of the surgery based on the proximity to the eye. He told me when cancer is found on the midline of the face it is considered high-risk. The face is made up of different types of skin cells so grafting to the area where my cancer grows with skin from somewhere else on my face (i.e. behind my ear) would not do very well. Instead he will be pulling a skin flap over the open region with adjoining healthy skin. This may mean skin pulled over from my top eyelid, bottom eyelid, or down from the bridge of my nose or forehead to the area of the medial canthus. Part of the difficulty of reconstruction for this area is the fact it is a concave pocket and skin likes to grow in a straight line from point A to B especially when they use a graft from another area of the body. However skin cells used from adjacent areas can more easily conform to the natural concave shape of the area.
We discussed the unknowns including the fact they won’t know how much skin will be removed until the actual day of the Mohs surgery. Therefore Dr. J does not know how much reconstruction will be required until I make it to him following the first surgery earlier in the day. Such is the nastiness of skin cancer. It likes to take root and grow just under the radar beneath the surface of the skin. The beauty of Mohs surgery is their ability to remove a layer, freeze it, look at it under a microscope to determine whether or not they got clear margins all in the same day. That way you don’t have to wait two days and come back for more surgery. They just keep cutting away until the margins are clear.
I can’t honestly say my anxiety was relieved by the pre-op appointment. There are still too many unknowns at this juncture. I did receive the date for my Mohs surgery and reconstruction the day after my pre-op so at least I now have a target date for which to mentally prepare. The cancer on my back will be removed first in a few weeks by my Dermatologist, most likely through excision. I will then have a month or so to heal before my face surgery occurs on September 8th. Relieved to have a date, however the intensity of it all gave me one big headache.
Dr. J gave me a handout with post-op care instructions before I left his office. There will be a period of time I most likely will not be able to wear my glasses due to inflammation, swelling and tenderness. This is not a great thing since I am pretty reliant on my glasses to read and see. They told me to expect redness, bruising, and swelling to not only my eye area but my face plus the possibility of bleeding into the white of my eyes for a period of 4-6 weeks. I will need to sleep with my head elevated (yay for brand new, über comfy La-Z-Boy recliners) and I won’t be able to do any heavy work, bending over, lifting or exercise. In other words I am going to be bored for a bit :-).
However boredom is the perfect trade-off for becoming (fingers crossed real tight) cancer free.