She got her first tattoo at sixteen. Typical teenage rebellion, the decision to get a tattoo came from a moment in time that many teenagers wrestle with. Most stop at one tattoo: the powerful need to defy or assert personal identity and power satisfied with a tiny heart on the ankle or butterfly on the wrist.
Not this girl, nope! Erin loves the individuality of beautiful ink: artwork as individual as a fingerprint. Parts of her shoulders, arms and legs are adorned with colourful pigments of her imagination.
Perhaps this is why she didn’t notice the imperceptible mark on the side of her nose: this Trojan Horse disguised as a freckle. “When did it appear Erin?” I asked her before I wrote this column. She couldn’t really say. She cannot remember when it wasn’t there, but she can’t recall when it appeared. It just “was”.
It wasn’t until her recent pregnancy that she noticed it begin to grow. Hormonal surges seem to do that to women: the same magical hormone elixir that grows and feeds a fetus also grows our hair, our nails and our skin cells. The freckled blemish began to change; the edges became ragged and red, a stubborn sore that would not heal. A topical over the counter antibiotic cream was applied, but to no avail. It simply would not heal.
A doctors appointment indicated that indeed it was a very suspicious sore and quite possibly cancerous. A surgeon was contacted and the journey for my young niece began: The journey that many, many take when diagnosed with basal cell carcinoma – one of the most common forms of skin cancer.
The first surgery was completed, the cancerous lesion removed and the lesion and margins of the area sent to a clinic for biopsy. The biopsy would determine the type of cancer and the margins would be inspected to see if any cancer remained.
Erin waited. Meanwhile, the scar faded quickly and you would hardly notice that anything had been removed.
Weeks passed and the results came in….they were both good and bad news. The good news was that the cancer was indeed basal cell carcinoma (one of the easiest to treat and rarely life threatening), the bad news was the margins were not clear and that she needed to be referred to another surgeon, one that specializes in removal of this type of cancer.
This was the first time I had heard of MOH Surgery. MOH surgery (MOH because it was developed by Dr. Frederick Moh) is now one of the most effective techniques for removing basal cell carcinoma. A very precise technique, the doctor removes very thin pieces of tissue, examining each section for cancer cells until the microscope can identify no cancerous cells in the tissue. The goal is to keep as much healthy tissue as possible, while removing the cancerous tissue.
Erin would also be referred to another surgeon, one that specializes in reconstruction of a MOH surgical site on the nose. This doctor would reconstruct Erin’s beautiful nose following the cancer surgery.
As I write this column, I have just left the hospital where Erin is recovering following her reconstructive surgery. The MOH surgery that happened last week successfully removed a circular section of tissue and Erin is now cancer free. Unfortunately, the surgery comes with a cost and that cost is now undergoing another procedure that came with a lot of trepidation.
The reconstructive surgical procedure is called a Paramedian Forehead Flap or PMFF for short. The surgeon harvests a piece of cartilage from the ear and uses it to recreate the stability of the nose. The forehead flap is a fancy-pants surgical technique that means, “take some tissue from the forehead and use it for the nose”. As Erin said with a sarcastic laugh, “thank goodness I have a big forehead’’.
The doctor says that she will have at least two more surgeries before she can put this experience behind her. When she was first diagnosed we said, “No way! Not Erin – she HATES the sun” and that is true now, but wasn’t the case when she was 20 years old. Those days were spent in the tanning bed, trying to get a bronze tint to her skin that refused to change colour. She is not saying that a tanning bed did the damage, but the type of cancer she is battling is generally caused by repeated unprotected sun exposure including tanning beds.
Of course I asked Erin’s permission to use her story this week in my column and she said this: “if it encourages people to take a good look at their skin and go to the doctor if they notice anything suspicious, then that is a good thing”. She also wishes she had never used a tanning bed but knows that you can’t go back in time and change it, you can make the choice to do better and move forward.
My beautiful niece decided to face this scary medical experience head on and document her surgeries and reconstruction progression on Instagram. If you are interested in finding out a little more about her story or perhaps dealing with this type of surgery yourself and want to learn more, you can follow her on Instagram at BCCNOSEJOURNEY.