Using Tableau to Visualize Healing After Skin Cancer (BCC) Surgery

Introduction

Throughout my life, I have often been amazed at how fast the human body heals itself. Whenever I try to find information on this topic, I rarely find what I am looking for.  For this reason, I decided to do my own study and publish this article.

I hope that the content of this article eases the fear that some people will have when they are faced with a situation like this.  Fair Warning: the visual content of this article may not be suitable for all viewers.

The reason that it is hard to find information on the rate of skin wound healing may be twofold. First, medical data is private and regulated by HIPAA privacy laws. Second, people generally do not quantitatively assess their rate of healing. I know what you are thinking. Only serious data dorks will ever do something like this. That’s OK with me, because I’ve already professed that I am a data dork.

Recently, I decided to do my own study on the rate of skin wound healing, using my own body and experience to avoid any HIPAA violations. I was interested in finding out how long it took my body to repair a section of my scalp that had been surgically removed.  The reason I had to have this surgery had to do with a condition known as basal cell carcinoma (BCC), as shown in Figure 1.

Bcc

Figure 1 – Information on Basal Cell Carcinoma

 


 

Background

I remember the first time I ever experienced a major skin injury. I was playing baseball as a kid and slid into second base. I experienced deep abrasions on my knee and hip that eventually turned into a scabs that seemed to take a long time to heal. It was painful and irritating because the wounds would weep and the injured skin would stick to my clothes. Eventually the scab would dry out and then crack open again, leading to more bleeding and pain. This was especially true in places like elbows and knees, where the skin had to flex a lot.

Those were the days before I discovered the topical antibiotic known as “Neosporin”.  That medication has been in my life and in my medicine drawer ever since. Neosporin became especially great when “pain-relief” was added to the medicine.

The second time I had another sliding injury, I used Neosporin on the wounds. I was amazed at how much faster the wounds healed and how much less pain I experienced.

Now I will ask you to fast-forward about 40 years and a half-of-a-lifetime of sun exposure.  For the second time in five years, I have gotten to know a little about the most common form of skin cancer, which is called Basal Cell Carcinoma, or BCC.

In my case, the lesion was a small and innocuous looking (reddish) area shown on the top of my head in Figure 2.  I had felt the bump in that area develop over a month or two and it reminded me of the first case I had on my forehead about 5 years prior. This area was less than the size of a green pea.

During my next dermatology appointment, I had the doctor look at it and he didn’t think it was anything to be concerned with. When I told him that it reminded me of my first BCC case, he decided to biopsy the lesion and it was determined to be another BCC. The lesson I learned is that we know our bodies better than anyone else, and if you think you might have a problem, insist that it be examined.

20160106_140443

Figure 2 – The site of my BCC. Click on any pic for full-size image.

 

Chances are good that some of you reading this will experience this condition, too. In fact, my surgeon performs 20 of these operations a day. In the US, there are nearly 3 million occurrences of this form of cancer per year. This occurrence of this condition is on the rise and is something that we should all pay attention to.

The Surgery

For me, the surgery occurred on Monday, February 29, 2016. During this 4-hour Mohs surgical procedure, I had to have two-rounds of tissue excision. Although I didn’t video record my procedure, you can view this type of procedure by clicking here.

I did ask the surgical associate to show me the wide-open wound, but I do not have a picture of that because she used her phone and promptly deleted the picture. The wound was bigger than I thought it was going to have to be (maybe 2 inches long, 1 inch wide).Figure 3 shows the wound and the stitches used to close the gap.

Unexpectedly larger excised areas can occur because the cancerous cells grow on your basal skin layer and can spread out laterally, before erupting vertically through your skin. There are people that have long surgical cuts made because they ignored their symptoms and let the BCC grown unabated. Early detection is key if you want to minimize the extent of the surgery.

20160302_113042

Figure 3 – The 5 stitches needed to close the incision.

The Healing Period

I was interested in observing how long it would take my body to rebuild the skin on top of my head. To quantify this I either asked my wife and my 4-year old to take a picture of my wound every day. Surprisingly, I wasn’t able to take a good picture of it myself because I couldn’t properly visualize where the wound was on my head. I also couldn’t get the camera to focus properly.

I developed a Tableau dashboard to visualize the healing process. I used the techniques I previously documented in this article to build the dashboard. This dashboard is available by clicking here and is shown in Figure 4. When using the dashboard, you can click on the picture to zoom into the image.

Tableau - Surgery_healing_timeline 4112016 33757 PM

The stitches were removed by about day 11 and the skin was completely reformed by day 33.  I used topical antibiotic on the wound throughout the healing period, even after the stitches were removed. This speeds up the healing and makes the removal of the stitches much easier.

For many people, BCC’s develop on their ears, nose or their face. For me, my scalp seems to be my most exposed area and most susceptible to BCC development. According to my surgeon, both acute sun exposure (sunburns) and long-term exposure are responsible for BCC formation. Hats are my best friend, but for me the sun damage was done long ago when I was a kid. If you get a BCC, there is a 50% chance that you will develop another one within 5 years.

I decided to document this healing process so that people could anticipate how long they would need to recover normal skin after their Mohs BCC surgery. When you are at a hospital having this operation, there are dozens of people in the waiting room. As each person goes back for their procedure, they come back to the waiting room with a white bandage on their face, head, ear, nose, etc. Some people will need multiple excisions to remove the entire perimeter of the cancerous cells.

Final Thoughts

For anyone experiencing this condition, you might expect to have post-operative headaches for 3 or 4 days if your wound is on your scalp. You will not be allowed to use ibuprofen for pain relief because that drug can exacerbate bleeding. You should expect to use acetaminophen (Tylenol).

The operations are completed with local anaesthesia, so that helps reduce the impact on your body. There isn’t much pain during the procedure, so don’t worry about that at all.

I was going to be a total data geek and digitize the scab pictures to develop a mathematical model of the rate of scab reduction. I wanted to know if a linear, exponential, or logarithmic function fit the data the best. However, the picture dimensions varied too much and I couldn’t easily scale the digital images to get an accurate assessment of the reduction in scab areas over time.

What I learned is that I should have made a grid of points on my head using a sharpie so that I could quickly scale the pictures for area comparisons. I thought I was going to be able to do was to use the variations in skin tone that exist on my head. The problem was, however, that the picture exposures varied too much for me to identify landmarks on my scalp.

Therefore, the pictures alone will tell the story. Once the stitches were removed on Day 11, it took about 3 weeks (from day 11 to day 33) for the scab to form and then disappear. One day I’m going to study why our bodies form scabs to aid in the healing process. Interestingly, one of the internal stitches emerged from the wound at time = day 29.4 and my wife managed to take a really creepy macro picture of the stitch using my cell phone. Once she cut the string, I pulled out the stitch.

Lastly, don’t get too upset when you get a BCC diagnosis because the doctors are really good at treating this condition. You should try to find a surgeon that is willing to do multiple rounds of tissue excision rather than depending upon topical chemotherapy cremes to treat any remaining cancer cells. About a month after your operation, you will back to normal, although you will have a divot in your skin where the layers of tissue were removed and you will also have a scar.

 

 

 

 

One thought on “Using Tableau to Visualize Healing After Skin Cancer (BCC) Surgery

  1. Pingback: A Dynamic Image and Web Page Viewer Using Tableau | 3danim8's Blog

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