Note: I recently had a surgery to remove a basal cell carcinoma lesion. In this essay, I share about the experience and the healing process.

Fair warning/ heads up: the content here includes descriptions of the surgery and images of my scar. If you’re sensitive or squeamish, please be advised.

To Be Alive at All is To Have Scars

February 2, 2023

Diagnosis: Left Superior Chest: BASAL CELL CARCINOMA, superficial and focally micronodular patterns, extending to deep and lateral margins.

A formalin-filled container is received labeled with the patient’s name and information. The specimen is submitted as “left superior chest” and consists of an irregular shave of wrinkled, tan-gray skin measuring 8 x 7 x 1 mm. The surgical margin is inked blue, trisected, and entirely submitted in cassette 1A.

MICROSCOPIC:

1. Left superior chest: sections show superficial and dermal aggregates of neoplastic basaloid epithelium that extend into margins.

Dear Rachel:

Enclosed is a copy of the pathology from your biopsy that was performed on January 25. As you are aware, the lesion from your chest proved to be a basal cell carcinoma. While this type of skin cancer rarely spreads, if left untreated it will continue to grow and become locally invasive, with the potential of becoming quite disfiguring and dangerous. We look forward to seeing you March 1 for further treatment of this lesion.

***

A few months before my 35th birthday, I found out from the dermatologist that a small spot on my chest would need to be removed.

When I got the call, the lady on the other end of the phone asked me, “Do you know what a basal cell carcinoma is?”

Tears welled up in my eyes as I answered, “It’s cancer, right?”

“Yes,” she said. “But of all the cancers you could have, this is probably the best one.” I smiled weakly, realizing she had given this speech many times and it was supposed to help me feel better.

“Basal cell is very common,” she said. “It’s non-life threatening and rarely spreads. We see it all the time.”

I quickly grabbed a pen from my desk and jotted down on a sticky note: basal cell, non-life threatening. I started to cry silently.

“You will need to schedule a procedure for the excision,” she said. “Did you want to take care of that now?” She asked the question like it was no big deal, but my body said otherwise: my hands were trembling as I wrote down excision.

“Yes,” I said, pulling up my calendar on my phone. We set up the appointment and it all sounded so straightforward: one hour surgery, local anesthetic, stitches, two weeks to recover. The facts were simple, but in my heart they felt jumbled. I was terrified, confused, anxious.

I’m healthy, I thought. I’m young. Cancer… really?

In the weeks leading up to and following the surgery, I’ve spent a lot of time reflecting.

Reflecting on what it’s like to get older.

What it’s like to have an unexpected change in my health.

What it’s like to be in pain.

What it’s like to surrender to the experience of a changing, aging body.

And how freeing it is, learning to love myself in the process.

***

After each appointment, the dermatologist’s office sends a follow-up letter in the mail.

There is something both comforting and terrifying about seeing the words on the page– seeing it all laid out in tidy paragraphs.

The words the doctors give me are clear-cut. They explain, define, instruct. They tell me what the data shows, what to expect. As a wordsmith myself, I love the words like surgical margin, inked blue, trisected– words that are so precise they sound like poetry.

But they are outweighed by words like invasive, disfiguring, dangerous.

And they pale in comparison to the feeling in my body as I read them: the feeling of, what if I am dying? It flickers in the palms of my hands; trembles in my belly when I go to eat; anxiety hovering like a moth near a flame.

Looking back, perhaps the anticipation leading up to that surgery– wondering what if– perhaps that was the hardest part.

***

PROCEDURE

I’m sitting in the middle of the room at the dermatologist’s office, leaned back in the chair they put you in for a procedure, the kind with the crinkly white paper on it. I can feel the low-dose Valium pill trying to push down my fear. It’s only half-working.

My doctor hovers over me with the bright light angled at my chest. She has successfully determined in the last few minutes of poking and prodding and injecting more lidocaine that I’m now sufficiently numb. We can begin.

To my right, the medical assistant woman hands her the scalpel. A few moments later there is this incredible sound– equally as gentle as it is disturbing– a faint metallic scraping. Like a gentle etching. The sound is delicate but rocks me to my core. I know she’s only working at the surface of my skin, but it feels like my heart is being scraped out of my chest.

I can’t feel the exact pain now, but I know I am being cut open at the skin just below my left collarbone.

I can feel other parts of my body reacting to what’s happening. There’s a tightness in my neck, a sharp catching in my ribs, a shakiness in my throat.

I’m staring at the pattern of the panels on the ceiling when I realize I need to close my eyes, to shut down at least one sensory input. Everything feels so intense right now and I wish I could somehow block this out. Breathe, I tell myself, trying to relax. I try to use the breathing technique I’ve done so many times in yoga but I feel anything but calm. My hands are tangled together under the sweatshirt I’m holding in my lap, rigid, tight, my fingers gripping even though I don’t want them to. I try to breathe, to wait for this to pass, but it feels impossible.

The doctor announces when the excision is complete. “It’s out,” she says, her eyes smiling. She always seems to have a big smile under her mask when I come for my appointments. I appreciate her calm demeanor and I feel like her confidence is my life raft right now. We’re still not done but there’s something to celebrate: no more basal cell carcinoma in my chest.

A few agonizing minutes later, a burning smell floods my nostrils.

Is that… me?

I realize she must be cauterizing the wound. No one warned me about this. I do my best to hold my breath while the smell passes but time feels like it’s standing still. I still can’t feel anything at the location of the surgery, but everywhere else in my body there is a sick, vulnerable feeling– the same sensation I always seem to get when my blood is drawn, my body quietly revolting.

The doctor and nurse get to work stitching me back together and it is the strangest feeling, the way my skin pulls– a webbing that spans shoulder to shoulder, jawline to sternum, everything connected in between. I can hear the needle weaving the stitches.

Every few seconds, the nurse blots where the scar will be, holding off the blood. At one point I feel a horrifying drip near my left armpit but am not sure what to make of it. I can’t quite tell what’s numb or not. I feel curious, in awe of my body and shocked all at once, suddenly aware of the connectedness, the way my skin holds all of me together, webbing below the surface.

I manage to sit through the rest of it uncomfortably.

“Okay,” the doctor says, “You did great.” I open my eyes. She walks me through the aftercare instructions and reminds me that they’ll send the biopsy for testing.

“Oh, and one other thing,” she says, pulling off her gloves. “You can expect the skin there to be raised at first. When you take the bandage off, it will look like a little caterpillar on your chest. That’s normal. That’s what we want. As the incision heals, the skin will become smoother and flatter. I just don’t want you to be alarmed when you see it.”

I nod.

“Okay,” I say. “Thank you. I wouldn’t have known to expect that.”

She gives me another big smile and says she can’t wait to see how my healing has progressed when I come back in two weeks.

The nurse continues to bandage me up, pressing firmly into the wound as she covers it.

I start to cry, silent tears falling down my face.

The pain isn’t where the scar will be. It’s deeper. It’s gathered in the area around my heart, edging around my throat. My hands relax enough for me to reach up and wipe the tears.

I did so great holding it all together up until now, like I usually do. Keeping the wall up as long as I can until there is nowhere else for the pain to go but straight through me.

***

Post-Op Care for Sutures (Non-Flap or Non-Graft)

You have just had surgery. Often, because lesions are removed from the skin, patients think that they can immediately go back to their usual routine. This is not always the case. Due to the fact that local anesthesia was used, and tissue has been removed, we recommend you take it easy for the next few days. Please be diligent and read the following aftercare instructions.

***

The next day, I wake up feeling like someone has punched me in the chest.

I’m not supposed to unwrap the bandage for at least 24 hours, which is a relief– I’m not particularly keen on seeing what’s under there. Plus, I’d rather not mess with it– any movement I make seems to cause discomfort, especially if I raise my left arm above shoulder level or extend it out to the side to reach for something.

The pain ebbs and flows.

I take the day slowly, focusing on work to distract myself from the discomfort.

That night, when I unwrap the tightly packed gauze, I discover the caterpillar that my doctor told me to expect. There is a 3-inch diagonal line on my chest, the skin around it reddish brown in color. A thin blue nylon thread snakes its way through the incision path. The area of my skin that’s been under the bandage is wrinkled, wavy and soft.

Staring at it in the mirror, I feel uneasy, shaky.

Vulnerable.

***

In the week following the surgery, the healing process is slow, each day a little less painful than the one before it.

There’s an unfamiliar tightness in my chest– a strange, zig-zagged feeling of tension, like I can feel the webbing of my skin knitting itself back together. The labyrinth of fibers pulls at my left shoulder, my neck, even my back ribs.

Each night when I change the bandage, I watch how the bruise fades into a sickly yellow, the skin around it red and angry.

I am careful with the gauze and the tape.

I feel exposed, raw. Tender.

My heart feels guarded and the scar feels heavy.

***

It is about 10 days later when I feel a shift.

I get out of the shower and I’m standing in front of the mirror to change the bandage. I’m taking my time with it, noticing the raised edges of the skin, the soft slope of my collarbone. The start of wrinkles at my neck, soft etchings under my eyes.

I feel used to the routine of this– changing out the dressing over the wound, checking on it, seeing how it’s doing. I can stand here now and stare at the scar without feeling shaky. I feel a faint sense of pride at how well my skin is healing, each day a little less sore. There is still the feeling of tightness, like a catching, but it’s improving.

The little tick mark across my chest is diminishing, fading slowly in color. My awareness of it is shifting. The scar itself is teaching me patience, trust in myself, hope.

I love that it’s a caterpillar– an exemplary symbol of transformation. I’m emerging from my unexpected cocoon, this experience of skin surgery.

Looking at the scar with a sense of gentleness, I feel a glimmer of compassion for myself and for all of this.

It’s happening, I think, so that from now on, I have a visual reminder to connect with my heart more often.

What felt unthinkable and overwhelming– cancer– perhaps there’s a softness to it after all. A deeper purpose here. A new awareness of how to let go, and how to live.

***

The follow up letter comes in the mail the same day I have the stitches removed.

Dear Rachel:

This is a note to let you know that the lesion from your chest has been completely removed. This is good news and should be sufficient treatment for this particular lesion. We look forward to seeing you in May for a regular follow-up appointment. A copy of your pathology report is enclosed.

Dermatopathology Tissue Exam (Final Result)

Specimens:

1 - Tissue, Left Superior Chest

Clinical Diagnostic Information:

Irregularly pigmented macule with irregular borders. DDX: Micronodular basal cell carcinoma. Notes: please check margins. 12 o’clock superior pole.

Diagnosis:

1- Left Superior Chest: SCAR, EXCISED, NO RESIDUAL BASAL CELL CARCINOMA IDENTIFIED

***

At the office, the appointment to remove the stitches is faster than I expected.

A nurse’s assistant walks me back into the exam room and I ask, “Is this going to hurt?”

“It shouldn’t,” he says. He takes a photo to document the healing progress. “Ready?”

I nod.

Then, in one slow movement, he pulls the blue thread that’s been in my chest through and out.

That was easy, I think. I guess it’s over.

I check out from the appointment and walk to my car. I sit there for a moment and take a slow, deep breath. I fold down the mirror above my seat and move my shirt to the side so I can see the scar. The line is thin, light red, becoming more and more faint.

I place my hand gently over my chest for a moment, then run my finger over the scar. The edges still feel tender, slightly raised, but it isn’t too painful now. I take another breath and let out a sigh.

I let go of my shirt and it rests over the newly healed skin. The fabric is soft and noticeable against the scar. After two weeks of being protected, now there is no bandage layered over the incision site.

No chrysalis.

It will continue to heal, I think to myself. As I heal.

My eyes well up with tears as I go to start the car.

Relief.

Little wings unfolding.

This experience has transformed me.

I welcome the change.

***

Sitting here now, the scar on my chest has healed more.

Writing it all down has helped me mend even further.

Again and again, I come back to questions that have brought purpose out of pain:

What is this here to teach me?

How am I feeling? What can I do to honor those feelings?

What support do I need to feel safe through this?

Can I trust my body to heal?

Am I willing to ask for what I need?

Where do I go from here? What beautiful things does this scar remind me of?

How can we help each other through these weird, wild moments when our bodies feel like anything but our own?

I’m still processing what happened to me, but what I know for sure is this: getting older is a gift. Even on days when I don’t understand my own body, or when I feel pain, I’m grateful for the growth and transformation that continues within me.