Last summer I
started to notice a spot on my nose. It looked a bit like a pimple but it
didn’t go away. After a few weeks I went to a dermatologist and had a biopsy.
Bad news: basal cell carcinoma, not the worst kind of skin cancer but not to be
ignored. Doctors call BSC “the rat cancer” because it burrows under the skin,
out of sight; there is no way to tell how much (or even where) it has spread.
The
dermatologist told me that I should have Mohs surgery to remove the cancer. The
procedure is for the surgeon to shave off skin a layer at a time, testing each
layer as she goes, until a cancer-free layer is reached. There is no way to
know ahead of time whether the surgeon will remove one layer or seven. In an
area as delicate and contoured as the nose, a seven- layer procedure would
leave a large wound that would take weeks or months to heal completely and
might require plastic surgery. For me, that would mean canceling the annual
scuba diving trip and possibly ending up with a permanent, unsightly mess at
the end of my nose. Surely, I thought, there must be a better way.
And there is.
It’s called superficial radiation therapy and it has become available within
the last ten years. It is distinct from an earlier form of radiation therapy
that was commonly used before the introduction of Mohs surgery, which became the
standard treatment for BSC in the 1970s. SRT is not available everywhere and
has advantages and disadvantages compared with Mohs. The experience of having
an SRT treatment is similar to having a dental x-ray and takes about as long.
- SRT is non-invasive, painless, and
non-scarring. Like any surgery, Mohs causes bleeding, pain, and an unpredictable
amount of scarring.
- SRT requires 12-15 very short visits for
treatment. Mohs surgery requires 2 visits, one of which may last all day. If
there are unforeseen complications, further visits may be needed and, possibly,
treatment by a plastic surgeon.
- The cost of both types of treatment is about
the same and both are covered by insurance.
- The cure rate of Mohs is slightly higher, but
both are above 90%.
- SRT may
increase the likelihood of getting cancer again, decades in the future. (If I’m
around then, I expect that there will be much better forms of treatment
available.)
For me, the
good news was that SRT is available
in Indiana. The bad news is that the best qualified facility is in Muncie, more
than 2 hours from my house (more like 2.5, with road construction at both
ends). But I did it anyway – 14 round trips between late September and early
November of last year. The facility had an oncologist to determine the dosage
but the actual treatments were done by a technician. At the time of the last
few sessions I had some mild bleeding from my nose but that was the only
discomfort. I’m so glad I did this!
