Here's my story--and I'm telling it because it's something I think anyone who thinks they'll ever need a surgical procedure for skin cancer should be aware of. While I understand why doctors detest the internet (every hypochondriac with a mouse can tell them how to do their job) it helped save my partner from serious disfigurement.

Last year she was diagnosed with a pinhead sized basal cell carcinoma beside her nose. She went to a reputable plastic surgeon who operated to remove it, taking also a chunk of surrounding tissue to allow for a margin of error. In more than 90% of cases that would have been it, but when the test results came back they showed he hadn’t got it all. This meant she require at least one more operation under a local anaesthetic, and if that still wasn’t clear then she’d need a third, more major operation under a general anaesthetic followed by facial reconstruction.

That was when I got on the internet—simply because I knew nothing about BCCs and wanted to know what we should expect. From a search I learned that while most BCCs grow in pea-shaped clumps and are easily removed by the ‘vertical’ method of surgery employed by my wife’s surgeon, a tiny percentage send out roots. To remove one of these sorts of BCC the vertical method inevitably destroys a huge amount of healthy tissue. More importantly, such trauma is completely unnecessary as there is a well-established method called Mohs Microsurgery that is both more effective and less damaging. Mohs surgery is a ‘horizontal’ method, which follows the passage of the carcinoma, removing it from the flesh with as little damage as possible. If the vertical method is akin to open-cast mining, the Mohs method is more like following the seam of coal by tunnelling.

It wasn’t easy for my partner to change from a surgeon she knew, but I was able to show her a file I’d downloaded about the procedure and eventually she sought a second opinion (see http://www.mohscollege.org/about/video_patient_education.php). After that consultation she switched to a Mohs accredited microsurgeon. It turned out that her BCC was one of the very worst—it had long roots spiralling in all directions—up to her eye, in towards her nose and down to her lip. Getting it all required multiple Mohs procedures over an entire day, followed by many dozens of stitches and a skin graft. While this was traumatic, it seemed less consequential alongside our knowledge of how far more profoundly damaged her face would have been had she remained under the care of the first surgeon (who somehow neglected to mention Mohs as an option). Without the internet we’d have remained blithely ignorant—conceding all power and authority to the doctor, just like the good old days.