Ouch.

Mohs surgery on my ear

Warning: photos below show an open wound and reconstruction of an ear, and graphic language describes the process.

It started out as a white crust on the side of my left ear. My fingers kept going to it. It felt rough and abnormal.

I showed the crusted area to my doctor during a routine visit. “Yeah, this needs to be looked at,” she said, and referred me to a dermatologist for evaluation.

White crusty area was the tip of the cancer iceberg.

A physician’s assistant at the dermatologist’s office poked at the area and said a biopsy was needed. With my assent, he stabbed several numbing injections into the area (“This will hurt a little”), clipped off a chunk of the ear, and bandaged the wound.

I got a phone call two weeks later. “It’s basal cell carcinoma,” the nurse’s assistant said. “It needs to be removed. We use Mohs surgery for that. It’s not urgent.” I made an appointment a couple of months out.

Basal cell carcinoma? Ok, I can handle that. I had one removed from my left forearm three years ago. These likely were caused by sun damage over the years.

Basal cell carcinoma almost never spreads (metastasizes) beyond the original tumor site. Only in exceedingly rare cases can it spread to other parts of the body and become life-threatening. It shouldn’t be taken lightly, though: it can be disfiguring if not treated promptly. www.skincancer.org

Research showed that Mohs surgery is the gold standard treatment for basal cell carcinoma.

The procedure is done in stages, all in one visit, while the patient waits between each stage. After removing a layer of tissue, the surgeon examines it under a microscope in an on-site lab. If any cancer cells remain, the surgeon knows the exact area where they are and removes another layer of tissue from that precise location, while sparing as much healthy tissue as possible. The doctor repeats this process until no cancer cells remain. www.skincancer.org

Once the cancer has been eradicated, the damaged part is reconstructed.

A week before surgery, I stopped taking tumeric and baby aspirin. These are blood thinners, and could cause uncontrollable bleeding during surgery.

On the appointed day, I arrived at the dermatologist’s busy office for the outpatient procedure. Nurses and assistants took me to an operating room, put me in a green sterile gown, and took photos of the tumor to establish medical necessity for insurance.

The dermatologist arrived and examined my ear. We chatted as she injected numbing agent and waited for it to take hold.

I asked why basal cell carcinomas are removed, since they don’t metastasize. “This one is infiltrative,” she said. “I’ve seen a lot of these. It could go into the brain.” I think she was pulling my leg a bit, but I’ve seen horrible photos of untreated basal cell carcinomas, and was glad to be getting rid of mine.

She poked around the area with something sharp. “Does that hurt?” It didn’t, so she started cutting.

I felt nothing as the dermatologist pruned my ear. She told me it would take about an hour to analyze the removed tissue, and asked me to sit in the waiting room in the meantime.

I was prepared with my iPad and other reading material. The Dermatology Channel was playing on the TV.

As I sat in the waiting area I chatted with other patients, many of whom looked like they worked outdoors, and who had skin lesions and bandages. Several had been in for surgery annually.

An assistant called me back to the OR for the next of four cycles of cancer removal, bandaging, and lounging in the waiting room during tissue analysis.

In the latter cycles the wound was cauterized, and it was strange to hear the sizzle and smell my own burning flesh.

After the last cycle, about four hours into the process, the dermatologist announced that she had gotten all of the cancer. It had taken longer than she thought it would.

I asked if I could take a selfie, which is below. I was surprised by how much ear was gone.

I told friends that Mike Tyson did this. No one believed me.

The dermatologist asked me what I wanted by way of reconstruction. We joked that this was my big chance to get at least one Spock ear, or perhaps to adopt the Tolkien elf look.

I accepted her recommendation to stitch the ear back together and to use a skin graft, stripped from the area in front of the ear, to improve the appearance and support healing.

She used a bunch of stitches to close the area from which the graft was taken, to pull the edges of the ear together, and to attach the graft. I could feel and hear the sutures as they were pulled through the flesh. This wasn’t painful at the time.

Here is a photo before the skin graft was applied.

The two edges were sewn together. If it was left like this there would have been a big hole in my ear.

Then the skin taken from in front of the ear was used to close the hole.

Skin was grafted over the gap.

An assistant bandaged the area, the dermatologist checked her work, and I was sent home with a sheaf of photocopies describing how to care for the wound. No mention was made at any time about post-surgical pain.

I drove home, checked in with my wife, and reviewed the paperwork. It said to take nothing other than Tylenol for pain. It was beginning to hurt so I took the maximum dose.

The pain grew. Soon it felt like side of my head was on fire. The Tylenol had no perceptible effect.

Dana Schutz, “Ear on Fire,” Oil on canvas, 40 × Courtesy Friedrich Petzel Gallery.

Unable to sleep, I took a strong prescription painkiller I use for back problems, and left a message for the dermatologist that I had done this. She returned my call the next day and said it was fine to take the painkiller I used. I wondered why on earth they hadn’t told me that sooner.

I was told to continue to dress the wound for another week, and did so. After that it was a relief to leave the area open to the air. A few weeks later the last large scab came off.

Here’s a photo taken after the last scab dropped. How does that ear look to you?

Healing nicely.

The reconstructed ear is somewhat smaller than its partner on the other side of my head, but symmetry is overrated in male beauty.

The partner ear, uncut. It’s bigger than the reconstructed ear.

The ear and the area where the graft was taken are a little numb. I imagine that some nerves were cut during the surgery. Maybe feeling will come back. I won’t mind if it doesn’t.

The final follow up visit, a couple of weeks later, gave a clear bill of ear health. The physician’s assistant said that more such cancers are likely, since this one indicates enough sun exposure and damage to cause them. I wonder if I, like the other patients in the waiting room, will need to return again and again for treatment.