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Not had the procedure I was told I would have?

JS59
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I had my skin biopsy 4 weeks ago, no results yet. In August, a small pearly spot quickly grew, becoming more wart-like. i did an online GP consultation on 3 Sept, attaching a photo. GP rang the next morning and said I was being referred to Dermatology on an urgent basis, in case it was 'anything sinister'. 
At my Dermatology appointment on 11 Sept, I was told i needed a 'deep have biopsy' and that, as I was going on holiday on 7 Oct, they hoped to do it before i went away. As soon as I got back to the car, I wrote down 'deep shave biopsy' as I was not given any leaflets or information on the procedure. I looked it up online and was happy that there would be no stitches and that the wound, which would be around the size of my 'spot', would heal from the inside out, leaving a small scar. My confidence was high.
The hospital could not fit me in before I went away, but it was booked for the morning after I got back. I was asked if I wanted a confirmation letter and I said 'no' (trying to save a tree, as usual) but I wished I had said 'yes' as it might have named the procedure and contained an information leaflet.
I had my biopsy on 18 October. The plastic surgeon used a scalpel, not the razor-type instrument I expected, then the wound was cauterized and quite a few stitches put in. I was told to leave the dressings on for a week, not to get them wet, and given a copy of my consent form - which did not name my procedure - and a wound care sheet. I was told that the results would take 6-8 weeks and that there would be no follow-up appointment unless something shows up in the biopsy.
When I removed the dressings on 28 Oct I was shocked - the wound was around 5cm long, a wiggly line which ran from just below my eye to lever with my nostrils. It had visible (dissolvable) stitches, and lots of lumps and bumps. I soon had a black eye and facial swelling, which I was told to expect, but I was not expecting such a big, ugly wound from a shave biopsy. I decided to investigate by signing in to my online medical record. There was a letter to my GP from the Dermatology department at the hospital which said 'suspected SCC on right cheek, may be a Keratoacanthoma, urgent incision required' and saying that I should 'remain on the cancer pathway'. But no mention of a deep shave biopsy.
I have been really struggling since my procedure, both with how I look, the aftercare, and with the way I feel about whatever procedure I had. I am also struggling with the SCC/Keratocanthoma part, because neither has ever been mentioned to me, although I do know what they are now. My wound has been quite difficult to care for, it is in a difficult position and it was quite hard to eat and clean my teeth at first. There is still some puffiness under my eye and my scar is still punctuated with lumps and bumps, plus I can feel a large, hard mass beneath it. 
Does the procedure I had sound like a deep shave biopsy or have I had, as I suspect, some kind of incision/excision procedure? I am grateful to have had my biopsy but I can't help feeling a bit miffed at being so misinformed.
On the plus side, at least I have had something to distract me whilst waiting for my results ;)

  • Hello and thanks for posting,

    I can appreciate your concerns around your recent experience.

    To begin with, if you want a steer on your wound/care, then you can ask your practice nurse at your GP surgery to have a look at it. There may also be a nurse available in the clinic where you had it done, that might be available via a telephone call to advise you. Swelling and bruising will take a number of weeks to subside. The lump you describe under the excision, is the soft tissue swelling that happens under the wound. You should hopefully get further aftercare advice once you have your follow-up appointment. 

    It does sound like you had a deep shave biopsy. This is when a dermatologist uses a curved scalpel to remove/scoop out skin tissue. So, yes, it is a procedure that will leave an incision line on the skin surface afterwards. There are guidelines that specialists follow, which dictate how much tissue is taken around and below a lesion (skin area of concern), to ensure full analysis and removal of the skin tissue. 

    It is obviously difficult waiting for results. But bear in mind, that should it be a squamous cell skin cancer (SCC), this diagnosis often involves complete surgical removal, and has therefore formed the main treatment for it as well, at the same time. 

    I hope this helps,

    Please get back to us if you need any more information or support.  You may find it helpful to talk things through with one of the nurses on our helpline.  The number to call is Freephone 0808 800 4040 and the lines are open from 9am till 5pm Monday to Friday.

    Yours sincerely,

    Vanda

  • Offline

    Communication often seems to be the first thing to suffer when services are stretched. Surgical incisions tend to look a lot better than you'd expect after time. I have a scar that looked awful for a couple of months but mellowed pretty quickly and my partner's skin graft is even not bad looking after time. It must be traumatic to get the shock of a more extensive face surgery than you expected. My surgeon was very clear about the choice of incision and so was my partner's.

    You could always explain to PALS about the communication issues so that they are more alert with future patients and you get to explain formally what you've experienced. I hope you heal quickly x

  • Offline in reply to CRUK Nurse Vanda

    Thanks for that Vanda, it is reassuring that the hard lump under the excision if normal. It was not a deep shave biopsy, as explained in my original post..

  • Offline in reply to Lyns21

    Thanks for your response, it's good to know that my scar will gradually diminish. 

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