Category: Age

No Italics Necessary: Adventures in “Kosgrowvic” Surgery

Join Sisyphus in his adventure in youthful indiscretion.

A Public Service Message (Warning: Graphic photos follow)

I greeted the good doctor early on a recent November morning, “You know Dr. Mehrany I have a low incentive threshold,” 

“How’s that Mr. Jones?” he asked.

“Well, all it takes is a maple bar in your waiting room, and I’m willing to have you take a knife to my face.”

“I guess it beats cancer, eh?” he replied.

“But what about donut-induced heart disease or diabetes?” I beseeched.

“Everything gives you cancer, there’s no cure, there’s no answer except that Mohs surgeries are 98-99% successful, the most  efficacious treatment for any cancer,” retorted the doctor, “You take your chances with cholesterol and blood glucose.”

Drop the mic!

My apologies to Dr. Mehrany whose response I doctored and Joe Jackson’s line about cancer from Everything Gives You Cancer.

What are the Odds?

And so began my most recent appointment with Kosgrow Mark Mehrany, MD, a skin cancer specialist whose practice is divided between San Jose and Modesto, near my home in the Central Valley. This would be my fourth basal cell carcinoma removal by way of a procedure known as a Mohs surgery. 

Skin cancer is the most common type of cancer in the United States, with about 1 in 5 people developing it at some point in their lives. Each year, more than 3.5 million cases are diagnosed, making it a significant health concern.  As one of the 3.5 million—it’s not a league in which I am proudly enrolled.

It Pays to Have Good Doctors

My now deceased family doctor, Christian Gallery, began detecting suspicious growths he diagnosed as a type of pre-cancer called actinic keratoses a decade ago.  He was comfortable removing most of these scaly patches on my back and chest by freezing or a simple surgical removal, the standard treatments.  When he suspected there may be a more serious basal cell carcinoma on my face he recommended I see a specialist. 

That was my first encounter with Dr. Mehrany in his office in Modesto, CA in the spring of 2019.  Dr. Mehrany confirmed Dr. Gallery’s diagnosis by biopsying a spot on my cheek.  The resulting confirmation was that of a basal cell carcinoma he proposed to remove, using what is known as a Mohs micrographic surgery.  

Mohs surgery is a procedure performed by a specially trained surgeon. Dr. Mehrany’s six page curriculum vitae* is impressive, but the fact that in his career he has performed over 20,000 Mohs surgeries is even more reassuring. 

His manner is straightforward yet he has an amicable sense of humor.  At least he feigns to laugh at my jokes. And once he’s executing the procedure his focus and attention is razor-sharp.  Ugh.   His staff are all equally genial and give you the sense that even though the office waiting room is full, each patient is accorded sincere regard and every effort is made to erase apprehension.  Perhaps that’s the purpose of the donuts and coffee…  

What Is Dr. Mehrany Screening For?  

Skin cancer comes in a variety of forms, and some kinds are more frequent or dangerous than others. More than 98% of skin cancers are either basal cell and squamous cell carcinomas. Melanoma is another, less common type of skin cancer. Melanoma can be deadly unless it’s detected and treated early. Getting your skin checked regularly by a skin cancer specialist, like Dr. Mehrany, helps to protect you by catching skin cancer early when it’s easiest to cure.

Given that my youth into adulthood was spent when skin cancer detection wasn’t as refined as it is today, all of the summers spent in swimming pools, backpacking in the Sierra, riding bicycles, running, sailing, golf, and skiing meant I had a healthy year-round exposure to UV wavelengths of natural sunlight. Skin cancer develops when skin cells grow uncontrollably, in my case due to damage from ultraviolet (UV) rays from the sun, or tanning beds for those whose desire for sun-kissed aesthetics don’t have the time or hobbies to bronze in hours of exposure outdoors. And for those whose labor exposes them to harmful solar radiation, my sincere empathy.

This damage can lead to changes in the DNA of skin cells, resulting in abnormal growths that can become cancerous.  Though I became aware of damage that repeated long exposure to sunlight was a form of Russian roulette that only emerged later in life, my haphazard mitigation with protective clothing and topical sun screens was preempted by naiveté.  In the hypocrisy of pretending that tanning beds were for the vain, I was convinced that celebrating life in the great outdoors could achieve the same aesthetic that was beyond consequence.  Vanity, it appears, is in the skin of the beholder.

Warning, the photos below are quite graphic. You can thank my wife who enjoyed the surgeries from the peanut gallery.

April 2019-The First Round:  Mapping the sutures

Cheek surgery site with stitches and the surgical wound dressing you flaunt leaving his office

January 2021-Round Two: Can’t You Hear Me Noggin

Start to finish, about three weeks. “Covid doesn’t stop for cancer…” declared Dr. Mehrany (I neglected to “flip” the selfies)

February 2022-Round Three: Another Cheek Crater

in the middle photo is the pressure dressing, awaiting results of the first scraping. We were still masking.

November 2025-Round Four:  Too Close to the Eye for Comfort

Oddly, all four carcinomas have clustered on the right side of my face. (The flipped selfie makes the appearance of the scar on the left side. I assure you, it’s on the right side.)

How Mohs Surgery Actually Works

Armed with a pocket full of syringes, donning appropriate PPE and surgical loupes, with a surgical blade called a curette, and a cauterizing pen at hand, Dr. Mehrany removes a layer of cells.  Although the official name for the procedure is Mohs micrographic surgery, the shortened version of Mohs Surgery is common.

The surgery is performed as follows: the skin suspicious for cancer is treated with a local anesthetic, so there is no feeling of pain in the area.  In fact, the most painful part of the procedure is the “poke and burn” of the injection.  To remove most of the visible skin cancer, the tumor is scraped using a sharp instrument called a curette. A thin piece of tissue is then removed surgically around the scraped skin and carefully divided into pieces that will fit on a microscope slide; the edges are marked with colored dyes; a diagram of the tissue removed is made; and the tissue is frozen by Dr. Mehrany’s technician, Manny. Thin slices can then be made from the frozen tissue and examined by the doctor under the microscope.  

I asked Dr. Mehrany if there’s any way to know when the damage actually happens. Turns out it’s impossible to pinpoint. The two biggest variables are how aggressive the mutation is and how well your immune system fights back. The damage could have occurred decades ago, but when it decides to show up as cancer? That’s anyone’s guess. 

Of course minimizing exposure is the gold standard for preventing skin cancers, however  a history of sunburns along with genetic factors of having lighter skin and a family history of skin cancer are the most common causes. Other factors include having many moles or atypical moles and certain skin conditions.  When the damage occurs and how long it takes for the cells to mutate is widely variable. Thus any pale skin entitlements are moot when it comes to skin cancer.

It Doesn’t Smell Like Bacon Frying in the Kitchen

Most bleeding during the procedure is controlled using light cautery, although occasionally, a small blood vessel is encountered, which must be tied off with suture. A pressure dressing is then applied, and you’re asked to wait while the slides are being processed. Dr. Mehrany will then examine the slides under the microscope to determine if any cancer is still present and subsequently annotate his map of the cancer location accordingly.

If cancer cells remain, they can then be located at the surgical site on the patient by referring to the map. Another layer of tissue is then removed, and the procedure is repeated until Dr. Mehrany is satisfied that the entire base and sides of the wound have no cancer cells remaining. As well as ensuring total removal of cancer, this process preserves as much normal, healthy surrounding skin as possible.

More Donuts Await

The removal and processing of each layer of tissue take approximately 1-3 hours. Only 20 to 30 minutes of that is spent in the actual surgical procedure. The remaining time is required for slide preparation and interpretation. It usually takes the removal of two or three layers of tissue (also called stages) to complete the surgery. Fortunately for me, the most recent surgery took only the removal of a single layer of tissue.  Even the more severe first case only took two tissue layers. I figure that’s about a donut per stage

Therefore, by beginning early in the morning, Mohs surgery is typically finished in one day.  I was in at 7:30 am and out by noon.  At the end of Mohs surgery, you will be left with a surgical wound free of tumor which is then reconstructed that same day. Several options for reconstruction may be discussed with you in order to weigh your preference of what will provide the best possible cosmetic outcome versus what will provide the easiest and simplest recovery.  

Time to Lace Up the Pigskin

Suturing the wound was interesting from my perspective. The site was completely numb, so I did not feel pain. However, the snugging of the suture was a little unnerving. For this surgery, there were some 25 stitches. Times four surgeries—those are the battle scars of freedom. Or inattention. Dr. Mehrany’s skill at reconstructing the surgical wound is truly his genius.

There was modest discomfort following the wearing off of the anesthetic. Not unlike what you might feel after a dental procedure like a filling or crown, and the slight pain was softened by a couple of extra strength Tylenols.  Sorry RFK, I’ll risk autism for relief from surgery whether I plan to get pregnant or not.  

Moving Forward

These days wide full brimmed hats have replaced ball caps.  UV protective arms and legs are a part of my cycling kit.  SPF 70 is used on the other exposed parts, namely my face and neck.  Prevention.  It’s never too late, I suppose.  It beats the consequences of my youthful naiveté masked as virility.  In January of next year, I have my six month follow-up exam.  I’m hopeful that I will get the all clear, until the following exam in July. 

Despite displaying the battle scars of freedom, I’m not ready to look like the patchwork of grandma’s quilt, but it beats an early departure for the dirt farm to join her…

My advice? If you’ve spent anytime in the sun be aware of the consequences! Also, you’re likely to gain more weight from the donuts than lose weight from the removal of the cancer…

*Dr. Mehrany’s Information

No Italics Necessary: On Friendship, Loss, and Survival

Friendship is messy. Loss is constant. And men? We rarely talk about it.

I’ve been thinking a lot about what we carry, what we lose, and how we show up—or don’t.

These thoughts came from listening to an episode of Offline with Jon Favreau called “Are Men Okay?” featuring Zac Seidler, a psychologist who studies men’s health for the Movember Foundation. The show opened with a startling fact: more than half of American men die before the age of 75, and that number is getting worse.

Seidler and Favreau talked about how men often misunderstand what wellness means, especially in a digital world that celebrates performance over vulnerability. His words struck a chord. I’m no longer a young man, but I have sons who are—and I recognized the quiet ways men of every age hide what hurts.

Among my own circle of old friends, I can see that same silence. We’re all facing losses—some recent, some long ago—and each of us is trying, in our own way, simply to survive them. You don’t conquer loss; you learn to live beside it.

Childhood Friend

One of my oldest friends is someone I’ve known since childhood. We grew up together, went to the same schools, drifted apart for years, and eventually both returned to town—he to teach college, I to teach younger students.

We still crossed paths occasionally, mostly through our shared obsession with staying fit: he ran, I biked. Once, during a casual conversation in a grocery store line, he surprised me with, “You were always an underachiever.” I never knew exactly what he meant. Maybe teasing, maybe judgment, maybe even a sideways compliment. It stuck with me.

Years later, at our fortieth high school reunion, he sat alone at a table that included me and a few mutual friends. Once known for his easy charisma, he seemed withdrawn, almost impatient with the sentimental tone of the evening. When a slideshow of classmates who had passed played to soft music, he muttered something about sparing him the “maudlin sentimentality.” I understood the impulse. Grief sometimes makes cynics of us all.

Not long ago, his partner died. I reached out simply to say I was sorry and that I was here if he needed to talk. He thanked me, but I keep thinking about him—loss isolates even the most social among us.

Teaching Colleague and Musician

Another friend is a former teaching colleague—someone I shared a wall, a schedule, and twenty years of classroom chaos with. We both taught math and science to sixth graders, juggling equations, experiments, and preteens on the verge of self-destruction.

We also shared a love of music: he played bass; I played drums in our staff band, proudly called Staff Infection.

When he retired, a few years after I did, he and his wife seemed to embrace the good life—travel, golf, family. Then, suddenly, she was gone. I saw him at her memorial and later sent a note, offering an ear if he ever needed one. He thanked me, but we haven’t talked since.

I think about him often—even deep friendships can slip into silence, especially after loss. Maybe it’s time to call again.

Cycling Companion

The last friend I want to mention is someone I’ve known almost entirely through bicycling, going back nearly forty years, with a few shared backpacking trips in the Sierra. Recently, he suffered two strokes, days apart, which threatened the thing he loved most: riding at a high level, even as he approached eighty.

When I checked in a couple of months later, I saw both his pride and his quiet embarrassment—the strokes had shaken him, but not his determination. He is slowly recovering, taking long walks and gentle rides, and refusing much of physical therapy because, in his words, it was “just balance work.”

His setback isn’t only physical. Since retiring from his photography business—a career largely erased by the digital era—he’s been more isolated. Cycling remains his anchor, the thing that keeps him connected to a small community of fellow riders. I just reached out again and will be picking him up tomorrow for a local ride.

Reflections on Friendship and Loss

Loss changes everything. Silence isolates. Connection saves us.

Thinking about these friendships, I see a common thread: loss reshapes our lives in ways both visible and quiet. And yet, it also reminds me of the enduring power of connection. Reaching out—even when it feels awkward, belated, or uncertain—matters.

The podcast Are Men Okay? reminded me that men rarely talk about how they’re truly doing, and I recognize that pattern in myself and in the friends I’ve written about. But in spite of—or perhaps because of—our losses, we can choose to persist in connection. A shared ride, a text, a moment of music, or simply showing up can make the difference between drifting apart and surviving together.

I don’t claim to have all the answers, and grief has a way of reminding us that life rarely unfolds as neatly as we wish. Still, I believe there is grace in reaching out, in extending empathy, and in sustaining the bonds that have shaped us.

So here’s my invitation: call the friend you’ve been thinking about. Send the note you’ve been putting off. Show up.

We survive loss better when we survive it together. And sometimes, survival is simply showing up—on a bike, on a walk, or in a conversation that refuses to be postponed.

10/22/2025