Basal cell cancer surgery complications: What your Doctor Doesn’t Tell You that may impact your life. Basal cell skin cancers are usually the least lethal in terms of death and spreading into organs such as the brain and lungs. Saying that they are ignored, misdiagnosed, and treated like they are nothing to be alarmed about. Just a basal cell cancer, not a problem. Downplaying the seriousness of a basal cell cancer can be dangerous to your health.
That is why mine had two years to grow and spread. Basal cell cancers can invade surrounding underlying nerves, muscles, and bones. They can spread via the lymph system. They can spread deeper into the tissue below the cancer seen on the surface. They can spread deeper than a normal excision surgery cuts out. Once they spread into the lymph nodes or muscle, only an MRI or CT scan can detect them.
I am still going through the impacts. I guess what irks me with my dermatologist, is that he dismissed my concerns that it had spread and left out important information in his discussions with me. I want people to be aware of what can occur with the surgery treatment for skin cancer.
Biopsies Can Be Painful
#1: Biopsies may hurt depending on where the basal cell cancer is located such as in the rib cage area or shoulder. This doctor stated to me the biopsy would not hurt. The problem is the lesion had hurt and itched badly for almost a year leading up to this point. The cancer is located in my upper back right next to the rib and shoulder blade on the right side. I had gone to him because it was affecting my movement for over a year and made it hard to sleep. The itching was incessant. After he cut the biopsy hole it itched and burned worse. I called their office after they informed me that the lesion was cancerous. I stated that the area was really hurting. His nurse said the biopsied area hurt because there was still cancer in the area. If you look it up, basal cell cancer usually doesn’t hurt unless it has advanced and spread underneath the skin around the main lesion. It should not have itched much or affected my movement unless it was advanced. He never told me that part. He insisted it would be a simple surgery without complications.
#2 He called back a few days later saying the biopsy was positive for basal cell cancer. He emphasized again it would be a simple surgery with little pain afterward. I was pretty sure that the fact that it had been growing and possibly spreading for over a year or two was an issue. It had been affecting my whole back causing it to itch and it had hurt as well for at least a year or two, which meant it had spread. He kept dismissing that. Simple and easy surgery he repeated. I knew if the lesion had impacted my movement before surgery, the surgery would make that worse, despite what he told me. I was told he would perform the Curettage and electrodessication (C and E) surgery which means removing the surface of the skin cancer with a scraping instrument (curet) and then searing the base of the cancer with an electric needle.
Surgery Day Was Not Simple nor Pain-Free
The day of the surgery my doctor came in and explained the surgery before he performed the C and E surgery. In and out he stated. He again said that most of his patients did not complain of post-pain surgery. The surgery took much longer than he expected. He ended up cutting 4 inches of material out of my upper back with 11 stitches. The shots to deaden the area were painful. The shots did not completely deaden the pain. They had to inject me with more shots to deaden the pain. I could feel the machine cauterizing the area as well. The skin was very tight between my right and left rib. I had to hold my right shoulder back in an uncomfortable way so he could pull the two sides of the skin together to cover the hole he had carved. I knew as he was having trouble pulling the skin tight, it was not going to feel great moving the arm or shoulder afterward. I was right.
What he didn’t tell me about C and E Surgery……
The difference between C and E Excision Surgery and the MOHs surgery for skin cancers.
What he never told me about C and E Excision surgery, is that they usually cut out a large area around the lesion to try and make sure they get all the cancer. The difference between the C and E Excision surgery I had, versus the MOHs surgery, is that the lab only examines less than 1% of the material removed under a microscope. According to other resources like Cleaveland University, it is less than 0.2 percent of margins are checked by the lab techs.
Again only 1 percent of 4 inches or more of material surgically removed was examined for cancer.
That leaves a lot of material that may or may not contain cancer cells. In the MOHs surgery, they perform small slices where each slice is examined under a microscope before going further. They cut out slices of flesh until the material margins are free and clear of cancer. This can take hours between cuts and microscopic examination. Mohs surgery is usually not done on cancers that they suspect have spread or have advanced. MOHS surgery is usually done on small cancers or those on the face, nose, or eye areas. My doctor never suggested the MOHS surgery because he suspected it had spread already and it was a large area. He downplayed the surgery even though he suspected it had spread by my pain and the time it had to grow.
The C and E Excision Surgery can be a failure which means they did not remove all of the cancer. That could mean more extensive surgery including the need for plastic surgery.
What he didn’t tell me until after cancer was still found after the surgery, is that if they fail in the C and E Excision surgery, you may need more complex surgery that could require plastic surgery. This is because if the surgery area is too large, there is not enough skin in the area to close the wound area. So they cut skin from your thigh or other places (a skin graft) to cover the wound area. That involves a plastic surgeon.
In my case, I would have had to drive from the surgery to another office 30 minutes away if it had required plastic surgery. He would not have known that until after he had recut all that same area again. That means that the area not yet healed from the first surgery would have to be recut with a larger area removed.
Call your insurance before the procedure to find out what fees are required before the surgery is performed.
I might add that our insurance might not have paid for plastic repair surgery after the surgery since the plastic surgeon would have had no time to get a preauthorization from our insurance. In my case, I don’t have Medicare so I would have had to pay a surgical co-payment then and there. My co-payment for the surgery was $150. That varies with the procedure and your insurance company. If you don’t have cash in your account or a credit card that could be a issue. It would have cost at least $150 or more for the plastic surgery co-payment due before the procedure. I will add that in some cases, the bill has errors or they try to bill you for the full charges not the plan allowance by your insurance plan. If they have an agreement with your insurance company, you do not pay the submitted charges but what the plan allows. We are fighting that right now. Finally, I called our insurance company and they are now fighting this doctor’s office. Do not pay anything unless they correct your bill. You do not pay the submitted charges by the doctor’s office….if you have insurance coverage. If your insurance states only a co-fee is due, do not pay more than that.
Surgery can affect your job or activities depending on where the cancer is located and the surgery area cut out.
After the surgery was completed and I was bandaged up, I asked him what chores I needed to adjust because of the surgery. It was then he said I couldn’t walk our dogs, lift anything heavy, vacuum, bend over, or extend that right arm much until two weeks at least when the stitches came out.
The Surgery or surgery complications may impact your job or lifestyle afterward!
Even if he says no, the fact is they may have to cut more flesh out than expected. They cannot know for sure how far a basal cell cancer or any of the other skin cancers have spread until they start cutting. My doctor told me the surgery would be simple and easy. He was wrong.
He did not tell me about any restrictions before the surgery or after the surgery until I asked on the way out of the office after the surgical procedure. It was not included in the directions for care of the wound and surgical aftercare period that he gave me.
Ask Questions Before the Surgery. Your doctor may not tell you important information.
What if I had a job that required a lot of movement or heavy lifting? Some people live on a farm and do a lot of heavy work with chores or animals. What if my husband had required my help getting up from a chair? Some people my age babysit to earn extra money or take care of young grandchildren. He should have told me that before the surgery so that I could have adjusted my job or lifestyle before the surgery. He never asked anything about my lifestyle and the fact that the surgery would be cutting into my rib and shoulder blade was an issue.
Surgery can impact your life with pain upon movement for weeks!
The surgery I had took out 4 inches of flesh and was deep right into the rib area. After the pain meds wore off, I found I could not even wash the dishes without pain. Movement of any kind pulled on the skin that he pulled tight to close the wound. There are stitches inside and on the surface. The inner stitches can take 4 months to dissolve and heal. Much to my displeasure almost every movement, even changing positions in bed caused pain. I could feel the effects over my whole right side down to my waist. That is because sometimes in the surgery, they cut nerves and or muscle tissue. In my case, the cancer was embedded in the Thoracic Nerves T5 through T8. Those sensory nerves really hurt when cut into. They may send out random nerve pain that shoots out when you move the area.
Your loss of function for chores and movement can go on for weeks until it heals! If they cut nerves or muscles during the surgery that pain may be permanent. They can’t tell you for sure.
I got my stitches out on November 16th. It is now December 8th. It is just now that I can finally for the most part use my right arm and shoulder without causing pain in my back. Even walking up to this point made my whole right side ache and hurt. I still cannot vacuum or lift 20 pounds without feeling it. The doctor did not want to do further surgery so he gave me the option of applying chemo ointment over the surgical area where the cancer remains. This will be applied for 4 weeks. He instructed me to apply the chemo ointment around the area where the stitches were including a half inch further. The cancer he said was still on both sides of those stitches.
The reality is the surgeon has NO idea how far the cancer has spread to the surrounding tissue.
He is guessing. I also had experienced terrible breast nerve pain for a month before the cancer was removed. The cancer was embedded in the Thoracic sensory nerves which start at the spinal cord and wind around your torso into your breast area. He has no idea if the pain in my breast is due to the cancer affecting those nerves or a separate issue. I suspect the breast nerve pain did come from where the basal cell cancer was embedded. I know that now after several weeks post-surgery, that breast pain is gone. What a coincidence! I did have a mammogram during this period that was negative. The female doctor I went to, did state that there were lymph nodes in the left side of the breast that were swollen.
Basal cell cancers can spread into lymph nodes. A mammogram would not show cancer in the lymph nodes.
The dermatologist stated he would not do another biopsy after the 4 weeks of chemo ointment treatment. It would not serve any real purpose. He does not know for sure that the chemo ointment is applied to all the area that has cancer left. He had no idea if it has spread to underlying nerves and muscle tissue? He is guessing! So the cancer could pop up again or if the cancer did spread to a larger area, where it can’t be seen but felt, I will have to find a doctor to explore that possibility. Once it is quite advanced, they can perform a CT scan or MRI to try and detect his presence in the lymph nodes, muscles, or nerves.
If your basal skin cancer has been growing for a long time over several years or if it itches and hurts, expect more than a simple C and E surgery. Realize that your surgery may very well affect you for a few weeks or months or possibly long-term depending on where the cancer is located and if it has spread to underlying nerves and muscles. If they cut muscle or nerves, this may or may not heal completely over time.
“Wide Local Excision
Standard surgical margins should be more comprehensive than clinical margins because of the infiltrative growth of the tumor.
With wide local excision, recurrence rates range from 40% to 60%. The standard histologic method of margin assessment, based on bread-loaf sectioning of the specimen, examines only 0.2% of the margin and leaves much room for undetected tumors.
Significant soft tissue defects can be noted after tumor resection and may necessitate reconstruction with local flaps and skin grafts. Reconstruction after incomplete tumor excision, however, could require the later removal of a flap or graft, which has further obscured the area of tumor positivity. This can result in delayed detection of recurrence and significantly increased complexity of definitive treatment.” Mohs Micrographic Surgery Evaluation and Treatment of Microcystic Adnexal Carcinoma – StatPearls – NCBI Bookshelf (nih.gov)
“Mohs surgery vs. excision: What’s the difference?
Excision is a procedure through which your surgeon removes the skin cancer and a margin of surrounding skin and the specimen is sent to pathology for processing and interpretation. In general, less than 1% of the margins are checked with wide local excision. . Mohs micrographic surgery involves excision with a smaller margin and the tissue is processed in such a way that your surgeon checks 100% of the deep and side (lateral) margins.”