Meet James B.
From Suspicious Lesion to Basal Cell Carcinoma Treatment: Learn His Story
James B. is a 75-year-old male patient who noticed a reddish, non-painful sore on his nose. He attempted to self-treat it with Neosporin for a few days, but it seemed to not respond at all. It was not painful or itchy. It was just simply present.
James showed the spot to his primary care doctor when he was in for a routine check-up, and his physician recommended he seek out care from a dermatologist. James immediately contacted Dr. Ellen Turner and scheduled the first available appointment, which was a couple of weeks away.
Before seeing Dr. Turner, James noted the lesion would occasionally bleed, especially after showering or washing his face. Usually, the bleeding was minimal and it would stop after a few minutes. However, the lesion still was not causing him any pain whatsoever.
When Dr. Ellen Turner saw the lesion on James’ nose, she immediately recommended a biopsy, or taking a sample, of the site. He agreed, and within approximately five minutes, the biopsy was completed after the area was locally anesthetized, and Dr. Turner was able to collect the specimen with a surgical blade. Dr. Turner reminded him that the test results would likely return in less than one week, and that the office would be calling him back to review the results with him.
Upon review of the biopsy from James' nose, the dermatopathologist, a specialized pathologist trained specifically in skin pathology, it was determined that the spot in question was a skin cancer known as basal cell carcinoma. Dr. Turner discussed with James how, at the time of his biopsy, the best treatment approach to his cancer would be Mohs surgery—a specialized type of outpatient surgery. Mohs allows excision of the malignant cells, while checking the surrounding margins to ensure they are completely clear of any malignant cells, before performing a closure of the site. In cases such as the nose, ears, or eyelids, Mohs surgery was the gold standard for this type of skin cancer until recently. Now there are additional options for patients, such as cutaneous radiation using the newest technology, SRT-100. However, at the time of James' biopsy, he opted for Mohs surgery based on Dr. Ellen Turner's recommendation.
When the Mohs surgeon performed the first layer of removal of skin cancer cells, he found more cells at the edge and then performed a second layer of removal. Upon review of those cells, it was determined there were still residual malignant cells left behind and thus, a third layer was required to completely clear the margin. The resulting defect was 5.5cm in size.
*Patient results may vary
This defect was large enough to prompt the Mohs surgeon to send James to a plastic surgeon for proper repair. The surgeon did a remarkable job, but it required multiple surgeries performed in stages in order to get the final outcome that James sees today when he looks in the mirror.
In accordance with Dr. Turner's medical advice, James returned to her dermatology office to undergo a simple full-body skin exam. Relatively easy and fast, this review of the entire skin surface allows trained dermatologists, such as Dr. Turner, to spot potential issues such as pre-cancers, such as actinic keratosis, or other skin cancers. In the case of James, Dr. Turner located two additional skin cancers; both were basal cell carcinomas. One was located on his ear, and the other on his arm. He quickly had both lesions treated as per Dr. Turner's recommendations and is currently doing quite well clinically. He is an excellent patient who keeps his scheduled follow-up appointments with Dr. Ellen Turner, and continues to monitor his own skin for any new lesions according to the guidelines Dr. Turner has given him. His goal, by sharing his own personal story, is to educate others about skin cancer and prevent someone else from having to undergo multiple skin cancer surgeries by getting in to see a dermatologist as early as possible.