High Number of Certain Skin Cancers Linked to Increased Risk

This rings true for me.

SpecialK -- I'd like to ask you some questions about your BCCs and surgeries and get some advice. I'll just jump in here, but tell me if we should move to private message or if there is a forum for skin cancers that you know of. I just got diagnosed with my first one, micronodular BCC (classified as infiltrating), right over my collar bone. It is literally sitting on my collar bone so it is also near lymph nodes. I have to have surgery because the shave biopsy didn't get it all; path report says: "extending to deep and peripheral biopsy edges."

The doctor at Kaiser wants to do an electrodessication and curettage, but from what I've been reading micronodular is high risk for recurrence and also re-excision, and jesus it is on top of my collar bone, so wouldn't Mohs surgery be better? Per the article the mods posted above, my BARD 1 gene mutation makes me higher risk for more of these, too. I don't think this dermatologist is trained in Mohs, which is why I don't think she suggested it. There is another doctor at Kaiser who is Harvard trained in Mohs, but I'm just wondering how far I should go in fighting for the Mohs.

Also, the reason I was seeing the dermatologist is because I've had a "rash" (for lack of a better word) along my MX scar. There is a red hive-like thing on my right MX scar that has been constant, and then there is a rough patch of skin next to my scar that hurts when touched. This morning that rough patch has turned red with two tiny papules (but honestly it changes a lot, just in general the skin is angry). Everyone has looked at this: the PA in the bs office, an oncologist, and the dermatologist, and no one thinks it is anything (dermatologist said "I don't know; try this anti-inflammatory oil" -- made it worse). I want to demand imaging before they do the skin cancer surgery -- like a chest MRI to include the shoulder/clavicle region, or should I ask for a CT? SOMETHING is going on with the skin on my chest, and I don't feel like we've gotten to the bottom of it yet even with this BCC diagnosis. I emailed my derma and asked her if she thought the scar issue and the BCC were connected, and she said no.

Any advice would be appreciated.

Thank you Special K for all that data, especially the long day part. I'm ALSO dealing with a terrible degeneration in my low back and I'm in a lot of pain. So I will definitely get on top of the back diagnosis and treatment plan before I do the surgery. My dermatologist said the surgery (that she wanted) could be any time in the next three months. I believe even though infiltrating, the BCC is still slow growing, hence the wait is okay.

I really liked the MO I saw at Kaiser, and she is the one who referred me to dermatology. Maybe I will email her and ask her for the imaging. I mean, it isn't unreasonable to do imaging of my chest I think when there is so much going on and we still don't know what's going on with my MX scar situation. My prior providers are all part of another insurance network and I can't see them or be referred by them. Good point on the MRI vs. CT; I don't want the contrast in the MRI either (I have some kidney damage) so I hope they can see what they need to see without the contrast.

They haven't biopsied the rash because they all think it doesn't look like cancer and they want to watch it. Interestingly, the derma didn't think the mole was cancer. I told her that it bleeds off and on, and she said she didn't think it was anything, "but do you want me to take it off if it's bothering you?" She gave me the option! I'm afraid of infection, so I didn't want to do something just for my convenience, but I said "If you take it, will you send it to pathology?" and she said yes if they take it they always do. I thought might as well, so I said "Okay then take it." My decision!! She takes it off, puts it in the preservative, and says "Oh there's a little blood vessel underneath it; that's why it was pink. I really don't think this is anything." So twice she said it was nothing.

I was in the ER on Thursday with excruciating leg pain from my back, being treated terribly btw, and I get an email from the derma where she copy/pasted the paragraph from the path report in block letters: BASAL CELL CARCINOMA, MICRONODULAR TYPE, EXTENDING TO DEEP AND PERIPHERAL BIOPSY EDGES. Now, like most bco sisters, I'm a tough broad and I usually prefer just getting a written report rather than someone spoon feeding me information. But I was in so much pain at that moment and so much has happened lately, and seeing no clean margins and knowing instantly what that meant, I just burst out sobbing. Most of that was because I was shocked. The reason I do so much research and ask so many questions is because I HATE being shocked. I want to be prepared. And she told me twice it didn't look like anything abnormal. So I was shocked.

Other than venting, I guess my point is that I don't really trust anyone so far who has looked at my MX scar and said "I don't think that's cancer," since the dermatologist didn't even think the mole was cancer -- and if I hadn't told her to take it off she wouldn't have.

I will definitely demand MOHS surgery. Definitely. I am also going to work on getting different insurance so that I can be seen at the NCI Comprehensive Cancer Center near me. At this point, I need to be followed at a cancer center so that a multi-disciplinary team can be watching all of the different parts of my body at once. So I may get that insurance and do the MOHS there (although the Kaiser doctor who does it near me is Harvard medical school and Harvard residency in MOHS, so doesn't get much better than that...)

Ok good to know. And of course I researched all of the things about micronodular BCC, and there would've been no way for her to get it al in the biopsy, so that part I understood later. It was just at the moment of reading the report that I was shocked. I think of this cancer as a skinny (hopefully) stalk of broccoli: she took off the top, now we have to go back and get the stalk! So I totally understand that we can have repeat performances of this, especially if the BCC is infiltrating/micronodular. There are some apparently that can just be burned off and boom you're done!

I will work on getting the MX scar rash biopsied. Ugh.

Wow MinusTwo and you had a bc recurrence after a BMX for DCIS! Yikes. I will for sure insist on the MOHS.

Thank you moderators for posting this very informative article.

Oh btw my handle is "I Spy" because I'm a private investigator. Everyone reads it backwards, but I like my handle so I explain. Also, I'm worried people will think I mean tipsy like I drink a lot.

Two cm? I'm not good with metric, but I think that's almost 3/4". Good heavens!!! Basal cells are known for going deeper in a 'column' instead of spreading out laterally like squamous cell), but the largest of my basal cell cancers was still not as big around as an eraser on the bottom of a #2 pencil. Most were much smaller in diameter, although some turned out deeper when the Mohs was finished.

I thought a basal cell was always infiltrating, although I may be wrong. Below is a statement from cancer.org.

: Mohs surgery has the best cure rate for basal cell carcinoma.

ispy - none of my skin cancers have been bigger than the top of a pencil eraser and I have had numerous wide excisions and MOHS. I can’t have steri-strips due to adhesive allergy so understitching with strips for a neater incision can’t be done. Unless MOHS is indicated (for me, any recurrence, anything on my face, or infiltrating - so far) I end up with what is essentially a lumpectomy. I stopped doing burn and scrape or freezing a while ago because that has proven not to be aggressive enough for me. Infiltrating BCC is more unusual - less than 30% of cases, most basal lesions are superficial. Infiltrating lesions are more aggressive and at higher risk of recurrence. I am guessing you are correct about the limited availability of the MOHS surgeon dictating who gets MOHS - this was also the reason I had to wait from May to July for my last one, even though it was classified as aggressive. California, like Florida, has enough sun that skin cancer is rampant and demand is high for removal. Sounds like USC is a good choice, as is City of Hope or UCLA - from an old LA girl to a new one!

special K I have adhesive allergy too! And it is worse than ever. Just trying to heal this biopsy incision is KILLING me because I'm trying to keep it covered and even the tiniest piece of bandaid adhesive or film is setting off a chain reaction rash.

I'm actually from LA! I moved to San Diego for a few years and now I'm back. So we're both LA girls!

Oh -- and I told the derma I got the mohs surgeon's email and yea, okay, fine, but can we at least find out if it is actually micronodular?? she replied she would and let me know. but OMG I have to ask??

Ipsy - below is a link to an adhesive allergy thread. Not particularly active but some great ideas. I only allow Hypafix (my first choice) or Medipore 'tape'. I actually carry it with me to all doc appointments. And make sure they are wiping a barrier film like Cavilon on your skin before using ANY type of tape. Most hospitals have this stuff, as do most infusion centers. But you have to ask & insist.

https://community.breastcancer.org/forum/91/topics...

sorry Ipsy, none of my cancers have been a mole. Hope someone else will know. But yes, in six months amazing cancerous & pre-cancerous lesions grow on my body. I actually keep a list and circle things on my skin with a pen before each six month full body scan.

ispy - none of mine have been a mole either, mine are red/pink irregularly shaped spots

Yes, we probably are talking about the same thing. Red or white or raised places; sometimes flat or sometimes a bump; sometimes crusty, sometimes bleeding. I get ALL my precancerous lesions frozen so they don't snag on my clothes & start to tear or bleed. In the past, most annoying were under the bra line or the elastic on a 1/2 slip.

BTW - I read on another thread what your name meant. So every time you posted I did a double take to remember it was not "ip-see". Which wouldn't be right either, but that's how my eyes registered it. Now I'll have to get used to the new actual spelling.

SpecialK, was anything done differently for the cancers on your lymphedema arm? At 64, I've only had two small bcc lesions (upper chest & back) and one squamous cell carcinoma on my non-lymphedema arm. I had a traveling job for nearly 5 years in my 20s so know the left side of my face & body got lots of sun while driving above and beyond the sun bathing and swimming / water skiing burns. That's my breast cancer / lymphedema side and I feel like it's only a matter of time before something noxious grows there. 😕

Lyn

Thank you SpecialK for that info. My sarcasm towards the pathologists was because they've said it is micronodular, making it a high-risk or aggressive form of basal cell carcinoma; however, my dermatologist said that the pathologists at kaiser lump micronodular with nodular (non-aggressive). I find that a bit haphazard. The subtypes are very distinct for a reason, and most literature I've found indicates that Mohs surgery should be performed on micronodular, but not necessarily on nodular. If I hadn't asked for clarification, I'd be thinking I have micronodular. I checked today and the dermatologist still hasn't heard back from the pathologist to verify which subtype I have.

Ohmigosh, SpecialK, you've really had a tough go of it! I'm sorry. 😖 I have to deal with the blasted sleeves and pump, too.

I'm allergic to adhesives, too, but my dermatology surgery staff was conscientious about that so, of course, the surgeon I liked moved out of state. My only issue with the recent 3-inch squamous cell excision was a 1-inch blister at the edge of the pressure bandage. The BCC on my chest was done by a PA and looks like a Frankenstein scar with big, white stitch marks.

I hope the skin issues settle down for you. You've faced so much already.

Lyn