Mohs Procedure is a Winning Hand for Skin Cancer Survivor

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mohs.jpgMore than 20 years ago, Florence Beck's bridge partner looked across the table at her and played a card that may well have saved Beck's life.

"She said, 'You have a skin cancer on your cheek. Go see a dermatologist,'" Beck recalls. "Since she was a registered nurse, I paid attention to her advice."

Beck did, indeed, have a skin cancer -- the first of many over the coming years. As a matter of fact, she has had so many removed that she's not sure of the exact number. Her best guess is 12: two squamous cell cancers and 10 basal cell cancers. The majority of them have been removed with Mohs surgery by Deborah Mac Farlane, M.D., professor in the departments of Dermatology and Plastic Surgery at MD Anderson.

In Mohs surgery, thin layers of tissue are shaved off and examined immediately under a microscope. If the tissue is cancer free, the procedure is complete. If cancer cells remain, the process continues until the sample is cancer free.

Surgery was not successful
Beck's doctors removed that first skin cancer, and a couple after it, with electrodessication and currettage, also called ED&C. In this procedure, a thin layer of skin is burned and scraped off.

But new cancers continued to appear, and cancers that had been removed kept coming back. About a year later, Beck developed a worrisome growth on her forehead.

"It grew outward, and the tip was dark pink," she says. "It was right at my hairline, about the size of the fingernail on my little finger, and it was ugly looking."

This time, Beck knew she needed a different approach. When she and her daughter researched skin cancer on the Internet, they found the Mohs Clinic at MD Anderson.

Mohs offers a better approach
At Beck's first visit to MD Anderson, Steven Mays, M.D., an associate professor in the Department of Dermatology, took one look at her and pegged the growth as a type of skin cancer called a squamous horn.

"He called in all the fellows and nurses to show them," Beck says. "I don't know how many photos they took."

Then, Mays introduced her to Mac Farlane.

"When he called Dr. Mac over to examine me, Dr. Mays said, 'I want you to meet Dr. No Scar," Beck says. "I knew I was in good hands."

Since then, Beck has had numerous Mohs procedures. She says she's recommended it to many friends.

"I've never had any bad effects," she says. "I've never had an infection or nausea. I have very little pain and get along fine with just a few Extra Strength Tylenol®."

Procedure has natural-looking results
Beck says the Mohs process is simple. Mac Farlane removes cells and examines them under a microscope, while Beck spends a short time in a waiting room.

"In a little while, she comes out and tells me if she got all the cancer or she has to take some more skin," Beck says. "They have microscopes right there. It's a busy place!"

To repair the surgery sites, Mac Farlane uses excess skin from Beck's facial laugh lines.

"It's really natural looking," Beck says. "I don't have as many wrinkles as a lot of my friends, and I think that's why."

After one procedure to remove a cancer on Beck's nose, Mac Farlane reconstructed a nostril with laugh-line skin.

"It looks very natural," Beck says. "You have to look very close to see one nostril is just a little different."

Cancer runs in the family
Beck's daughter, who is 47, has had several skin cancers removed by Mac Farlane with the Mohs procedure, as well as a nostril reconstruction.

"We're both natural platinum blondes with blue eyes," Beck says. "I've always tried to avoid the sun, but we lived in Midland for 16 years. Since we didn't have clothes dryers back then, I had to hang out clothes in the sun. When that sand blew, sometimes I had to wash and hang them out again two or three times. I think that's one reason I've had so many skin cancers."

In addition, Beck suspects a genetic link may play a part in her vulnerability to skin cancer. Her son had two melanomas removed, and her father had skin cancer.

Friendship is still in the cards
Now Beck and her daughter come to MD Anderson every three months for full-body skin cancer exams. If a suspicious area is found, it is biopsied immediately. They both use a chemical cream to help stop the growth of precancerous lesions.

Since that fateful bridge game, Beck has retired from her job as a bank accountant. For several years, she has lived with her daughter, and she still plays bridge every chance she gets.

And what about the partner who first noticed Beck's skin cancer?

"We're still close," Beck says. "She moved and bought a bed and breakfast. I just got back from there, and it's always so good to get together again."

Related story:
FA2 - Q&A: Mohs Surgery for Some Skin Cancers

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