Basal Cell on the lip...Lori's Story

From the Guestbook

"Help, i just had mohs surgery done above my lip, it is very deep and they want to do flap surgery but first they are going to do a skin graf which they do not think will work. i am still confused on how the forehead gets swollen and where does the skin then drop from? maybe you can explain this to me in laymans terms. by the way, thank you for sharing your experience with us. you look wonderful"...Lori

This is an email conversation I had with Lori over the next few months. She has agreed to share her story here in hopes that it may help others. Dealing with skin cancer, or any illness, is never easy and you'll see here that there is many ups and downs as Lori has had to make some serious adjustments in her life.

The conversation spans three of rather lengthy pages, but there has been a lot of correspondence, through which a nice friendship was started! Thank you Lori.

Note: As the website editor I'd invite anyone who wishes to share a story to contact me through the link at the bottom of every page or use the Guestbook.

Hi Lori,
Sorry to hear that you had to go through this. It's never easy to be cut on in any way but MOHS surgery isn't so bad usually. However MOHS is the best option for many, especially in critical facial areas like on your lip. Not sure what the doctor told you as far as where the flap would come from. It would seem like the lip is rather far for a forehead flap, I'm guessing that maybe it would come from the cheek? Remember though (my disclaimer) I'm not a medical specialist at all! So my thoughts are just that, Ok.

Regardless, the biggest benefit of a flap surgery is the fact that some skin is left attached from where the flap starts. This allows for a constant flow of blood into the flap and greatly increases the chances for a complete healing. When a 'Patch or Graf' is done the wound has to mend and the body has to accept the new skin there. Gradually small blood vessels will connect into the patch from the surrounding area and start to feed the graf nutrients so it too may heal. That's where the 'Flap' has the edge, it never stops getting the nutrients since it's not completely removed from the body. This allows healing to work in two directions, from the inside and the outside at the same time.

Where do they get the skin to close the area the flap comes from? That's what I wanted to know too. I didn't realize just how elastic that the skin is. In my case the flap was almost 2" wide at the top. Which for me was right at the hairline. But you know, that part of the face actually has quite some extra skin there and the doctor was able to pull it together to cover almost all of the opening. As you may have seen in my pictures, there's a little triangle area that wasn't covered. But it healed better than I thought it would. Now all that shows is just a very small depression there and it's really not very noticeable.

My two cents is that getting the flap would be the preferred option. Don't think I would have thought that before, but knowing now what I didn't know then, I can see that the flap was definitely the best way forward for me. I hope this helps and that everything works out for you. I'm sure it will and hey, your words "you look wonderful" in my guestbook, well that just made my day! So a BIG 'Thank You' to you.

I'm always around so feel free to contact me with any questions or thoughts. I'd like to hear from you.

Again, thanks for posting on my site,
Kent

P.S.
I realize there may be a gender thing in play here, where maybe I wasn't so concerned about my looks as you probably are about yours. I'd say try to let those thoughts just slid on by and let the body do it's thing. It'll heal you nicely if you'll let it. :)


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Hi Kent,
Thank you for getting back to me so quickly. I am a nervous wreck! If you don't mind I am going to ask you a few more questions. I am having a skin graf done at the end of the week. The surgeon told me I was not going to be happy with it at all as it is going to have a scar (which seems to be the least of my problem) but there was going to be a crater (large hole) in the area where the graf is going. He told me he will do this to start but then I will have to have the flap surgery. Did you get a skin graf first then the flap surgery?

Basal cell from sun exposure
This is Lori's lip before the MOHS
surgery. This basal cell on the lip
has the 'raised and shiny'
characteristics.
Sun exposure caused this basal cell

How long from start to finish is the whole procedure? My doctor told me I would be out of work about a month. From the time they blow up your forehead to the time the skin comes down how many weeks is that and do you need surgery for that part? So how many days does that flap hang on your face until the surgery? I noticed they covered your whole head? why?

The reason my doctor wants to do this on my forehead and not my cheek is that he said it leaves a scar on the forehead and i would rather have a scar their then on my cheek. It is not on my lip it is right above my lip between my nose and lip.

I hope i am not a bother with all my questions. Thank you so much for your email. You have no idea how much you have calmed me down a bit for the night. Hope to hear from you soon.
Lori

Hey Lori,
First of all, you are going to be alright. Really, you will. Lets not lose sight of the big picture here, the cancer is gone. Without MOHS things would be much different and probably wouldn't turn out as good as it's going to now. And I'm glad you've calmed downed a bit, getting all worked up is hard on a person! So lets answer your questions and no, your not bothering me at all. Just glad to help you.

Did you get a skin graf first then the flap surgery? This is how it worked for me. Keep in mind that I'm talking about the 3rd time that I had Basal Cell on my nose which resulted in the forehead flap procedure. No I didn't get the graf this time as the surgeon that did the reconstruction (flap) was scheduled for the very next day. So I had the MOHS done on a Tuesday by Dr. Goldstein and then Dr. Kreit did the flap on Wednesday. That just happened to work out for me, if Dr. Kreit hadn't been available I'm not sure what the course would have been. As it was, I just had to get through one night with a very bandaged face. I did go out to a restaurant to eat and then stopped at a store to buy some sweat pants since it had turned cold and all I'd brought was shorts!

How long from start to finish is the whole procedure? The flap surgery took about 8 hrs. followed by an overnight stay. I was released the next day. That was the first time I'd ever been put under and yeah I was quite concerned about that part. But honestly, looking back now, there really wasn't so much to be worried about as I had thought here should be. I was in the recovery room for another 3 hrs or so before I got to go to my room. Here's probably more than you want to know but I'll share it anyhow...I guess while you are 'out' they keep you pumped full of liquid through a tube. So when I woke up, I had to pee so bad couldn't hardly stand it. But there was no way I was going to let that pretty young aide that was there with me hook me up to some kind of drainage devise. Nope, no way. So I held it. Finally I get to a private room and tell the nurse that I need to go, she brings in one of those plastic bottles with the angled top, think it holds about a quart. Should have seen the look on that nurses face when I told her I had filled that one and needed another bottle. Hehe

How many weeks is that and do you need surgery for that part? Ok, there's actually 3 parts to the whole procedure. First the MOHS, which you've already had, then the flap procedure. That flap stays for 21 days. Then the third part is where they put me under again and removed the extra part of the flap that needed to come off. That was about a 2 - 3 hour surgery and after a short time in the recovery room I went home. No overnight for that part.

So how many days does that flap hang on your face until the surgery? I may not have understood the other question, #3, but it was 21 days and I pretty much stayed in the house and out of sight. That was hard for me to do, didn't want anyone to see me. Or so I thought, now look at me, got all those pictures of me on the website and every month a couple thousand people get to take a gander at a fellow that isn't looking his best!

I noticed they covered your whole head? why? I think it was to keep me from falling apart! Really, it probably helped the stitches and staples to stay in place for that first day. That big wrap around my head only had to stay for 24 hrs. Thank goodness for that huh.

Lori, you are going to be fine. It's a period in life that will soon pass and be behind you. It sounds like you will probably get the skin graf first, which maybe is just to get you by until you can get the flap procedure done. Without really knowing, I'd guess that it's a timing issue or else they probably wouldn't do the graf if you were to get the flap done right away. This is one of those things that you are really just along for the ride. You have little control over things, (that really bothered me) but you just have to trust in the Dr that he'll do his job and do it well.

Please keep in touch, email everyday if you wish, ask all the questions you have and lets see this thing through to the end. I have a favor to ask of you. Would you mind if at some point I shared our conversation on my site? I think what you are experiencing right now would greatly help some people to be able to read this account of the events you are going through. Your call, I totally respect if you'd rather not.

Keep your spirits up and concentrate on a point in the future, say about 2 months from now. Then this will all be part of your past. eh?

Be well,
Kent


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Hi Kent,
Again thank you, I think by the time I am done with my 1000 or so questions I will have picked your brain and you will probably will want to loose my email address. ha ha... the pee story is so funny, I don't blame you for holding it in, i would have done the same although it is easier I think for women to go in that situation.... Anyway, you are more then welcome to post all emails that we have between us. I am scheduled for Thursday morning at 7 am for the skin graft. I will be home for about a week and I will be emailing you 50% of that time. You really have no idea how much you are helping me through this... I will talk to you in a few days and again THANK YOU THANK YOU THANK YOU!!!!!!!!!!!!!!!!!!!
Best regards
Lori

Hi Lori,
You gotta ask more than a 1000 questions to bother me, maybe a 1001. Glad you liked my little story, was hoping that I didn't offend you...never shared that part before. Probably for good reasons! So Thursday it is, well I'll be thinking of you and will be waiting to hear how it went. Don't know if you have or not but maybe take some pictures as these steps progress. Also I really hope that you have someone near and dear to be with you and to baby you for a day or two. You'll probably need some extra TLC. My guess is though that the worse will just be how uncomfortable you'll be. Don't think you'll have a lot of pain, at least I never did. But it was sure uncomfortable, however that said, I'll take uncomfortable over pain any day.

Stay focused and just give yourself up to what has to be done. It'll be easier that way rather than fighting it in your mind. My Grandma always used to pop off an old saying that really helps to keep things in perspective, "I felt sorry for myself because I had no shoes until I saw a person who had no feet." Ok, I'll stop now and will be waiting to hear from you. Don't keep me in suspense too long now. :-)

Happy thoughts from Kansas,
Kent


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Hi Kent,
Whew!!! I made it through the skin graft. I didn't feel anything because it was done under general so i was out like a light. I was in some pain after the surgery and a lot on friday but today is getting better. Now i am just uncomfortable and tight. I have a huge cotton ball actually stitched to my face. I am not sure why but I go back to the doctor on monday and he said he was going to remove some of the stitches and the rest after a week. I have to assume at that time he will remove the cotton. I just went to peek at where they grafted the skin from (on my neck) and as i pulled part of the bandage off I saw a deep hole which is about 8 inches long, i decided not to continue looking and put the bandage back, i will wait for the doctor to remove as instructed. Now after this is when I need to get another opinion regarding the flap surgery...

You have become a household name with my family. After the surgery my mom and sisters keep coming over to my house to make sure I was ok, and now they just keep asking me if i have spoken to the "basal cell guy". Needless to say, you helped me so much and I told my family about what you went through and I think they are relieved that I have someone to discuss all of this with.

I will email you on Monday to let you know the results of the graft.... As always thank you for all your help and support "basal cell guy" ha ha
Lori

Hi Lori, Well it sounds like you had a rather tough time there but glad you made it through that part. Getting cut on isn't any fun that's for sure. When I had basal cell the second time they did the patch and the chunk of skin they took off my shoulder to use left a big wound there too. Actually that took about as long to heal as my nose did where they used the patch. That doctor stitched a big wad of cotton or gauze onto my nose also and it was tough to get it off. This'll just make your day here. I went to a different doctor to get it removed after the week or 10 days was up and he worked on it for quite some time and only got it loosened a little then gave up. I went home and finished cutting it off my self, took me three hours to do it. The stuff that it was sewn on with was like real thick fishing line and it was very hard to cut. I used an Xacto hobby knife to do it. Would work on it until I couldn't stand the pain, stop for a few minutes then go back to hacking on it. The graf/patch had already shrunk and I just wanted to cry when I did finally get it off and seen what I was going to have to live with. You probably saw my picture on my site, the one on the home page. That's what I lived with for about 5 years.

So getting the basal cell the third time was really a blessing for me, got that bad area cut off when the MOHS was done and the flap worked very well to rebuild my nose. Before any of this all happened I had my moms nose, kinda up turned end on it and I think she always liked that fact. She said it was "cute", yeah right... After the flap was done my nose was straight and she had some comments to make about how I didn't look like her any more. Well gee, sorry mom! I was just happy to have a normal looking nose again. In your case though things could turn out much better than the patch did for me. I was talking to a doctor the other day and told him about you and what all was being done. He said that there is more blood flow around the lip area than up on the nose and your chances for the patch to take hold was probably better than mine was on the nose. Got my fingers crossed for you!

A couple things I'm curious about. Aprox how old you are and how much sun exposure or tanning have you had. Also how long from when you first noticed something to when you went to find out about it. Because it sounds like the basal cell had got pretty deep. This coming Tuesday I go to see the doctor that did my flap reconstruction for a 2 year checkup. I'm going to ask him about how that works to use a flap from the forehead to fix a area on the lip. I'll certainly share any information with you. This doctor, Dr. Kriet, is the head of the facial cosmetic surgery dept at KU Med Center in Kansas City. Probably don't get much better than him. A super nice guy too he is.

Tell your mom that the "basal cell guy' says Hi. Basal cell guy, now that cracked me up there. I've been called a lot of things but never that before! Please don't laugh or smile at any of this, I'd hate to think that I caused you any extra pain now. By the way, did you happen to read my story about the first time I had basal cell? It's linked from the home page, now that was an ordeal and sure to make you laugh. Listen, I'm glad you have family around to watch over you, this is a tough period in your life and you need that kind of support. No matter what the results are when the bandages come off, you are still 'you' on the inside and that is the most important thing to remember. Don't let that part change.

Kent


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MOHS surgery on the lip - Click here for page 2