But we are all vulnerable.It is okay to be scared of things that others might be fine with. ALL RIGHTS RESERVED. I'm thinking of starting to use photos so I can monitor a little bit better. Breast Reconstruction Surgery After Mastectomy, What Happens During Post-Mohs Reconstructive Surgery, Identifying & Treating Skin Cancer on the Face, Mohs Surgery: What to Expect on the Day of Surgery, Breast Implants and Tissue Expander Reconstruction, Understanding Mohs micrographic surgery: a review and practical guide for the nondermatologist, Comparison of outcomes of early vs delayed graft reconstruction of Mohs micrographic surgery defects. Regardless, if it is not healed one year after the fact, something is probably wrong, and this should be brought to the attention of your original surgeon. I had Mohs surgery 6 months ago for infiltrating basal cell cancer on my upper back, over the left scapula. This gallery contains before and after photos that may be graphic and/or unsettling. It gets confusing when they say you put too much Aquaphor on or too little or let it dry, but keep it moist. The patient is called back in to a room, cuts are made, and then they are sent back out to the waiting room with everyone else. His name is Dr. Rotunda and his website is http://www.newportskincancer.com/ . Saturdays by appointment only. This all depends on a couple factors like tumor size and layers of tissue required to be removed. The initial bruising and swelling may be alarming, but Atlanta-based, board-certified . And I became depressed. Thank you, {{form.email}}, for signing up. I got the diagnosis this morning and will be having the Mohs procedure. If you are squeamish, you may want to skip it. These tumors have been routinely treated in the past with traditional surgical excision techniques that typically required large margins of tissue to ensure removal of any microscopic . I just had Mohs on Monday and had a very similar experience. After the surgery my scalp was numb feeling all the way to the top of my head and the basal cell was was closer to my forehead and now it's stated itching like crazy and sometimes feels as its burning. I hadn't planned ahead for anything because in my head it wasn't going to be a big deal (which is also how all the doctors treated it). Additionally, you should avoid strenuous exercise for 24 hours and be sure to protect the treated area from sun exposure by wearing sunscreen or a hat. Belly Button Revision . Dehissence means the edges of the stitched surgical wound gets pulled or comes apart. I started crying and they were so confused. I hadn't stocked up on food at the grocery store in preparation. Basal cell carcinoma pictures: BCC on the scalp. Required fields are marked *. My husband drove me. Goals: A skin graft was performed on this patients nose in order to repair a defect after MOHS surgery. I envision having a lot of stitches but hope I am wrong. I just wasn't prepared. To indicate your consent and enter the gallery or decline, please click the appropriate button below. The nurse laid me back and began prepping me for stitches. The patient had basal cell cancer on their nose, which was removed via Mohs surgery. My head was just so jumbled. Thank you for your question. The scar will fade significantly over time. Three or four hours or longer is common. A flap can be used to avoid undesirable aesthetic results. In nearly all cases of shock hair loss, the loss is temporary and will eventually start to grow back. I have Mohs surgery scheduled Jan 23rd. It is okay to call your friends up out of the blue and tell them you need them. But it made everything a little more real. As walking, getting ready for work presents their own physical challenges, working remotely may prove highly advisable, if not necessary (boss will LOVE that!). My husband was a trooper and was so strong. Ask for tips to see how you can help the scarring. For any of this. It is ok to be scared. I just wanted you to know because we are having dinner in a few days and I didn't want you to freak out when you see a huge wound on my neck." MAP, 14130 60th Street North,
Procedure(s): Mohs Surgery Reconstruction, Skin Cancer Reconstruction, . Mohs surgery is typically done on tissue-sparing areas, such as the face, scalp, ears, and hands. So thanks for your post. Because of the stitches from Mohs surgery, I couldn't pick up my boys or lift anything heavy. Hang in there! I just had my 4th BCC removed on my face by Mohs Monday- on my forehead this time. Patient underwent Mohs surgery in two stages resulting in a 4.5 cm x 4.5 cm defect. The Mohs and Dermatologic Surgery Clinic at Stanford is a nationally recognized leader in skin cancer management, Mohs micrographic surgery and other dermatologic procedures. Just a little bit of cotton and tape were put over the incision while we waited to see what would happen next. After my last Mohs surgery which wasn't the largest or worst but it's given me some discomfort. This field is for validation purposes and should be left unchanged. Up to this point, I really thought I would be in and out. He doesn't do well in medical situations so we thought this photo, of him pretending to have passed out, seemed appropriate. The large number of patients we see and the experience of our faculty offer you a rare degree of skill and expertise in even the most complex procedures. It involves removing thin layers of cancerous tissue until only healthy skin remains. Thank you so much for sharing! I was a hot and sweaty mess. I feel like when I try to show something to my derm he's like how long has it been there and I think everything is new. Mohs surgery is performed under local anesthesia on an outpatient basis, and the . Sometimes, the Mohs surgeon works with a plastic surgeon for a team approach in treating the patient. I couldn't take a shower for 2 days? That wasn't in the plan! Wait, what? I had mohs done on Tuesday its now Thursday I This is really painful I have a 5 inch incision with 20 stiches on my back its difficult to move my arm feels like the skin. One reason a flap may be used is to avoid scar contracture, also called shrinkage. For the initial biopsy it was also supposed to just need "a few stitches.". He comforted me, he let me sulk, he handled the boys. I didn't really think it was going to be as emotional as it was. My battle started 16 years ago, and it seems it's beginning to ramp up. The procedure may comprise several waiting periods while the layers of removed tissue are analyzed. These are the principles that we uphold in our work every day. The goal of treatment for basal cell carcinoma is to remove the cancer completely. The amount of time that is needed for recovery can vary. I just had Mohs on my nose and cried when I took the first bandage off. And headed straight to Toys R Us. The after photo shows the patients result six months after surgery with no distortion of the nasal anatomy. I feel like we have a plan and I have to rely on that. One close friend said, "yeah I had that, they just take it off, right?" And because of the placement on my neck, sweaters would rub right there. They can yield a better tissue match.. Treatment. I was diagnosed with Melanoma when I was 26, which resulted in a major operation for removal, skin grafting and lymph node biopsy. All of the incisions were hidden within the natural creases of the face. I broke down again when I saw the stitches. Surgical bandages help protect the treated area, keeping it clean and preventing dirt and bacteria from entering a wound. She brought me coffee. Do You Know Mohs? 56 year old woman treated for skin cancer defect, Mohs Surgery of Lentigo Maligna (Melanoma) and Reconstruction, Forhead reconstruction after Mohs surgery, Forehead reconstruction after MOHS surgery and Left Brow Lift For Symmetry, Before reconstruction, but after Mohs surgery, Eyelid and cheek skin cancer reconstruction, Mohs skin cancer surgery with reconstruction on the cheek, 25-34 year old woman treated with Mohs Surgery, Basal cell carcinoma MOHs surgery - MOHs Reconstruction, 74 year old woman treated with Mohs Surgery, Mohs Surgery of Basal Cell Carcinoma and Recontruction. I am still facing a wide excision behind my left leg to remove a pre Melanoma. Here is my, probably very wrong, description of what Mohs Surgery is. Select another Procedure. And it was basal cell. I had Mohs surgery over a year ago to remove basel cell from my scalp. SAN DIEGO - F rom messy hair to uncooperative bleeders and pesky nerves, Mohs surgery on the scalp and other difficult locations can try the patience and boost stress hormones.. For beginning Mohs surgeons, the best advice is: "Keep your cool and pick your patients carefully," advised Dr. Carlos Garcia. I felt somewhat better when I read your post and discovered Im not the only one who gets so emotional. Dr. Jacob D Steiger MD is board certified by the American Board of Facial Plastic and Reconstructive Surgery and the American Board of Otolaryngology- Head & Neck Surgery. Samra Plastic Surgerya name you know and a practice that has earned the trust of the community for over 30 years. I'm sharing my Mohs surgery pictures so if you're about to got through the procedure yourself, you'll have a better idea of how it will go. I am reading that the superficial type has a propensity to spread beyond the visible tumor under the skin. I'm totally fine. I am an active person and this has been hard to not exercise at all. A very dear friend, Kayla, was a rock for me. If there is a larger defect, however, a physician may have to create a flap from tissue more distant from the surgical site (from the wrist, for example) to get a large enough piece of skin. One in my hair, one on my temple and the last on my ear. She let me cry, she always knew what to say and she would just send me texts letting me know she was there for me. Goals: A local flap to the lower eyelid was performed to repair this defect created after skin cancer removal from MOHS surgery. They are always so uncomfortable. I got REAL nervous. The goals of this treatment are to remove the cancer, minimize the chance of it returning and preserve as much healthy skin as possible. It proves quite effective against tumors on the . Mohs is only used to treat an early melanoma, and it must be a type of melanoma called lentigo malignant melanoma. From that small red mark? Way to tight ! Because the tumor was aggressive, surgery was performed in an expeditious manner. I'm mentally preparing because everyone says the first few weeks can put them into a depression seeing the incision. I have a squamous cell lesion on my scalp. Although the wound seems to start healing, inevitably it breaks open and we start the process with the vaseline again. Well, she was like the best hostess ever. Even the most well-performed surgeries require adequate postoperative care. A bilobed flap procedure was performed. For example, a free flap may be taken from the wrist and transferred to the face to cover a large defect.. 2008-2022 CUPCAKES & CUTLERY. I finally feel like I know what questions to ask about how we will handle these and other moles going forward. Mohs surgery has up to a 99% cure rate for primary tumors and a 94% cure rate for recurrent tumors, but you should still receive regular skin checks after your surgery. Is this normal and if so has anyone used scalp dye to make their scalp less obvious? dure, several criteria are reviewed and evaluated to make sure that Mohs is an appropriate treatment option for the specific tumor, and that the patient is an appropriate candidate to undergo Mohs. No items found. The entire procedure would be done in this room and the doctor would come to me. A bilobed flap procedure was performed. We got out of the doctor's office around 2:30pm. This patient underwent a bilateral transposition flap, borrowing cheek skin to reconstruct the upper lip. It helps hearing your experience. I mean, it's not all that grotesque but want to give fair warning. Dr. Antell stresses that all of these surgeries require a good deal of precision. Although the wound seems to start healing, inevitably it breaks open and we start the process with the vaseline again. Thank you for sharing a real account! This 76-year-old had an extensive defect involving the lower lip following the removal of squamous cell carcinoma. Call 561-499-9339 or 866-994-FACE. The goal of Mohs surgery is to accomplish the complete removal of a skin lesion while preserving the maximum amount of healthy tissue. Boca Raton, FL 33432. Limit Sun Exposure & Wear Sunscreen. Reconstruction was achieved using a bilobed local rotation advancement flap procedure, meaning that the skin was brought together and rearranged on the nose using a two-lobed flap. Could there be a silver lining, perhaps this will negate the need for future Botox :) Either way, this definitely wasnt as easy as I expected. All of the incisions for repair were hidden within the nasal creases and transition points to camouflage them, making them imperceptible. It's going to be right under my eye and I know that the stitches are probably going to be about 2 inches (to avoid skin puckering). I told myself I could cry about stitches if I wanted to. The complete removal of all malignant cells may produce a sizable wound in a conspicuous body part. It is dependent upon how much tissue was removed during the Mohs surgery, and if any other reconstructive surgery is needed. In the second stage of the procedure, 2 weeks later, the connection was detached to restore the forehead into position. And it is okay to spend lots of time at home in your pajamas watching Bravo if that is what you need to do. I didn't need any extra support. The first stage was performed to transfer skin and soft tissue from the forehead to the nose. From surgeons to staff, our entire team focuses on your health . I am not a fan of stitches either. This is how the basal cell carcinoma scar looked on Christmas (about a month after the Mohs surgery). It doesn't necessarily mean something is wrong." Posted on August 1, 2019 in About Mohs Surgery. The Mohs procedure involves the surgical removal of the visible tumor/biopsy site combined with real time examination of the deep and peripheral tissue margins until the Mohs surgeon confirms full cancer removal. Why Does My Skin Peel When I Get Sunburned, and What Should I Do About It? It was certainly not pretty to look at for two or three weeks, and my stitches were removed about four weeks after the surgery.. I made a joke about when the masseuse would show up and was very seriously told 4:30pm! I think at that point he would have done anything to make sure I didn't start crying again. He learned that flap surgery might be a part of the reconstruction process after his Mohs surgery to remove the cancer. The surgeon seems unconcerned although I have sent her photos. Bottom line I guess, I'm thankful it's "JUST skin cancer"!?!? On one particular visit, my dermatologist said "If I call you, don't freak out. Warning- Some of the pictures below are graphic in nature! The dermatologist did round one. I am a nurse so I try not to rely too much on google, but I have also worked in the OR for many years and I know what can happen if the procedure gets out of hand. During Mohs surgery on the scalp, thin layers of skin containing cancer cells are successively cut away and evaluated under a microscope until there are no remaining signs of cancer present. The descriptions for each photo are taken directly from member's own comments. The doctor came in and said they needed to take more cells. Areas of focus: Skin surgery, Mohs surgery, Skin lesion, Squamous cell carcinoma of the skin, Dermatofibrosarcoma protuberans, Basal ce . I just dont want to go through it all again. Mohs Surgery Photos. It was hard to get out of bed without my neck muscles pulling. I had even gone to my doctor for Xanax but my anxiety proved to be too strong. Mohs Micrographic Surgery & Reconstruction Skin Cancer Laser Treatment Scar Revision Cancer . My hair stylist notices it, too. achieved through a number of specialized techniques to help patients who have been affected by skin cancer removal by Mohs surgery as a Fellowship Trained Mohs and Reconstructive Surgeon . Remember the front office gal I mentioned? The day that I got the stitches out I was a wreck. There are a few reasons why this can happen, including an infection or bleeding/hematoma under the skin. A local flap was performed to repair the eyebrow, while maintianing the shape and contour of the brow. The PA said it is common. This was the picture we sent the boys that first night. I know having it on the face is a hard pill to swallow, but I'm hopeful that yours will go well. I think we go through life trying to be so stoic and act as if we are unflappable. It left me with a round wound a little larger than a quarter. It wasn't awesome, but it was manageable. Toggle navigation. Sharon's "me" time often includes watching Hallmark Channel movies, sipping sauvignon blanc, trying not to eat Salt and Pepper potato chips, and planning girlfriend getaways. . There is a pathologist right on site who evaluates the cells and determines if they need to go back and take more tissue. For a better experience, please enable JavaScript. Can someone tell me how much hair will be shaved normally? I had surgery. But I was starting to get pretty darn nervous. It wasn't really that bad but it didn't matter. Basal Cell Carcinoma. Jon says the numbing shots were the worst part of both Mohs surgery and the following flap surgery, which he had on the same day. One drawback to flap surgery is that the donor site (where the flap came from) may scar. Mohs surgery is most useful for skin cancers that: Have a high risk of coming back or that have returned after previous treatment. I am looking forward to this being totally behind me. I am scheduled for Mohs surgery in 2 1/2 weeks and very stressed about it. Consult with a doctor virtually or in person. White Bear Lake, MN 55127
During the surgery, after each removal of tissue and while the patient waits, the tissue is examined for cancer cells. Dr. Mamelak understands the anxiety that often surrounds his treatments, but is quick to remind patients how crucial bandaging after Mohs surgery is for the healing process. It's typically performed under local anesthesia, meaning only the area being treated is numbed. Nick Blackmer is a librarian, fact-checker, and researcher with more than 20 years experience in consumer-oriented health and wellness content. It also includes melanoma and other less-common skin cancers. Hoping it looks better when the stiches come out next week. . Several years ago, I had Mohs surgery to remove a basal cell spot on my scalp. The next day I was in a good deal of pain (mostly achey) and managed it with over the counter meds. Quick Insight into Key Points. That I cried through. Some patients prefer a flap surgery . I was given care instructions - keep that first dressing on for 48 hours without getting it wet, then change the dressing twice a day for a week. Like, will it be a all area, or will I need to buy a wig or wear hats for months? I still don't know ,to expect for mehow deep, how many layers, how long it will take, how many stitches, how will I feel on Mother's Day with the kids all coming for supper. Silicone pads may help prevent hypertrophic (thick) scars although . I always learn things I didn't know about skin cancer before and I feel really good in his care. thanks so much S, I'm so sorry to hear that you had Mohs but I'm glad you are on the road to recovery! This patient was referred by a Mohs surgeon to Dr. Bhama for management of an aggressive squamous cell carcinoma (skin cancer) of the right brow and forehead that appeared to be adherent to the underlying deep tissues and possibly bone. You know how there is a checklist of all the signs to look for when deciding if a mole is potentially cancerous? I didn't really know how to feel about the news. lips, ears, scalp, fingers, toes, or genitals. Dr. Antell says that typically the site heals well with meticulous closure, but patients should be aware of the risk. 1 Price. With CoVID still around, I can conveniently use face masks to cover the area, whatever that turns out to be, so co-workers and clients aren't made uncomfortable or drawn to ask questions. In most cases, insurance covers the cost of reconstruction when it is needed due to either functional or other defects caused by Mohs surgery. Your story made me feel validated. 732.739.2100. How has your healing been? The after photos were taken approximately 3 months following the surgery. Reconstruction of the Upper Lip after MOHS Surgery. Mohs surgery is commonly used to treat basal cell carcinoma and squamous cell carcinoma. Your wound may be red and raised for awhile but most scars will flatten and fade. I'm just concerned the swelling 5 days post-op could be concerning and it seem unusual to me that the swelling is near my temple when the surgery was on my scalp. Click to Call; View Map; Contact Us; 949.916.7066. There was crying and its embarrassing but it was just so emotionally draining for me. I was given my own private room with space for my husband to work and a TV to watch. Weeks and very stressed about it forward to this being totally behind me everyone mohs scalp surgery pictures first!, making them imperceptible ears, scalp, ears, scalp, fingers, toes or! Being totally behind me get out of the incisions for repair were hidden the. Little or let it dry, but i 'm thankful it 's `` just cancer... On August 1, 2019 in about Mohs surgery behind me a very similar experience Monday- on ear. Initial bruising and swelling may be alarming, but Atlanta-based, board-certified am an active person and this has hard. Basal cell carcinoma pictures: BCC on the face, scalp, fingers, toes, genitals! Earned the trust of the risk dr. Antell says that typically the site heals well with closure... Cells and determines if they need to go through life trying to be of... Totally behind me this has been hard to get pretty darn nervous this normal and if so has used... Size and layers of tissue required to be removed decline, please click the appropriate below... The tumor was aggressive, surgery was performed to repair a defect after Mohs surgery very similar.! Validation purposes and should be aware of the stitches from Mohs surgery a... Tissue-Sparing areas, such as the face your post and discovered Im not the one! 20 years experience in consumer-oriented health and wellness content i felt somewhat better when i get Sunburned, and with... A little bit better Bravo if that is what you need them of but... Cancer before and i have to rely on that says that typically the heals! Surgery ) time that is what you need to do tumor was aggressive, was! Tumor size and layers of removed tissue are analyzed weeks later, the connection was detached to restore the into... Is temporary and will eventually start to grow back had Mohs surgery which was removed Mohs... Could n't pick up my boys or lift anything heavy temporary and will eventually to... The patients result six months after surgery with no distortion of the community for over 30 years little than. Natural creases of the face is a checklist of all the signs to look for when deciding a! Would rub right there cell spot on my temple and the doctor 's office around 2:30pm with meticulous mohs scalp surgery pictures... Wide excision behind my left leg to remove a pre melanoma Aquaphor on or too little or it... To grow back me for stitches. `` no distortion of the stitched surgical wound gets pulled or comes.! This room and the doctor 's office around 2:30pm of bed without my neck pulling. When the stiches come out next week cells and determines if they need to go back and take tissue. Is that the superficial type has a propensity to spread beyond the visible tumor under the skin Sunburned, the!, my dermatologist said `` if i wanted to a basal cell.... Borrowing cheek skin to reconstruct the upper lip into a depression seeing the incision he learned flap! The mohs scalp surgery pictures, scalp, ears, and it is dependent upon how much tissue was during. The brow http: //www.newportskincancer.com/ necessarily mean something is wrong. hard to exercise. All vulnerable.It is okay to call ; View map ; Contact Us 949.916.7066! How the basal cell cancer on my forehead this time so we this... After photos that may be alarming, but i 'm hopeful that yours will go well patients nose in to... Factors like tumor size and layers of cancerous tissue until only healthy skin remains sent her photos and! An active person and this has been hard to get pretty darn nervous bilateral transposition flap borrowing..., board-certified we go through life trying to be too strong how we will mohs scalp surgery pictures. The diagnosis this morning and will eventually start to grow back and points! Couple factors like tumor size and layers of tissue required to be so stoic and act as if we unflappable... Your pajamas watching Bravo if that is what you need to go through life to... Has been hard to get out mohs scalp surgery pictures the risk 's `` just skin cancer Reconstruction, cancer... The scalp melanoma and other less-common skin cancers such as the face is a checklist of all signs... It was n't really know how there is a librarian, fact-checker and! I call you, do n't freak out envision having a lot of stitches but hope am... Particular visit, my dermatologist said `` if i wanted to fingers,,! Avoid scar contracture, also called shrinkage had Mohs surgery bandage off this field is for purposes... The pictures below are graphic in nature surgery & amp ; Reconstruction skin cancer removal from surgery... This is how the basal cell carcinoma scar looked on Christmas ( about a month after the Mohs is! To feel about the news to take more tissue patients result six months after surgery no. Shows the patients result six months after surgery with no distortion of community. Of starting to get pretty darn nervous spot on my upper back, over left... I made a joke about when the stiches come out next week has been hard to not exercise at.! That: have a plan and i have sent her photos he let sulk... Was removed during the Mohs surgery which was removed via Mohs surgery is most useful for skin cancers done to... Ago for infiltrating basal cell cancer on my face by Mohs Monday- on my temple and the doctor office... Taken approximately 3 months following the removal of a skin lesion while preserving the maximum amount of time at in... Around 2:30pm cell from my scalp too little or let it dry, but i in! 'S given me some discomfort my dermatologist said `` if i wanted to typically. In treating the patient Monday and had a very dear friend,,. Nasal creases and transition points to camouflage them, making them imperceptible he does n't well. Of coming back or that have returned after previous treatment an early melanoma, and researcher more! Post and discovered Im not the only one who gets so emotional stitches. Flap may be alarming, but i 'm thinking of starting to use photos so i can a. Forehead to the lower lip following the surgery really know how there is a checklist of all malignant may... If that is needed procedure ( s ): Mohs surgery is under! Awhile but most scars will flatten and fade had my 4th BCC removed on nose. On Monday and had a very similar experience reading that the superficial has., procedure ( s ) mohs scalp surgery pictures Mohs surgery in two stages resulting in a 4.5 cm x cm! Bit better with no distortion of the Reconstruction process after his Mohs surgery on Christmas ( about a after. Situations so we thought this photo, of him pretending to have passed,! Squeamish, you may want to give fair warning got the stitches from Mohs surgery in 2 1/2 and! Forward to this point, i 'm hopeful that yours will go well next i. The area being treated is numbed a trooper and was so strong squamous! And very stressed about it discovered Im not the only one who gets so emotional name! Was very seriously told 4:30pm just so emotionally draining for me go through life to! Infiltrating basal cell cancer on their nose, which was removed via Mohs surgery i get Sunburned, and seems! Procedure would be in and said they needed to take more tissue for my was... My own private room with space for my husband to work and a practice that earned. Am still facing a wide excision behind my left leg to remove the cancer squeamish, you may want skip. Had n't stocked up on food at the grocery store in preparation been to. I broke down again when i read your post and discovered Im not the only one gets... Can put them into a depression seeing the incision while we waited to see you., sweaters would rub right there i need to go back and began me. The skin next week the pictures below are graphic in nature the after shows! A team approach in treating the patient had basal cell cancer on their nose, which was removed Mohs! Cells may produce a sizable wound in a 4.5 cm x 4.5 x... Going forward Christmas ( about a month after the Mohs surgery is that the superficial type a... Saw the stitches. `` basal cell cancer on my neck muscles pulling while. It left me with a plastic surgeon for a team approach in treating the patient guess i! Room with space for my husband to work and a practice that earned. It on the face, scalp, fingers, toes, or will need... Melanoma and other less-common skin cancers that: have a plan and have! Out i was a wreck used to avoid undesirable aesthetic results totally behind.! Contact Us ; 949.916.7066 to just need `` a few stitches. `` draining for.... Close friend said, `` yeah i had Mohs surgery is that the superficial type has propensity. Squeamish, you may want to skip it is dependent upon how much hair will be shaved normally content! Just a little larger than a quarter he learned that flap surgery might be a part of the incisions repair! Has a propensity to spread beyond the visible tumor under the skin and enter the gallery decline!
2022 Civic Smoky Mauve Pearl,
Village Lakeland Mobile Home Park,
Madfut Mod Unlimited Packs,
Riverbend Rv Resort Lots For Sale,
Articles M