Warning: graphic imagery ahead.
On a bright June day in Hermosa Beach, CA in 2017, Lauren Quinn was sitting inside her car in the CVS parking lot, chatting with her brother while her husband went inside to pick up her prescriptions. She heard a knock on the window and was startled to see a crowd of paramedics and firefighters gathered outside. “Ma’am, we need you to open the car door,” one of them ordered. “We need to get you to a hospital.” Quinn, who was dressed in a hospital gown and bleeding from the face, overcame her surprise and tried to laugh it off, promising him she was fine. Unconvinced, the paramedics stayed with her trying to decide what to do. Quinn distinctly recalls that one of the men just kept whispering, “There’s so much blood.”
Eventually, her husband returned and they both explained that Quinn had just undergone surgery to remove a basal cell carcinoma on the bridge of her nose, followed by a skin graft surgery. Quinn looks back on the incident now as a type of comic relief in the midst of what was an otherwise harrowing experience of being diagnosed with skin cancer at a young age.
The sun protection refrain is one we all know by heart: Wear sunscreen daily, re-apply often, use a shot glass worth of SPF each time, get yearly skin checks. As the number-one most common preventable cancer in the U.S., non-melanoma skin cancer affects over 3.3 million people a year. And, according to dermatologist (and co-host of The Doctors) Dr. R. Sonia Batra, “Basal cell carcinoma is the number one type of cancer in the United States right now—it exceeds breast, lung, and colon, combined.” There are many risk factors and while using SPF reduces your risks, it doesn’t mean you are immune. Quinn, who is so fair she’s “basically translucent and only burns,” has always been responsible about her sun exposure—so she was shocked to learn that, at the young age of 37, she had developed skin cancer.
The skin cancer had actually first emerged four years earlier. “I was 33 and I had just gotten back from Rio,” says Quinn, “A clear, symmetrical cyst appeared on the bridge of my nose. I had been getting my skin checked regularly, so I told my dermatologist at the time that I thought it was weird.” To her dermatologist, it looked fine, but in an abundance of caution, Quinn asked her to take a biopsy. The report came back that it was nothing more than a cyst.
Fast forward four years later. Quinn had just given birth to her daughter, Frankie. She noticed the “cyst” had suddenly turned cloudy and was constantly scabbing over, like a wound that wouldn’t heal and was painful to the touch. She went to a new dermatologist, Dr. Annie Chiu, and requested another biopsy.
“I knew it was cancer,” says Quinn. “[At that point], my hope was for the best possible news, which is that it would be basal cell carcinoma.” That kind of optimism might seem a bit morbid, but for anyone facing skin cancer diagnosis, says Dr. Batra, the slow-moving version of the disease really is the best-case scenario. “If you have to have [a diagnosis] with carcinoma in it, basal cell is definitely the best one to have, because it almost never will spread to your lymph nodes or elsewhere in your body, provided you have a normal immune system,” she explains.
Unfortunately, says Dr. Batra, basal cell carcinomas — if left untreated — will erode the surrounding skin over time, which is what happened in Quinn’s case. “She was a bit unlucky for it to be of the ‘infiltrating’ subtype of basal cell and in the trickiest location to remove,” says Dr. Chiu. The area itself is front and center on the face and the skin over the bridge of the nose is very thin, making it difficult to match for a graft. She was also significantly younger than the average age for this type of cancer to appear, which is after 50.
So, how exactly did the first biopsy miss what was clearly a carcinoma? According to NYC dermatologist and skin-cancer survivor Dr. Ellen Marmur, it came down to bad luck. “We call that clinical pathologic correlation. [When a biopsy happens] the pathologist will get this piece of tissue and maybe that tissue was just a cyst or maybe it was a cystic cancer. Sometimes the most aggressive facial cancers come out looking like a cyst.”
After her biopsy came through as positive, Dr. Chiu immediately referred Quinn to Dr. Batra for Mohs surgery, an in-office procedure that essentially “scoops” out the cancer. The idea with Mohs, says Dr. Batra, is that it is the “most accurate and tissue-sparing way to ensure that you get 100% of the skin cancer.” After injecting anesthetic into the area, Dr. Batra used a curette surgical tool to scrape out all of the visible carcinoma, then used a scalpel to cut out a one to two millimeter margin of the skin surrounding and underneath it. She then applied a temporary bandage and sent Quinn back into the waiting room while she examined the skin cells to determine if the cancer had been completely removed. Unfortunately, it had not, so she had to repeat the process once more. (Quinn was lucky—some people can be called back in as many as eight times in order to fully remove the cancerous cells.)
While the cancer itself was gone, Quinn was now left with a two-centimeter circle of skin — about the size of a nickel — missing from the bridge of her nose. Dr. Batra notes that for many Mohs patients, the area can be left to heal on its own, usually leaving behind a prominent scar. But because of the location, Quinn wanted to know her options for a more proactive approach. Prior to her Mohs surgery, she consulted with plastic surgeon Dr. Behrad B. Aynehchi and determined that a paramedian forehead flap would be her best option. Three hours after getting the all-clear from Dr. Batra, she found herself in Dr. Aynehchi’s Santa Monica office.
Paramedian forehead flaps are considered the gold standard for this type of wound. As Dr. Aynehchi explains, it involves moving the skin from the forehead to the bridge of the nose. “We cut [the skin from her forehead] out in the exact same size and shape as the defect on the bridge of her nose,” he explains. “We raised it off the forehead, but we left it attached to the blood vessels that were originating around the eyebrows.” This is so that it can keep getting the blood supply and prevent the tissue from dying.
"The forehead flap was incredibly painful," Quinn describes. "My forehead had been split open, a piece of it was cut out, twisted with the artery, and used to cover the hole in my nose from MOHS. They then had to wait three weeks in order for there to be sufficient blood supply from the bridge of the nose." During that time, Quinn was bedridden, unable to leave the house as the area was basically an open wound. After the three-week mark, Dr. Aynehchi “released” it from the forehead donor site and reconstructed the forehead in a second stage. This entire process is done under local anesthetic while the patient is still awake—meaning it’s something Quinn remembers vividly.
“The first one was the worst because there was a point where I could feel Dr. Aynehchi tugging my forehead back together,” she recalls. “I am [awake and] of complete sound mind while all this is going on.” The reality of it hit home when she first saw her face post-surgery. “It was super-shocking and kind of like, ew,’” she recalls. “But then from that moment on I was like, ‘Reset. It will never be worse than it is today at this moment, it is only going to get better from here.’” Cut to the parking lot scene and the group of concerned paramedics. She jokes, “Maybe I was being a little too optimistic.”
Unbelievably enough, this was just phase one of a two-years-and-counting ordeal. Since that initial surgery, she has had to have two more revisions. According to Dr. Aynehchi, the skin on the forehead is significantly thicker than the skin on the bridge of the nose, so the initial flap has to be thinned out. However, because there is a live blood supply, if you thin it too much, you risk the edges of the flap dying. Meaning that in order to get the skin to be less prominent when it was moved over to the nose, Dr. Aynehchi had to do more work when Quinn came in to have the flap released.
“After you’ve already released it from the forehead, you go in and basically cut along the edges of that flap and cut out scar tissues and thin it further,” he says. “It has to be staged to where you do one side, then you do the other side—you can’t do both sides at the same time or you’ll cut off all the blood supply to that flap.”
Unfortunately, Quinn’s scarring was too severe and Dr. Aynehchi was only able to thin out one side. After a cross-country move to the East Coast, Dr. Chiu connected Quinn with Dr. Marmur. She worked with Dr. Aynehchi to put together a course of treatment using injectables and lasers to lessen scarring and make each revision more effective. Botox, in particular, says Dr. Marmur, was critical in the first few months of Quinn’s recovery.
“Anytime there’s a scar after facial surgery, or a scar healing over an area of muscle movement, Botox has been proven to improve the healing process by reducing the tension and movement of the muscles,” explains Dr. Marmur. “Therefore, it's keeping the skin still and quiet for three months while it heals.” Dr. Chiu injected Botox immediately post-surgery to reduce skin tension and movement (she likened it to placing a cast on a broken leg) so the scar could heal with minimal tension.
Also helpful were lasers, which addressed the pigmentation and severity of the scar. “I've been injecting Kenalog, a type of steroid, into the thick skin to eliminate the scar and then using two different lasers,” Mamur notes. “One is broadband light to eliminate the excess redness and the other one is called Sciton ProFractional. It normalizes the scar tissue and erases the seam that was going down her forehead and over her nose.” Quinn received Botox every three months, and lasers every three to six weeks.
Looking at pictures now, it’s remarkable to see just how far Quinn has come from that first moment after her Mohs surgery. She still has one more surgery to go: Dr. Aynehchi is no longer able to manipulate the skin on her nose without risking more scarring, so to narrow the bulge, he’ll be going from inside the nose and shaving down the bone underneath the flap to correct the height difference without having to cut into the skin again. She’ll get to be asleep for that one, though.
For someone who has been through so much, Quinn has managed to maintain an almost supernatural positivity. “My story is a cautionary tale, and such an extreme example, but I feel like everything was the best worst-case scenario,” she says.
She’s obviously passionate about sun protection now and urges people to go above and beyond the bare minimum they might be doing. “Remember that UV rays are present in the winter, so you have to wear SPF every day,” she warns. “Automobile glass does not protect you from most rays. What I say to everybody is you’ll never be younger and healthier than you are today. Get a skin check and learn how to be your own advocate: If you see something change or that looks strange, make an appointment.”
Dr. Marmur adds to that point, noting that while being misdiagnosed like Quinn is rare, it’s still important to speak up when you think something isn’t right. “I think people are always worried about upsetting their doctors, but you’re not being antagonistic,” she says. “You’re helping us.”
Since being given the all clear about her cancer, Quinn has found herself having to explain her diagnosis to those curious about her scar. “One of the hardest parts is that you are going through kind of how society now sees you. There is a perception of people being ruined because they have a scar and the reality is, no—that’s a survivor.”
For more stories on sun safety, check out the below:
10 Sunscreen Myths Experts Want You to Stop Believing
9 Surprising Places That Need Sun Protection
This Is What Having a Melanoma Removed Actually Looks Like
These Sunscreens Prevent Sun Damage on Dark Skin the Best
How to Read Your Sunscreen Ingredient Label: A Guide
This Is What It's Really Like to Get a Skin Check
These Are the 8 Best Face Sunscreens of 2019