Daria Doering

It all began in 2015 when I noticed a strange flaky patch of skin on the side of my nose that would not heal. I went to a dermatologist and he said he would burn it off, but if it came back, I should get a biopsy. He did not mention that time was of the essence. It did come back, but I waited until 2018 to come in for the biopsy, due to my general avoidance of doctors and health issues, I guess. By this time I had researched basal cell carcinomas (BCCs) and concluded that that was probably what this was, since one of the signs is “a wound that will not heal.”

I got the biopsy elsewhere since my regular dermatologist was scheduled for months out, and the biopsy confirmed this was a BCC. The derm wanted to do Mohs surgery, in which they cut out the BCC, and then keep cutting away at the edges, or margins, biopsying as they go, until the margins are clear of any cancer cells.

I had seen my mother and others go through Mohs, and although they had ugly holes after the surgery, they generally healed up to where the holes were undetectable. However this BCC was on the side of my nose, and I was very reluctant to get a hole punched in the middle of my face. I rarely wear makeup, so I need to look as good as possible au naturel.

I called friends for referrals to the best plastic surgeons in San Diego. I went to one, and he was not at all encouraging. He said that my BCC was not located in a place where there was skin that could be pulled over it, and that there would be deformity. Then he started talking about cutting a flap or something, and I tuned out … It just seemed like a really bad option.

I went back to my original derm, and he mentioned that radiation was an option. I was so thrilled to hear this, and shocked that no one else had mentioned that any treatment other than Mohs was available.

I went to the cancer center he recommended, and they set me up to do electron beam radiation. However I was not feeling at all comfortable with this either. The doctor in charge seemed to have no particular concern with where the margins of my BCC were, which is the major concern in Mohs surgery, and how he would know if they were zapping the right area. When I asked him how he could tell where my BCC was, he said, “by looking”! Well, if that were true, why did I get a biopsy at all? It just didn’t add up to me.

Plus my original derm had noted that my BCC had “moved” from where he had first seen it in 2015. What sense did that make? Cancer does not “move,” it spreads! Now I was really scared and just in a state of shock over doctors saying things that did not make any sense.

So I started doing my own internet research. I found something called Superficial Radiation Therapy, or SRT, which claimed to be a more appropriate and less damaging form of radiation for treating BCC’s. It had a very slightly lower “success” rate than Mohs, but was still highly successful, and sounded much better to me than anything else I had found. I looked online but could not find any doctors in San Diego or Orange County who did it.

So I called Sensus, the company that manufactures the SRT machines. They gave me a list of doctors that have SRT machines. There was one in Hillcrest, right near where I live, and I went to see him. Although he had a stellar résumé, a number of things made me uncomfortable. He would set up the SRT treatments, but the person who did the actual treatments was the same woman who answered the phones in his office! When I asked her about her credentials, she did not say anything related to radiation!

I did ask this doctor why so few derms have SRT machines. He said he’d had to go through a huge professional certification ordeal in order to be able to use the machine, and he thought this was why more doctors did not have them. Also that Mohs is more profitable … surprise, surprise.

But I was still uncomfortable about his lack of concern about the margins of my BCC. Then I remembered that Sensus also manufactures “SRT Vision” machines. These include ultrasound, which shows the actual BCC, with every treatment. So I called Sensus again, and they told me there were two doctors in California with SRT Vision machines – one in San Francisco and one in Marina del Rey.

I looked up the derm in Marina Del Rey on Yelp, and she had mixed reviews. A number of reviews described how abrupt and terrible her bedside manner was, while others extolled her knowledge and that she was a diplomate with the state board of dermatology. I had a hard time even proceeding after reading these reviews, but finally forced myself to call her office to ask some questions. Within a few minutes they put the doctor herself on the phone! She answered all my questions and couldn’t have been nicer! So I made an appointment to go to Marina del Rey for a consultation with her.

Mike and I took the train up to Marina del Rey, and talked with her extensively. We really liked her, and she ultrasounded my entire nose. She confirmed that the BCC was only in the area where the flaky skin was. So that anxiety on my part was put to rest. I liked her practice so much that I thought I would just go to her.

After awhile, however, the reality of needing to take 17 trips to LA started to worry me. It had taken all day to go up and back on the train, and I knew I would go insane doing that even one more time. I thought I might drive, starting off very early, but it would be at least a two hour drive.

My original plan had been to go to the derm in Hillcrest if my case was straightforward, which it was, so I thought I would go back to that plan, despite my concerns. But I called his office and he could not start until after Christmas, which would be a month or two. They also routinely did 13 treatments, which I knew from the derm in LA was considered the “travel challenged” protocol, and I didn’t like that idea either. I preferred the regular 17 treatment protocol – a larger number of gentler treatments.

So I could barely believe I was doing this, but I called another doctor, the seventh at this point – in San Juan Capistrano – and went for a consult with him. He told me that radiation can cause cancer, so I should consider it carefully. He said he did quite well with Mohs surgery on the nose, and that his most successful procedures involved taking cartilage from the ear and inserting it in the hole. Ouch. He asked me what my biggest concern was, and said that in terms of the cosmetic result, SRT probably was the best option. He recommended doing the 17 treatment protocol rather than the 13, saying they had found it gentler and better, and I breathed a sigh of relief.

He also had a dedicated radiation therapist, Kim … another sigh of relief … who also drove up from San Diego, and I really liked her. She told me what I could expect at every stage of SRT treatment, and even introduced me to her own mother, in her 80s, who was from South Carolina but staying with her for awhile in order to get SRT! Her mom had already had Mohs and reconstruction on her nose, but another BCC appeared, and she did not want to go through Mohs again. Her mother’s nose looked very red, but she said it did not hurt, and I figured I could live through some major redness.

Kim also advised me to buy a cream called Miaderm, which was specifically formulated for skin undergoing radiation treatment, on Amazon. I was again so relieved, because I had a feeling that it would be helpful to use some sort of a cream, but the other doctors I’d talked to did not recommend doing so.

So I started on my twice-weekly sojourns to San Juan Capistrano. I actually really enjoyed the one-hour early morning drive, listening to my book downloads and watching the sunrises and ocean views! Kim was a really warm and interesting woman. It turned out we had a lot of odd things in common, such as that her daughter was a college rower … and strangely or sadly enough, these treatments and visits were often the highlight of my day!

I took a few photos as I went, in order to be able to publish my story with photos. I swore to myself that no one else would have to go to as much trouble as I had to find SRT. I don’t know why doctors don’t seem to advertise their SRT services online … or at least I could not find them online or on Yelp.

I just finished my final treatment today. I will post another photo and followup when my nose goes back to normal! But since I know there are a gazillion people out there facing BCC treatment, I thought I would publish my story right away. I think everyone deserves to know that SRT is an option!