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Hope after cancer: Woman undergoes 49 facial surgeries after skin cancer diagnosis

USA TODAY logo USA TODAY 8/14/2018 Cortney Roark
a girl taking a selfie in a room: Cancer survivor Marisha Dotson poses for a portrait at her north side apartment in Knoxville, Tennessee on Wednesday, August 8, 2018. The Clinton, Tennessee native was diagnosed with extremely aggressive squamous cell carcinoma on her nose, and has since undergone 49 facial surgeries to treat the cancer and repair her face. © Calvin Mattheis/News Sentinel Cancer survivor Marisha Dotson poses for a portrait at her north side apartment in Knoxville, Tennessee on Wednesday, August 8, 2018. The Clinton, Tennessee native was diagnosed with extremely aggressive squamous cell carcinoma on her nose, and has since undergone 49 facial surgeries to treat the cancer and repair her face.

When Marisha Dotson looks in the mirror now she sees hope.

She's grateful.

She smiles.

Four years ago she didn't think she'd ever smile again. Dotson underwent a 16-hour surgery to remove a squamous cell carcinoma from her nose. The tumor took most of her nose with it.

"When I looked at it (after surgery) all I saw at first was this huge hole where my nose used to be," Dotson said. "I thought, 'I don't know if this is ever going to be okay again.' "

The diagnosis

When Dotson, now 29, noticed a small red patch on her nose in 2014, she assumed it was ordinary skin irritation. When it raised to look more like a pimple within the week, she didn't think much of it.

It continued to grow throughout the second week, so Dotson visited the Student Health Center at the University of Tennessee where she was studying psychology,  sociology and political science. The doctor there treated her with antibiotics for a skin infection.

Three weeks later the bump had grown to almost the size of a quarter. Dotson, originally from Clinton, Tennessee, sat at the Dermatology Associates of Oak Ridge office as the dermatologist discussed the possibilities. It could be an infection, it could be a few other conditions. Or it could be skin cancer.

"Prepare yourself," Dotson was told.

A week later the 24-year-old was diagnosed with squamous cell carcinoma.

"It had grown from nothing into this huge tumor in like seven weeks," Dotson said. "It was still growing. ... I was freaking out, because I didn't have health insurance at the time. I didn't know what to do."

She was referred to Dr. Kathrine Kerchner, whose team performed the 16-hour surgery that would shape the rest of Dotson's life.

The first surgery

Dotson's first surgery was performed to remove the cancer. No one in the room — not Dotson, not Dr. Kerchner and not the team of nurses — was sure how much of her face Dotson would lose.

Each removed layer revealed another that needed to be removed.

"The team of nurses that had been there all day ... Every time they had to come back and take out more, they were crying," Dotson recalled. "I was crying. I tried to make them not feel as bad about it, because the entire time they were like, 'I'm sorry. I'm sorry.' I said, 'It's OK. We have to do this.'"

Dotson couldn't look at her face until the surgery was complete, but said she could feel that most of her nose was gone.

"At that time, I didn't know if I'd be okay with it, because it had just happened," she said. "There were so many emotions I was trying to process at the time. The grief didn't hit me until a couple weeks later. I was devastated."

Shortly after, Dr. Clyde Mathison, reconstructive surgeon at Farragut ENT, received a call from Kerchner explaining Dotson's case.

a person posing for the camera: Cancer survivor Marisha Dotson poses for a portrait at her north side apartment in Knoxville, Tennessee on Wednesday, August 8, 2018. The Clinton, Tennessee native was diagnosed with extremely aggressive squamous cell carcinoma on her nose, and has since undergone 49 facial surgeries to treat the cancer and repair her face. © Calvin Mattheis/News Sentinel Cancer survivor Marisha Dotson poses for a portrait at her north side apartment in Knoxville, Tennessee on Wednesday, August 8, 2018. The Clinton, Tennessee native was diagnosed with extremely aggressive squamous cell carcinoma on her nose, and has since undergone 49 facial surgeries to treat the cancer and repair her face.

The reconstruction

Mathison was not dealing with anything he wasn't used to as he reviewed Dotson's case on paper.

"From a surgeon standpoint, the defect was not anything unusual," he said. "I wasn't taken aback by the size of it. I knew how to fix it. From a human being standpoint, I felt horrible for Marisha, for such a young lady to have such a large defect on her nose and be missing such a large portion of her face."

Mathison knew Dotson didn't have insurance at the time. He knew she would need at least three trips to the operating room. So he contacted Turkey Creek Medical Center and got everything covered pro bono.

Dotson underwent what is referred to as "Mohs" surgery during which a flap of skin from the head was brought down to repair the missing portions and cartilage from her ear was shaped as a nose.

When Dotson woke from the first reconstructive surgery, she met Lori and Stephen Cupp, two of the many Church of Jesus Christ of Latter-day Saints members who "rallied around" Dotson throughout recovery. Aside from her roommate and younger brother, Jack, Dotson hasn't seen her family since her mother died when she was almost 16, so various members of the church and other friends stepped up, she said.

The Cupps received a call from a church member explaining Dotson's story. They didn't think twice about opening their home to Dotson as she recovered.

She stayed at the Cupps' home for almost a month. They took her to doctors' appointments. They made sure she had her medicine. They cleaned her wounds.

"They were so great," Dotson said. "I love them."

To hear Lori Cupp tell it, Dotson is the one who helped her.

"Initially, it broke my heart to think that here is this young girl waking up from a surgery and going home with a stranger, having to open up her life, her struggles, her trials to a stranger," Cupp said. "But it was also encouraging to me to see her strength and her determination. ... She pushed through. She never really complained."

As the reconstruction process continued, Dotson and her doctors became more and more pleased with the progress of her face.

"We had a very good result," Mathison said. "Minus a scar on her forehead, her nose looked pretty darn good. She was very happy. I was very happy."

Mohs surgery has a 97-98 percent success rate, Mathison said. Dotson fell into the 2-3 percent.

"We started having these little spots show up," he said. "I thought, 'Oh, this is probably acne or a mild infection.' But history repeated itself.

"The cancer was back."

The recurrance

Between October 2015 and September 2016, Dotson underwent various surgeries to remove cancer occurrences as they appeared.

There were occurrences under her eye, around the skin graft tissue, beneath the nose, and eventually the cancer metastasized into the bone through the oral cavity. Tumors had grown into the hard palate, the upper jaw and into the teeth, which an oral maxillofacial surgeon worked to remove.

But the tumors were still growing. It was almost summer of 2016 when Dotson had to decide to either undergo a surgery to remove everything within the cancerous margins or live out what was left of the rest of her life and leave her face the way it was.

"That's when they told me I had a less than 20 percent chance of survival," Dotson said. "I decided to do the surgery. I decided to keep fighting." 

She underwent a partial maxillectomy in September 2016 in which the rest of the nasal bone and everything inside the nasal tissues were removed.

She's been in remission ever since.

a person holding a sign: Marisha Dotson received the Outstanding Sociology Graduate award from the Department of Sociology at the University of Tennessee when she graduated on May 7, 2015. © Submitted Marisha Dotson received the Outstanding Sociology Graduate award from the Department of Sociology at the University of Tennessee when she graduated on May 7, 2015.

The reflection

Dotson's life didn't go in the direction she planned. She didn't graduate when she thought she would. But she did graduate in the midst of it all. She walked across the stage a week after one of her surgeries with a B.A. in psychology and sociology and the Outstanding Senior Graduate award in the sociology department.

She didn't go to law school as she planned, but she now plans to travel out of state to attend graduate school for social work or trauma counseling.

She's had 49 incisions on her face, including biopsies, and has been put under anesthesia more than 30 times. Her student debt is nothing compared to the approximate $150,000 of medical debt she acquired after going through the marketplace for insurance six months after her diagnosis.

But as she looks back at the past four years of her life, Dotson sees a story of hope and gratefulness. It's a story she tells to inspire others who may be facing a similar diagnosis.

a man wearing a suit and tie standing next to a woman: Marisha Dotson and her brother, Jack, pose for a photo the day she graduated from the University of Tennessee, May 7, 2015. © Submitted Marisha Dotson and her brother, Jack, pose for a photo the day she graduated from the University of Tennessee, May 7, 2015.

"It's not just about how you look," Dotson said. "It's about identity too, because when you look in the mirror you see your face. That's your face. You attach a lot of emotions to your face, so it's just been a whole process of trying to adapt. Sometimes I think the old me died a long time ago, but now I'm starting to think that I'm a seasoned blend of who I used to be and who I am now.

"I should be proud of my scars, because I fought really hard to live."

A GoFundMe is set up for Dotson's medical expenses. As she reflects on those that showed support through her diagnosis and recovery, she puts it simply as she smiles.

"I think it's a beautiful thing," she said. "People trying to connect or just show their support is the best kind of humanity."

Follow Courtney Roark on Twitter: @CortneyRoark


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