Squamous Cell Cancer Upper Lip and Philtrum

@grammato3 Thank you. I am not sure yet of how many laser treatments. They are first waiting to see if the Kenalog gives me some relief from all the discomfort and tightness. Then we move on to the laser in August. How long after your surgery did you start the laser treatment if you recall?
Thank you.

@moorjan3: I had surgery in June and a revision in August with first laser done in October I believe it was. Now in my case it was for aesthetic purposes but the laser treatment does help to soften scar tissue and improve flexibility which ought to assist your healing if the Kenalog isn’t fully effective.
It’s still relatively early for you so as uncomfortable as you may feel now I’m going to remain optimistic that you’ll be seeing improvement. Please keep me updated.

Thank you. Do you mind if I ask what type of revision needed to be done? This is helpful. They are looking at August right now for the laser and it would also be for aesthetic purposes as well. Even better if it can soften things. Hoping for improvement as you mention above sooner.
Thank you.

@moorjan3 Oh, I should have been more specific about that - sorry. My revision was actually due to not having clear margins after my WLE (wide local excision) which was surprising to my surgeon and of course to me! In fact, the pathology had to be sent to Mayo Phoenix from the the facility where I had the procedure performed in Scottsdale, AZ because it was so difficult to determine. I needed to have the wound re-opened and have a slow-Moh's performed to be certain that the melanoma from that site had been removed. Did that contribute to my unsightly scar formation? Probably, but the end result has been favorable at least in terms of appearance and function.

@moorjan3 yes, my mouth in slightly uneven, centered but left side is slightly shorter in width and I do use a lip liner in the morning but I have full use of my mouth and I'm just happy to be living at 77. I was lucky because I had a great MOHS surgeon in Tuscon. He did suggest lots of massage to make sure it didn't curl up when it healed. I massaged and it healed flat. I had another pop up in the same area a few years later and had that removed at Mayo in Jacksonville where I've been in infusion treatment for 2 yrs. That also turned out pretty good. My mouth looks different but still like me and I have no discomfort ever. Its been 2 yrs since my last MOHS. You have to give it time, like 6-9 months to settle in. Thinking back to when I had surgery by my left ear for squamous tumor, surgeon sliced from below my ear, along my cheek and up to hairline above and pulled a HUGE amount of skin to close up. It looked like frankenstein but after a few months skin relaxed, scar diminished and not visible today...I call it my free Medicare half facelift. Again, patience and time.

@louisejewell Thank you. I continue to have a high level of discomfort which is concerning. The tightness and pulling on my lip to my nostril is pretty much all day every time I move my mouth. This doesn't seem to be consistent with others have experienced. I do have assymetry and my left side of my lip is slightly lower than the right. I also cannot move that side up and down like my right currently. I am not sure what is normal and what isnt at this point. It has improved but at 3 months, I am getting concerned there is more going on here. I do massage 3-4 times a day for about 3-5 minutes. Massaging inflames the area but does seem to make the rope like scar under the surface a bit softer for a little while. It then hardens back up again. I am also using Biocorneum Gel on the area from the top of my lip to my nostril. It doesn't seem to be doing much but does have SPF protection. I am not unclear if we should be taking more proactive steps at this point to address the tightness, discomfort and function issues as well as continued asymmetry. It has improved some, but still so very uncomfortable and function is still limited. Thank you for sharing your experience. All information is truly helpful.

@grammato3 I am just checking in because I am now at 13 week post surgery and I continue to have such a high level of discomfort and functional issues. My MOHS surgeon just keeps telling me to wait. The impact to my daily life is quite significant professionally, personally, socially and emotionally and of course physically which is what is causing the issues. I cannot eat or speak with comfort. It constantly pulls and is strained causing the issue around it to become inflamed and irritated. It looks better but I do not feel better. My MOHS surgeon can't explain the pain. He gave me a referral for pain management but that does not address what is causing all the discomfort. I am not sure what else to do at this point. I asked for a facial nerve specialist and again my MOHS surgeon said it will take time. I don't see others with similar surgery with this level of discomfort 3 months out so that is very concerning to me.

@moorjan3: I'm no doubt it is concerning! What a pain...literally...to be going through all this. Pain management may include a wide variety of specialists, or perhaps a referral network such as orofacial pain specialists, so it might be worth following up on that referral. Although 3 months is the general time line for resolution, deeper healing can take longer, see the section on stages of healing: https://dermskinhealth.com/mohs-surgery-recovery-process/

Has there been any further consideration of the use of laser or is the provider waiting to see what pain management has to offer?

I do plan to follow up and have asked about orofacial physical therapy as well. Yes, my surgeon is looking at the C02 laser for my next appointment. Does that help with tightness and tension as well? I read that it can but he hasn't talked much about that. I also asked about other laser treatments that might be available elsewhere that could help. I am in the Boston area and so is my MOHS surgeon. Do you have any guidance on other treatment options and practices I could look at?

@moorjan3: It sounds like you’re doing you’re best to stay on top of the situation. From what I know, CO2 laser does help soften stiff tissue, improve elasticity and improve discomfort, but I don’t know the timeframe for when it can be performed. The providers who specialize in this area could best guide you both in the most appropriate timeline and any possible alternatives.

Hope things ease up for you. Please let me know how your follow up appointments go.