Basal Cell Lip Cancer

[Bill Troiano]

Yeah, I just received the news I didn't want to hear this morning. I had a biopsy of a red spot on my lip last week and I received a phone call today saying that it is basal cell cancer. It will require surgery and I have a consultation tomorrow. The spot is right on the left side of my upper lip where the mouthpiece contacts the face (just above the red of the lip.) I can't imagine that they will take off part of my lip without creating a negative effect on my playing. Maybe, that's it for my playing days. I'll find out more tomorrow.

Has anyone here had any experience with this sort of thing?

[tbn.al]

Gosh Bill, I hate to hear that. My wife had a spot taken off her cheek that hardly left a mark. Two years later and you can't tell it at all. Still, I know what feels like to hear the Doctor use the word cancer and your name in the same sentence. I would think that it all depends on how much they have to remove to get it all. My prayers will be with you and my hopes that they only have to take a small bit off.

[tubajoe]

Bill, so sorry to hear about that! I've dealt with a similar skin situation, but not on my face.

With regards to your embouchure... the human body is remarkably adaptable! Remember that Bud Herseth got in a car wreck in the 1950s, smashing his face on the steering wheel. Along with a bunch of teeth he lost much of the feeling in his lower lip, which he never completely regained and dealt with his entire career. (this changed his mouthpiece choice as well as placement supposedly)

Keep us posted on the prognosis and progress. Horn playing versus *human* conditions is an interesting situation... and something we all deal with in one regard or another eventually!

Hang in there!

[imperialbari]

This is the worst nightmare of brass players. I most certainly hope you will manage the cancer part of the problem.

As for the involved mechanical damage to the lip I have seen two very good trombonists perform amazingly after recovery from very bad damages to their upper lips. Hurt by a stray golf club and a bike accident respectively.

Klaus

[basspiper]

I wish you the best in everything, Bill. I'd also encourage you to consult more than one oncologist, if it's at all possible. They may differ quite a bit in how they'd want to proceed.

Dave

[Art Hovey]

Bill,

I have had several basal cells and melanomas removed, but not from my lip. It's going to be ugly for a couple of weeks, but it will heal, and you will be able to play again. They don't have to remove any muscle tissue; just a little skin and a thin layer of subdermal fat, and you know I don't have much of that.

A friend of mine who is an amazing and well-known tubist has a scar on his lip that makes me wonder how he could ever play tuba. I never asked him about it, but it's clearly the result of a cut much worse than what you will have, and it never stopped him!

[TubaRay]

I'm with Bloke on this one: "I wish you well, and I believe you will do well."

[KCarubia]

I had squamous cells removed from my ear lobe. It now looks like I had an earring ripped out. My doctor offer the name of a plastic surgeon if I ever wanted it fixed. Maybe they will have that for your lip? I know speech therapists offer physical therapy for the face. That will hopefully help you out after surgery...but you have to ask for it. I don't know about insurance...evry plan is different.

Best of luck,
Kevin

[bort]

I don't know if this makes any sense... but lips are high-use and high blood-flow areas of the body, and these parts seem to hear more rapidly than other parts. Seems logical to me, but I'm not a doctor...

Good luck, you'll be in our thoughts, and we're all hopeful that it'll be a quick recovery. There's never been better medical treatment available in history!

[Bill Troiano]

Thank you everybody for the kind and encouraging words. I have a consultation with the doctor/surgeon this afternoon. I may very well choose not to go with him. I did had a melanoma on my foot about 5 years ago. It just looked like a freckle on the top of my foot. I elected to go with a different surgeon at that time also. For a melanoma they cut a large area around the site. My foot looked like Frankenstein's (Boris Karloff) forehead. It healed fine and you can hardly see the scar today. But, that was my foot and melanoma and this is my lip and a less severe form of cancer. We'll see what happens today.

[bisontuba]

Bill-
The very best of luck!!!!
Mark

[bearphonium]

Bill,
Several things. I echo bloke's sentiments: You will do well.

I have had a basal cell carcinoma removed from between my eyes, no scar. The surgeon used a technique called "Mohs" which is really effective, taking minute layers and testing them until there is no more cancers.

Scary stuff, and you'll get through it just fine!

[Bill Troiano]

Saw the surgeon yesterday, and yes, I'll be having the Mohs surgery on Feb. 23. At least I get to attend the Army Band Conference with an uncut lip. We'll be at TMEA in early Feb. too. (My kids all live there.) So, I'll get to play all the tubas I want before they start slicing away. The surgeon said there will be stitching and scarring, but it should be minimal (wuddeva the hell that means)!! I'll probably be off the horn for a month before I attempt my comeback.

It reminds me of the joke (edited for tuba players):
"Doc, will I be able to play a pianissimo Bb above the staff after the surgery?" Doc says, "sure!" "That's great because I wasn't able to play it before!"

[JHardisk]

Bill,

I'm terribly sorry for the discovery you've made on your chops. It's never fun to find out those sorts of things.

Some encouragement:

7 years ago, I was playing softball with my work team. I had just won my gig in the Air Force band, and I took a direct hit to my chops at a very strange angle, and my upper teeth went completely through my top lip at a very jagged angle forming about a 2 inch laceration. I had nerve, muscle, and tissue damage right in the middle of my embouchure. The wonderful Air Force doctors did their best to reconnect things and minimize scarring when they sewed me up. I was off of the tuba for 4-6 months before I could play without excrucitating pain. Luckily, my employer saw it fit for me to remain and rehabilitate my chops.

Needless to say, I'm back, stronger than I ever was. I did have to move my embouchure to the right to accomodate the lumps of scar tissue, but I can honestly say it was an incredible learning process that actually allowed me to eliminate some bad habits by neccessity as I relearned how to buzz. A smaller mouthpiece also helped me get out of the way of the damage as well. I still have some numb areas on my chops, but honestly, they are just flaps of skin that we convince to vibrate with air and muscles.

Things will go well, and life will go on. Don't sweat it, and be thankful it isn't worse.

I look forward to hearing of your recovery!

[Bill Troiano]

I'm having the surgery for my skin cancer on my lip tomorrow morning. This has gotten me to thinking about the negative effect of the skin, especially membranes, coming in contact with raw brass. Although my dermatologist said that the damage is most likely due to sun exposure from years ago, I can't help but wonder if years of my mouth coming in contact with brass has contributed to my condition, or even caused it. The cancer is right where my mp sits. I now know that I am prone to skin cancer. I had a melanoma on my foot that I dealt with 5 years ago. I've had other pre-cancerous things frozen or cut off me. Now, I have this basal cell cancer on my lip. I've always told students not to play on raw brass mouthpieces. Over the years, as a middle school/junior high band director, I would see students come in with old mouthpieces with the plating worn off the rim. I would tell them to buy a new mp and call the parent. I didn't know what negative effect playing on raw brass could have, but I was told years ago that it wasn't good and that a skin condition could develop from it.

I don't know what kind of mp's I played on as a kid. I played on whatever was in the room. I did play on a gold plated 7B for a while and it currently has no plating on the rim. I don't know if it was like that when I used it 20-25 yrs. ago. I also have a Shilke 67 with plating worn off. I haven't used that one since my Guy Lombardo days and I don't recall its condition when I used it.

So, I don't know if there has been any study on this. I do know that when I attempt to play again, in 4-6 weeks, that I will likely go back to stainless. I recently returned to a brass mp, the Dillon/Olka mp. It had a much livelier sound than the stainless mp I was using for the past 10 years. It's similar to a Laskey 30H, but with a more round inner rim. I would like to find a stainless mp that gives me the same lively sound and feel as my current mp. Maybe, that sound doesn't exist in stainless, which is what prompted me to return to a brass mp about 4 months ago. I'll also likely sell my beloved Gnagey tuba. It is raw brass and I don't want to flirt with this danger any longer. I want to reduce the variables.

It sucks getting old. And, use sun screen!

[Doug Elliott]

I hope it goes well. I have looking into the subject of brass sensitivity many times before, because there is a lot of concern in the brass playing community, although plenty of people play on raw brass with no issues at all. I don't remember seeing any connection with cancer. Sun exposure is more than likely the cause; lots of people get it. Also, I doubt that your playing will suffer at all. Enjoy your 6 weeks off.

[Wu299]

I would like to also add my wishes for you to play well (and even better) after the surgery. Hopefully, it will be just an experience for you and nothing worse.

Doug, did you find any problems that using raw brass (other than no connection with cancer) may cause?

Petr Horák

[bisontuba]

Bill-
The very best of luck to you!!

Mark Jones

[Doug Elliott]

Doug, did you find any problems that using raw brass (other than no connection with cancer) may cause?

Some people are (or become) sensitive to certain metals, just like an allergy. Nickel is probably the most common metal to cause sensitivity, followed by brass and silver. Most people have no problems with silver. A few people are sensitive to gold, and even stainless steel. That's why they use titanium for implants; it doesn't cause any problems in the body.

The symptoms would be described as contact dermatitis, and range from a rash to swelling.

I make Lexan rims to take care of that problem. Lexan feels the best to play on of all the plastics I've tried, and it is completely non-allergenic.

[stufarris]

Have a fellowship trained Mohs surgeon remove it.