I’m a 32-year-old introvert who doesn’t particularly enjoy outdoor activities. However, in April of this year I was diagnosed with a Basal Cell Carcinoma on my right temple. This is the story of my diagnosis, the treatment, and early stages of my recovery. I’m sharing this in honor of Skin Cancer Awareness Month and to give a message of hope for anyone else who finds themselves in this situation.

(Warning: Contains graphic images and description of my Mohs surgery which some may find disturbing)

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I’ll begin this post by stating the obvious: I’m really pale.

I love my porcelain skin except for the summer months when I sunburn if I’m outside for more than five minutes. Over the years, I’ve developed moles on my arms, shoulders, and legs. I’ve always known that my complexion places me within the high-risk category for developing skin cancer.

I suppose this caveat should have prepared me for the reality of skin cancer- which is to say that it can occur anywhere on the body. More often than not, it’s found in places exposed to the sun. Naturally, the face is no exception.

I’m in my 30’s and have cultivated a good skin care routine which includes avoiding the sun because I don’t like to be even a little sunburned.

If I’m being honest, up until now it was more to do with vanity than health: I hate the way my face looks when it’s sun burned, all pink and shiny. I use a day cream with SPF and when I go outside, I cover my chest with a scarf and don a wide-brimmed hat. I make jokes to friends about how I’m too lame be out in the sun, tanning with the cool kids. Being sun-cautious was a part of my identity, and on overcast days I bare my alabaster arms and shoulders with pride. Because of this, I thought that I would be older before I would have to deal with having suspicious growths removed from my body.

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When I moved to Chicago at the end of last year, I noticed a spot on my face that I’d not seen before. It was pink, maybe about the diameter of a pencil eraser, and was flaking slightly. I didn’t remember burning my forehead with a curling iron (something I’ll admit happens too often) so what could this be? Eczema? Ringworm? A new mole? Being underemployed and battling insomnia late one night, I found myself Googling “pink spot on temple”, hoping for a diagnosis in the absence of a doctor.

At this point, I had not considered the possibility of cancer. My spot was round, light pink and frankly not sinister looking at all. When I pictured skin cancer, I imagined raised moles in ugly colours without clear borders.

However, my heart sank when one of the Google images searches returned something that looked exactly like my pink spot: Basal Cell Carcinoma. Skin cancer.

I decided to wait to see if it went away. If it was cancer, it would grow and change- I had been told many times this was one of the markers of skin cancer. I’d wait a month to see if the spot changed and then if it hadn’t gone away, I could call the dermatologist.

Over the next month, however, I noticed changes. It was around Thanksgiving, and the cold Chicago weather made the rest of my face feel dry. I found at one point the flaky skin washed away, but I noticed it was darkening, almost turning red. It would remain red for a couple of days. Some mornings I’d notice that it had faded back to pink. Some days I would forget it was even there.

I thought many times over those weeks that perhaps it was in fact a burn- and that I was simply now watching my body’s healing processes more acutely than usual. It gave me hope as we entered the Christmas holidays, which we spent in humid Houston and my skin returned to a balanced, dewy state and the spot seemed to disappear.

However, we returned to Chicago in the New Year and I again noticed this flaky patch. Thinking it might just be reoccurring eczema brought on by the cold, I decided that it was time to get reassurance. I didn’t hesitate to call the first dermatologist I could find on our network. Unfortunately, I was unable to get a quick appointment; the earliest I could be seen was in mid-March.

Fast- forward to mid-March. My appointment was imminent, but as most people know, everything changed in March.

The coronavirus outbreak meant restaurants and shops were closing, and non-urgent medical appointments were getting postponed. I got an email to inform me that my dermatology appointment would be a phone call instead of an in-person visit. This annoyed me, because even on my iPhone’s camera the spot barely registered up some days. I insisted that I be seen in person and was given a slot in mid-April.

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My appointment day finally came. I distinctly remember each moment of that morning because it was the first time I’d wandered more than a block from our apartment in downtown Chicago since the stay at home order.

I remember that because masks were sold out online, I had to wrap the lower part of my face with a pashmina scarf. When I set off for the appointment, I made a joke to my husband that I’d return after I finished robbing a bank.

I also remember that the streets were empty. Not a soul, save myself and a few scrub-clad doctors who were also briskly walking towards the hospital. I felt like I was in a post-apocalyptic film, walking through a major city with my face crudely covered up and feeling on edge because of a mystery virus.

I remember walking towards the hospital and seeing nurses standing guard at the large glass doors. I had my temperature taken before I was allowed past reception and needed to confirm that I free of any upper respiratory symptoms. “Give her a mask…Use the hand sanitiser before you get on the elevator”. The germaphobe in me simultaneously never felt safer from the coronavirus, but suddenly appreciated how easily this must spread.

I arrived at the dermatologists’ office and noticed I was the only person in the large waiting room, which I could see had been stripped of all but five or six chairs, spaced six feet apart from one another.

I was called back for my appointment by a nurse wearing a surgical mask over her N-95 respirator mask.

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The spot, looking rather inconspicuous that day, was almost instantly diagnosed by my double-masked dermatologist. “It looks like a ‘little’ Basal Cell”. It was then scraped, something which I was bizarrely aware of because I could faintly hear the scalpel being dragged through my skin. I was told to expect the results in the next week.

I suppose I should have been prepared for the forthcoming diagnosis because the dermatologist also explained to me then and there that he would treat the spot on my face with a surgery called Mohs, a procedure which removes the cancer piece by piece to preserve as much healthy tissue as possible. This is possible because the excised tissue is examined under a microscope to see which direction the lesion is growing under the skin. The growth is mapped out and then they come right back to cut away more. This process is repeated, removing only affected tissue until no cancer is seen under the microscope.

I was told at the appointment that this was the “better” kind of skin cancer to have since it rarely spreads to other parts of the body (as with melanoma). Because of the method, the removal by Mohs has a 99% success rate. The dermatologist told me that in the event the test came back showing Basal Cell Carcinoma, my prognosis was good.

When I received the phone call the following week, confirming my diagnosis, I asked to have my procedure rescheduled as soon as possible as I wanted to take full advantage of the stay at home order to heal. They fortunately had availability the following week.

The week passed. Slowly.

I found myself growing unbearably anxious, something not aided by my incessant Googling of “Mohs on the face”, “Basal Cell Carcinoma Mohs”, and various other iterations of the phrase sure to return distressing images.

The dermatologist didn’t explain at the time was that this type of cancer spreads deep under the skin, meaning the lesion is usually the tip of the iceberg. Suddenly my small pink spot didn’t seem so small and I felt like a moron for not booking something years ago.

I was growing increasingly uneasy at the idea that my face, something which I never thought of as particularly pretty to begin with, would be changed by this. I’d likely have a scar, and depending on how skin needed to be removed, it could be a rather large one. The pictures on various plastic surgery pages showed Mohs reconstructions, some of which looked worse than the “hole” left by the tissue removal. My skin cancer was in the same part of my face as my eye- did that mean I would have a black eye as well as an ugly scar running along my eyebrow?

Deep down I knew that the concerns about the way I would look were superficial in comparison to a cancer diagnosis. However, being a young woman I am in the unfortunate position to understand how important appearance is. I was terrified that I’d end up permanently disfigured by my Mohs surgery.

Morning yoga helped to focus my nervous energy, but beyond that I found it impossible to do anything productive in the week leading up to my procedure. I knew that life was going to change, and after having to navigate several recent major life changes it felt as though everything was spiralling out of control.

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Miraculously, on the morning of the procedure, I found myself overcome with a sense of calm.

My surgery was scheduled for 8am, so I set an early alarm so I could get up and make my customary comfort breakfast: sausage, egg, potato taco. I also made a point of wearing my favorite t- shirt. Every little thing helped to make the task of setting out of the door less daunting.

The dermatologist’s office was busier than my last visit: three other people were arriving for their Mohs surgeries that morning.

I was sent to a room in the clinic and told that because of COVID-19 I would wait in that room for the day rather than go outside to the waiting area. I took comfort in knowing I wouldn’t have to worry about additional exposure but was a bit uneasy knowing I’d have only the sterile walls and ominous surgical tools to keep me company for the day.

The doctor came in accompanied by a nurse and a surgical fellow. It was go time. I was asked to lie down on the table. My palms felt sweaty, and I was suddenly aware of how vulnerable I felt, lying prone on a table with three people hovering over my head.

I decided I wanted to keep my eyes closed but I could feel the heat from the lamp on the side of my face when the light was switched on. The prick from the anaesthesia, and the only thing I’d really feel during the procedure, didn’t hurt at all. I could feel the pressure from fingers pressing on the spot, and I felt a vague sensation of movement on my face.

After what only felt like a minute, I could feel gauze on my eyebrow, and then the heat – and smell- of a cautery pen. The nurse applied a bit of gauze and tape to the area to stop the bleeding.

My first pass was finished.

I was told they’d be with me in 45 minutes with the results.

I took a selfie to share with my husband, who wasn’t allowed to accompany me. It was difficult to see much of anything because of the pressure dressing, but based on the size of my biopsy site, I imagined that there was a pencil tip sized hole- nothing too scary- underneath.

True to their word, the nurse and surgical fellow entered the room after 45 minutes.

They said that the tests ‘didn’t show much cancer’, and that perhaps the biopsy scraped off most of it. They wanted to do one more pass to be sure they got clean margins.

I was elated- perhaps this wasn’t such an ordeal after all? Feeling much more positive than the last time, I lay back on the table, and was numbed again.

I felt sensation of something touching my face, but then a “click”.

I was hearing a distinct “crunch” each time I felt the pressure of the blade on my face. It took me a few seconds to realise why: the surgeon had cauterised tissue during the first pass, and I could now hear each slice into charred skin.

The sound made my skin crawl and made me hope with renewed fervour that this would be the final pass.

Unfortunately, after an agonising 90 minute wait, the surgeon came in to inform me that they found more cancer, growing towards my hairline. They were confident that one more pass would clear the margin but also that they were referring me to a plastic surgeon to close the wound.

My heart sank. I had not seen under the pressure dressing on my forehead. How big was this wound? How much more tissue did they intend to remove?

They repeated the numbing process again. My heart was pounding after the news that I’d have to see a plastic surgeon. I tried my best to ignore the sound of my crispy skin being cut away and focus on my husband’s earlier promise that he would pick up a Chicago-style pizza for dinner.

The surgeon was apparently so confident that they would be able to discharge me after the results from the third pass that the nurse came in with papers for my referral to the plastic surgeon and my prescriptions for antibiotics and narcotic-grade pain killers.

The pressure dressing after my third pass was slightly larger than the previous two, and my eyebrow looked a bit swollen. I struggled to think of why the Mohs-specialising surgeon couldn’t close what must surely be a small opening given the size of the original lesion.

I knew these thoughts weren’t helpful, so I tried to focus on the prospect of going home.

However, not 20 minutes passed when the surgeon came into the room again. The margins weren’t clear, and they wanted to remove more.

“One more time! It’s okay, you’re going to a great plastic surgeon to close this. We can also laser away any scars. You’re doing great!”

I was clenching my fists so tight that my knuckles were white. I could feel little beads of sweat collect under my knees. At one point the surgeon told me they’d try to get me out of their office and into the plastic surgeon’s as quick as possible, and instead of saying something like, “Yes, that sounds great,” I found that my jaw was clenched too tight to form words.

“Rrrmmmhhhmmm”

Reduced to a nonverbal mess, I sat down after the fourth pass and snapped another selfie. I behind my mask I could that my face looked swollen and blotchy, but I was too pumped up on adrenaline to let myself cry.

Twenty minutes later the doctor poked his head into the room: “Your party’s over!”

I looked at the clock. 12:42pm. Had I really been there nearly five hours?

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I was sent across to the plastic surgeon’s office across the street. They seemed to have been aware I was walking over because upon my arrival I was whisked to an examination room that seemed to have been repurposed into a photography studio.

The nurse removed my pressure dressing and curiosity got the better of me.

“Can I see it?”

It was nickel-sized, and quite deep. Because of the cauterised edges, it wasn’t bleeding too much but I was shocked nonetheless.

“Holy shit… sorry.” I realised the nurse was standing in the room. “Sorry for that, I hadn’t seen it yet.”

“Oh, don’t worry,” she said, “I’ve heard people say much worse than that.”

Photos were taken and I was led into an operating room. The plastic surgeon came in, and immediately felt him press on the skin on my forehead and cheek.

“This is a big hole. We can close it but your eyebrow will be lifted at the edge.”

A big hole. He surely sees Mohs patients all the time and he’s saying it’s a big hole?

It was the first acknowledgement of something I ought to have discerned by the sheer fact I was referred to a plastic surgeon. Suddenly the emotions I’d kept welled up from the morning came flooding up to the surface. I didn’t know what my face would look like after this- did he mean I would look like half- Jack Nicholson?

Eyes closed and jaw clenched shut again, I tried my best think of my husband waiting for me outside of the hospital and the deep dish pizza.

Because my emotions were frayed at this point, it felt like the closure process took longer than my 4 Mohs surgeries combined. When the surgeon was finished, I was told that I had internal external stitches and steri-strips. the first of which will dissolve over the next few months. The steri-strips would fall off, and the external stitches would be removed in a week.

I couldn’t believe my eyes when I saw it.

The hole was gone.

My face looked… normal. My eyebrow was incredibly swollen, but nothing else was out of place. I felt my eyes burn as relief and gratitude washed over me.

As promised, my husband was waiting for me outside of the hospital to walk me home. He wanted to get me a donut and because I hadn’t eaten anything since my early breakfast we wound up leaving the bakery with three. We had our deep-dish pizza that evening and I found that the combination of sugar, cheese, and narcotic-grade pain killers sent me to sleep earlier than usual.

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Being a logical person, I knew that recovery from a nickel-sized hole in my face wasn’t going to be easy. However, I was not prepared to experience the emotional fallout in the week following the surgery.

Because COVID-19 closed offices, I wasn’t getting my usual work and was able to rest, without guilt. I wasn’t absorbed in writing or my job search, so my mind was idle for the first time in months.

I had a few concerns with the wound itself- my steri-strips didn’t want to stay on- and found that I had a dull ache around my hairline. I also became acutely aware of how often I move my face, particularly eyebrows, even when I don’t intend to.

Laughing, the real and uninhibited kind, was painful and reminded me of the fact that I had a hole in my face.

I wondered when I could laugh without feeling stitches. I also wondered if I’d ever be able to look at myself again without checking for a new pink spot.

I soon found myself crying over insignificant things.

I was going through a crucial stage in the recovery from trauma. It was only natural that part of my healing would be to process, albeit belatedly, the emotions- fear, disgust, anger- I didn’t fully experience on the day.

The morning and day of the procedure I remained calm- a remarkable feat given my penchant for the theatrical. I shut my emotions down so that I could get through the day in one piece. My body was protecting itself from… well…itself.

I needed- my body needed- to complete the cycle.

I let myself mourn the loss of normalcy. I let myself feel upset that I’d taken my health for granted. I let myself cry if I felt moved by message from a friend.

It was incredible to feel unashamedly sad and overwhelmed for as long as I needed. Learning how to be kinder to my mind, body and soul was one of the many valuable lessons from this experience and is hopefully one of the positive life changes going forward.

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It has been three weeks since my surgery. My next check-up will be in November, in six months’ time. At the time of writing this I have an ugly scar on my temple which will fade over the next year.

I’ll probably ask my hairdresser to style my hair to cover it in the meantime.

I also have a Photo Dynamic Therapy (PDT) session scheduled in July to kill any potential cancers on my face, neck, and scalp.

I’m cancer-free for now, but I still find that my thoughts race back to the what ifs: “What if I’d caught this earlier?… What if it comes back?” These aren’t helpful, but I do have a solution for the latter: I doubt I’ll ever put off that dermatologist appointment again.

Lessons learned from this:

-Pizza is wonderful. Especially so when it’s delivered to you by a handsome English guy (who is, of course, also wonderful)

-The human body is amazing. It knows how to protect and heal itself. Your body is your friend, listen to your body.

-Get your arse to the dermatologist for regular check-ups. There is no time like the present to invest in your health.

I hope that this post- while graphic and a bit sprawling in its presentation- comforts anyone with this diagnosis.

More importantly, I hope that my story of the little pink spot inspires someone else to book their own dermatology appointment. (Seriously, just go!)

Thank you for reading- I promise my next post won’t be anything like this one!