The Word Is "Squamous"

Two days before my 59th birthday, my telephone rings at 8 a.m. When I see my dermatologist's caller I.D., I assume his staff is contacting me. I've recently had session two of moles and other weird thingies removed from my face, mostly for cosmetic reasons. I don't want my grandchildren to see an old witch when they look at my face.

After session one, everything was benign. I haven't thought twice about the lab work from session two until I hear my doctor's voice on the line. He says that one tiny bump on my face has come back positive. "Remember that one bump that I thought looked suspicious?" he asks. I remember. He says I need to come in and have it cut out. No big deal.

What could be difficult? Nothing really, except that he will excise some skin, freeze it, and send it to the lab. We will then wait for the lab results before sewing me up or before cutting deeper. If he cuts more, he will freeze more cells and send them to the lab, and the procedure will repeat until there is no sign of cancer.

He asks me to look up "Mohs surgery" on the Internet. Hmmmm. I've been looking forward to this year's birthday. I'm not sure how to feel now. Once I Google "Mohs," it becomes difficult to be optimistic. I read that the physician makes an oblong incision, plenty long to get all the cancer cells. Nothing significant on someone's forehead or arm, but my tiny lump is on my cheek, near the smile crease that goes from my nose to my mouth.

I call the doctor back and talk to his staff. "I need to know what kind of cancer this is," I say. "The doctor told me to look up "Mohs surgery. He did not say what kind of cancer it is." The nurse says: "Squamous cell carcinoma." "Isn't this worse than basal cell carcinoma?" I ask, trying my best to pump her for info that will give me some peace of mind. She seems noncommital.

I find out that both basal cell and squamous cell carcinomas are usually 100 percent curable if treated right away. Squamous cells may metasticize more quickly, but basal cells go deeper and may be more disfiguring. In my case I'm more concerned about potential disfigurement--I think. I request the name of a plastic surgeon.

When Dr. Ting calls me with some surgeons' names, I ask to schedule an extra appointment to discuss my options, face to face. Is surgery a must? I don't want to be disfigured. I love Dr. Ting. He fits me in two days from now. I've decided that once I do everything possible to insure success, I will put this topic out of my mind. I'm feeling more in control as I pursue more information.

Meanwhile, I find infinite sources on the Internet indicating that the Mohs procedure provides the highest assurance of complete cancer removal but preserves a maximal amount of normal tissue.



I go to my consultation two days later. Dr. Ting draws an incision on my face as plan A. He will do Mohs procedure on eight different people on my big day, and I'm second in line. I like the order. He can warm up on number one, but still be fresh during my turn.

Below is the squamous cell carcinoma on my left cheek. What you see started as a tiny thing before it was cut and sent to the lab a few weeks ago. Note: I cropped away my face like they do in the medical journals--to display these silly cancer cells.



Dr. Ting erases the ink and draws plan B, in case there are lots of cancer cells. He tells me that the plastic surgeons will charge $6,000 to stitch the hole closed. This fee is obscene. Why would one human overcharge another human to do an hour's work when this procesure is not optional?

Dr. Ting looks like an Asian Doogie Howser. He credits his consistent use of sun screen for his youthful appearance. (He reminds me to put on my SPF50 before I step outside.) He has performed Mohs technique many times; he is confident that the scar will not be a problem for me. I believe him. I decide to count on him. June 19th. I will say so long to "squamie" and update this topic.