On the last day of 221, on my way home from the hospital, I began to struggle with whether to shave my head. Before this, I never thought that the first thing I would think about after I had cancer would be the problem of hair retention.
There is a mole on the top of the head that is always scab
In the winter of more than a year ago, I found that there was a place above my head that was always scabed and always cut off unconsciously by me. Later, I finally realized this problem and asked my boyfriend to help me take a look. He said it looked like an ordinary-looking, scabed black mole.
Because of the daily mix in various popular science numbers, and was brainwashed by various medical dramas, I vaguely felt that this mole might not be a good stubble, so I went to the dermatology department of a small hospital in front of my home. After the doctor read it, he waved his big hand and said that it was an ordinary mole, and when the epidemic passed, find a larger hospital to cut it. If that's the case, let's wait until the epidemic is over, and I don't take it seriously.
In the blink of an eye, a year has passed, and it is another winter. Towards the end of the year, I thought it was time to solve problems big and small. Checked a few hospitals with good dermatology rankings, and I picked a more convenient one and hung up the general outpatient number.
However, during the face-to-face consultation, just after hearing that there was a mole with repeated scabs on the top of the head, the doctor quickly opened a dermoscopy and said that he wanted to confirm the nature. After the examination, before I got the report, I was reminded by the doctor who audited the report: "Be sure to review it!" ”
I was most afraid of the doctor's sudden concern, so I quickly printed the report form, only to see that it said "To be excluded basal cell carcinoma." Instantly, my heart beat faster and I tensed up!
In order to communicate with the doctor preparedly, I quickly took out my mobile phone to search for this term that I had never seen before, and when I saw the words "low transfer rate", the nervousness calmed down a little.
I took the test results back to the clinic, but I did not expect that the small doctor in the outpatient clinic actually became nervous after seeing the report, and quickly took me to the director to confirm. The director took a look at it and said: "It's quite similar, why is it that the onset of the disease is getting younger and younger now?" Then the director comforted me again: "It's okay, just cut it, you have to shave your head." ”
Having shaved my head, I donated my long hair
The next step is to make an appointment for an outpatient procedure and complete the preoperative examination and skin preparation before the date of the procedure. Dr. Bipi said that even if you don't shave your head, you should reserve at least four fingers wide, so there is the scene where I struggled at the beginning.
However, close to the day of the operation, I received a call from the hospital: "Our department has been isolated because of the epidemic, the operation has been postponed, wait for the notification." "It's a twist and turn!
In the days of waiting for the operation, I was not idle, and I checked various papers and learned a little more, which allowed me to maintain a cautious and optimistic attitude. At the same time, my boyfriend and I both said that we could finally contribute to the fruit shell patient!
In the process of reviewing the paper, I learned that basal cell carcinoma is quite common in the elderly. It's just that most people think that it is just a black mole, which only affects the appearance, and does not necessarily want to get rid of it.
Finally surgery! The day before the operation, I went and shaved my head. The reason for this decision is that the surgical position is on the top of the head, even if only the part is shaved, it cannot be covered, and when it is shaved, you can see if there are other moths on the head.
Don't shave don't know, a shave frightened, it turns out that I have eight other big moles on my head, which have been hidden in long hair before, it is really a "mole multi-star person", ah, fortunately, there is no problem in the follow-up zooscopy.
When shaving her hair, my aunt was very careful, and shaved her long hair neatly against the scalp as I requested, so that I could donate it to cancer patients in the cancer hospital.
Cut off and tied long hair 丨 Author courtesy of the author
The surgery went well and the results were ideal
On the day of the operation, my boyfriend accompanied me to the hospital, and it was the director who operated on me. After the local anesthesia, I only felt as if I had a pen drawing on the scalp, and there was no other special feeling. Soon the surgery was over and the excised scalp was sent for intraoperative rapid freezing pathology. The director had confidently begun to stitch up the wound, and after the stitches, he left me alone on the operating table and waited for the pathological results, and he went to the next operation quickly.
After the director finished two surgeries, I also waited for the results of the intraoperative frozen pathology: "Basal cell hyperplasia lesions, consider basal cell carcinoma, lateral incision margin and basal margin have been cut clean." "I was relieved to see this result. The next step is to cover the wound and go home. The operation lasted almost an hour.
Intraoperative rapid freezing pathological results 丨 Author courtesy of the author
The cut tissue was taken to the pathology department by my boyfriend, and he took a special photo so that I could see it. The tissue as a whole is olive-shaped, and a thread is also worn on it.
Surgically cut off scalp tissue 丨 Author courtesy of the author
My boyfriend and I carefully discussed it a few times before the operation, and he was worried about whether there would be other possibilities, so he also checked a lot of information. When he saw the pathological results, he was also relieved.
Half a month later, I got the final pathological results: "Basal cell hyperplasia lesions, consider basal cell carcinoma, lateral incision margin and basal margin have been excised, it is recommended that the immunohistochemistry is clear." So I tossed and turned to the director to read the report, he said, "You are basal cell carcinoma, but also removed clean, do not do immunohistochemistry is no longer meaningful." "After telling me how often I'm reviewing, I left.
When I decided I wanted to shave my head, I bought a few wigs. I met several waves of friends during the New Year, who said my new hairstyle was cool, but also like opening the door to a new world, they tried on my wig, and some even became a women's clothing boss.
After tossing and turning, reviewing it, the conclusion is that it is a wake-up call. Although I got a cancer that didn't seem to even need to be hospitalized, didn't have to go through a painful chemotherapy process, wouldn't affect my life, and didn't need to be careful about the rest of my life, I still decided to take care of my body, do a good job of sun protection, especially not let go of the position of the scalp; at the same time, I must cherish the time and continue to run to the next beautiful life.
Doctor reviews
Zhang Hui | Attending physician of the Department of Dermatology, Yangmei Group General Hospital affiliated to Shanxi Medical University
Basal cell carcinoma (BCC) is a common skin malignancy with a similar incidence of male and female incidence, most commonly occurring in exposed parts of the body, such as the cheeks, nose, nasolabial folds, and eyelids. At least 26 subtypes of BCC have been reported, most of which grow slowly and rarely metastase.
There are some exceptions, such as superficial BCC, which is the most common subtype in young people, and its growth pattern is mainly horizontal growth, but occasionally it can grow aggressively to the deep, and there is a high recurrence rate after conventional surgical treatment. Another example is basal squamous cell carcinoma (variant BCC), which is easy to metastasize and easy to recur after treatment. In addition, BCC needs to be differentiated from multiple diseases, so patients need lifelong follow-up.
The age of onset of BCC is more common than 50 years old, and rarely occurs under 30 years old, which is why the director read the author's report and felt that the onset of the disease is getting younger and younger. As the aging of the population in mainland China becomes more and more obvious, BCC is becoming more and more common in clinical practice.
In addition to age, what other factors are BCC associated with? UV radiation is the most important environmental risk factor for BCC, and is more common in outdoor workers and light-skinned people. Ionizing radiation, which occurs on the basis of chronic radiation dermatitis, is more common in the site of long-term exposure to X-rays. Chemical carcinogens, long-term intake of inorganic arsenic or drinking foods with high arsenic content. Burn scars and other scars. Occurs on the basis of certain hamartomas, such as sebaceous adenous nevi, verrucous epidermal nevus, etc.
In addition, having a family history of skin cancer, being immunosuppressed, having certain genetic disorders increases the risk of BCC, and mutations in some tumor suppressor genes and proto-oncogenes also drive the occurrence of BCC.
When dermatologists consider BCC, patients are often advised to do a dermoscopy to observe changes at the submicronic level of the skin, which helps in the diagnosis of the disease, safe, non-invasive, and convenient.
After the authors of this article underwent a dermoscopy, there was a high suspicion that it was BCC. But the gold standard for diagnosing BCC remains histopathology. There are a variety of benign and malignant skin diseases that may be histologically similar to BCC, and misdiagnosis may lead to unnecessary resection or delay in the diagnosis and treatment of metastatic diseases, and if necessary, distinguish between key histological features and auxiliary tests such as immunohistochemistry.
The specific treatment method of BCC should be determined according to the specific situation of the patient, and the tumor risk, patient tolerance, disease site, primary or recurrence, cosmetic results, and treatment costs need to be considered. Surgery is the preferred treatment option, and radiation therapy is an option for patients with contraindications to surgery. Other treatment modalities include medication, physical therapy, etc.
The recurrence of BCC is a concern. This requires patients to follow up as directed by their doctor, avoid intense sun exposure, and conduct regular skin check-ups. Just like the author of this article, after having this life experience, she decided to take good sun protection, and also hopes that the majority of readers and friends can pay attention to sun protection.
The author of this article is lucky, although it is not paid enough attention at the beginning, but the ending is ideal. Although BCC is characterized by slow development, rare metastasis, and low mortality, it first requires dermatologists to differentiate from some diseases with the help of relevant tests to confirm the diagnosis. Therefore, from a professional point of view, it is still recommended that you find suspicious lesions and diagnose them in the dermatology department of a regular hospital as soon as possible, diagnose them early, and treat them early.
bibliography
[1] Basset-Seguin N, Herms F. Update in the Management of Basal Cell Carcinoma. Acta Derm Venereol. 2020 Jun 3;100(11):adv00140. doi: 10.2340/00015555-3495. PMID: 32346750.
[2] Stanoszek LM, Wang GY, Harms PW. Histologic Mimics of Basal Cell Carcinoma. Arch Pathol Lab Med. 2017 Nov;141(11):1490-1502. doi: 10.5858/arpa.2017-0222-RA. PMID: 29072946.
[3] Dermatology of Bolognia[M].4th edition,Zhu Xuejun et al.,Beijing:Peking University Medical Press,2019.2087-2092.]
Zhao Yan. Chinese Clinical Dermatology[M].1st Edition.Nanjing:Jiangsu Science and Technology Press,2009:1523-1525.
Sharing personal experience does not constitute a diagnosis and treatment recommendation, can not replace the doctor's individual judgment of a specific patient, if you need to go to a regular hospital.
Author: Mo Huan
Editors: Xiao Ai, Li Xiaoqiu