Mrs AZ

The first thing that Mrs AZ to me when she came into my clinic room, before she’d even sat down, was ‘My granddaughter is getting married in August and I can’t have this thing on the end of my nose in the photos!’
She went on to tell me how she’d been ignoring the crusty lesion on the tip of her nose for at least 6 months before finally seeing her GP. The week before she came to see me, she’d been to see a plastic surgeon who informed her that, unfortunately, to effectively remove the skin cancer, she’d have to lose the end of her nose. This news had hit her hard.
At the age of 79, the thought of losing the tip of her nose was unappealing – even with the best reconstruction on offer.
She’d spent her life outside – she enjoyed the great outdoors and was a passionate rambler and gardener. As a child, she’d grown up in Egypt as her father was in the army. From middle age, she’d been an antiques dealer and spent 5 days each week working at outdoor trade events. In her heart, she knew that the non-healing ulcer, that she first thought was a persistent pimple, could be a skin cancer, but it took her a long time to seek help.
She eventually saw a dermatologist who took a biopsy that confirmed that it was a basal cell carcinoma.
Mrs AZ was understandably anxious and upset when she came to see me. She thought that her only option was disfiguring surgery. Thankfully, I was able to offer her an attractive alternative.
Over the course of two weeks, she received 10 radiotherapy treatments. She attended the hospital for less than 30 minutes each time. She was able to carry on with her life as normal throughout the treatment. She drove herself to her treatment each day.
As predicted, she experienced some tiredness in the period immediately after the radiotherapy finished. She also had a predictable skin reaction – the skin at the site of the skin cancer became red and sore towards the end of treatment and for a couple of weeks afterwards. Eventually the skin formed a scab which repeatedly came off until new, healthy skin appeared from underneath. As she was forewarned about this temporary change in her appearance, she was able to schedule her social activities around it. I saw her regularly during this period. For a short time, I recommended some dressings to cover the treated skin at night – just to make it more comfortable while she slept and to protect her pillowcases.
By the time I saw her 6 weeks after the treatment had finished, the skin had completely healed. The skin where the cancer had been had a slightly different texture to the skin around it, but nothing that was obvious or immediately apparent. She was over the moon with the appearance of her nose – not only had the cancer gone, she hadn’t lost the cartilage and skin of the tip of her nose.
When she came to see me in the September of that year, I was pleased to see her confident smile in the photographs she brought from her granddaughter’s wedding. It was clearly a proud day for her – a day she could enjoy without worrying about her appearance.
