I write this to help educate others, to warn others about skin cancer. I have waited so long to share this journey because the pictures are painfully hard for me to look at…harder to post for the world to see. The scars are never-ending reminders of paying for my days in the sun, unprotected or under-protected. This is my plea to the masses to love the skin you’re in, stay away from tanning beds and use enormous amounts of sunscreen with high levels of SPF. Throw way expired sunscreen. Know your body and have anything suspicious looking checked out as soon as possible. Having beautiful skin that tans easily does not make you immune to skin cancer. A gorgeous young lady (under age 30) with glowing brown skin sat in the waiting room with me…her verdict was melanoma and she was scheduling an appointment with an oncologist. She said she never used sunscreen because she tanned so well…she did not know she needed protection from harmful UV rays. I hope this will educate many. This is my story.
In the beginning
As a kid born and raised in the south, I spent most hot summer days playing sports, swimming and just being outside. I was not blessed with warm, tan skin tones that a lot of my friend’s had, but nonetheless, I continued to “try” to tan my lily-white, freckled skin that God paired with my red hair and blue eyes.
Back in those days, the commercials catered to tanning products, not sunscreen with varying levels of SPF like we see today. My friends and I spread quilts on the front lawn and worshipped the sun in all of its UV glory applying countless layers of baby oil and such. Yep, we would burn…and peel…and burn…and peel…but eventually my friends would have that deep, glowing tan and I would have the faintest of a sun-kissed hue.
My late teenage years saw the introduction of tanning beds with newfound hope of a gloriously suntanned body! Three trips into my revelation, I was struck with the tough realization that I would still burn in these beds, even though it wasn’t the “sun.” And, information was beginning to slowly come about with startling data regarding sun exposure and sunburns…and the strong link they shared with cancer.
Still, I loved the outdoors…always have, and suspect I always will. I made sunscreen a part of my regime, but continued to chase the dream of life with a tanned facade. Every serious burn upped my chances of skin cancer, but I didn’t know anyone with skin cancer, so the risk didn’t seem real to me. Today, it is real. Damage done is damage done.
At 28 years old and pregnant with my last child, my son Eli, I had a “suspicious” looking spot in the bend of my arm. It had been there for a while, but during my pregnancy it had changed shapes, colors and conditions. My OB/GYN noticed it during a routine appointment and insisted that I see a dermatologist and after a biopsy, it was confirmed to be basal cell carcinoma…not the most serious of all skin cancers, but certainly a word I wasn’t ready to hear. It was deeper than expected and a plastic surgeon was called in to do the procedure with a specialized closure that afterwards resembled a large burn on my arm. Eventually, it settled down and blended with my skin into a thin two-inch scar.
The following 10+ years were a series of random skin cancer sitings: another place, opposite arm (further down on my forearm) had a similar experience to the first one. No surgical procedure was required, and the dermatologist was able to do the follow-up removal in the office closing it with a few stitches. A spot followed on my upper back, my forehead and my chest…all basal cell carcinoma and all were contained to the biopsied area so nothing further was required.
During this time, I was traveling more and more as my career as a travel journalist had really taken off, calling me to the beaches and the Caribbean over and over. I purchased sunscreen the way most people purchased toilet paper…with the attitude that one must never run out! I used it all the time, and purchased make-up and moisturizers that contained added SPF as well. However, there were times when it would sweat off of my face or I “missed” a spot…it seemed simple enough that when that happened, I always caught new spots early and the dermatologist always had the same report: it was basal cell carcinoma, but we got it all with the biopsy.
Fall of 2013 I noticed a spot on the side of my nose, right in the crook (as we Southerners say)…a small spot, but it seemed “funny.” I had learned what to keep an eye out for and quickly put it on my watch list. During the winter I noticed it was gone. No trace of it, so I put off a trip to the dermatologist. As summer of 2014 came, I noticed it was back and a little larger than before. It would form a slight thin scab over it, then it would slough off, but never really heal. I was traveling and decided when I returned home for any length of time, I’d see the doctor. In the meantime, I found a teeny little spot on my scalp…right on my crown where all the hair kind of separates…the only spot the sun could really touch through my thick head of hair. I could scratch the top of it off and it would come right back. I felt like it also needed to come off.
Late summer I saw the doctor and she agreed the one on my nose was likely “something” and should come off. The one on my scalp was so tiny that she didn’t seem concerned, but biopsied it since we were doing the other one anyway. I left that day looking at my calendar to see what day I expected the call that both were basal cell and had been fully taken care of with the biopsy. The call came, but with a different verdict. They were both basal cell carcinomas, but there were not clear margins and I would be sent to a Mohs surgeon for a specialized procedure.
Mohs Surgery for skin cancer
Mohs surgery (developed in 1938 by Frederic E. Mohs, a general surgeon) also known as chemosurgery, is microscopically controlled surgery used to treat common types of skin cancer. During the surgery, after each removal of tissue, the patient waits for the biopsied tissue to be microscopically examined for cancer cells. That examination determines if margins are clear of cancer cells or will need an additional tissue removal. You can read more about Mohs surgery at http://en.wikipedia.org/wiki/Mohs_surgery.
After a consultation with the surgeon, I went in for the procedure…all done under local anesthesia, and we decided to do both spots during the same appointment. I was expecting, as I think the doctor was, to have one tissue removal on each spot, get a clear margins report, stitch me up and ride off into the sunset (with sunscreen on, of course)! I arrived at 8 a.m. that morning and was one of eight folks in the waiting room. We all took our turn going back, and then returning to the waiting room to see what the results were. Most were gone by lunch. I had my wounds covered and was told to come back after lunch…and I was the last one to leave that day. Three times in on my nose and four on my scalp before the margins were clear thanks to the sweet little cancer cells growing inward in what was referred to as fingerling patterns under the surface.
My concerned and courteous doctor talked to me before handing me a mirror and explained that his job was to get all the cancer out. He went on to say that it’s great when that happens and he can stitch it up, but sometimes we have to have some help from the plastics guys. This was one of those times. I was totally and completely unprepared for what I saw in the mirror that day – a hole in my scalp that you could sit a quarter down inside, and a nice hole in the side of my nose. I am not a vain person, mind you, but I do television spots for travel assignments, speaking engagements and appearances. I couldn’t believe what I was seeing…and even though it was “only” basal cell rather than the more terminal squamous cell carcinoma or melanoma, it felt devastating.’
Plastic Surgery for skin cancer
Two days later I saw a wonderful plastic surgeon who promptly scheduled surgical procedures to close both wounds during the same operation under general anesthesia as an outpatient. Skin grafts from the nasal area and scalp were used for closure, along with lots and lots of stitches. It was hard to look in the mirror, but each day that passed saw improvements. A week later stitches came out of my nose, but my scalp took another 10 days to heal enough to pull out the stitches. The next week an area on my nose was not cooperating in the healing process and the doctor determined the flap was “dead.” He cut off the dead portion and stitched it up under local anesthesia in the office.
I have one more surgery ahead of me to do some final reconstruction on the nasal area and to cut out a little dead spot on my scalp, and then I’ll be finished with this ordeal going on 10 months and five total surgical procedures. Whew!
And then what? Two new spots that will be biopsied next week. **sigh**
Are you at risk for skin cancer?
The information below outlines the facts about skin cancer. If you are at risk or if you are not, your response should be the same. Know the facts as they relate to you to determine how much of a risk you actually are. Act on that knowledge. Wear sunscreen every time you are outdoors other than walking to and from your car or a building. I actually use a daily moisturizer with SPF and my daily makeup also contains SPF. If I am outside, at the beach, on the water, at a ballpark or amusement park or simply working in my yard, I have on sunscreen with no less than 30 SPF. And, don’t neglect your eyes. Wear sunglasses with UV protection. Better safe than sorry friends.
The risk of basal cell carcinoma is increased by 73 percent if one tans six times per year in high school or college. (Zhang M, Qureshi AA, Geller AC, Frazier L, Hunter DJ, Han J. Use of tanning beds and incidence of skin cancer. J Clin Oncol 2012; 30(14):1588-93)
Basal cell carcinoma is the most common form of skin cancer; an estimated 2.8 million are diagnosed annually in the US. BCCs are rarely fatal, but can be highly disfiguring if allowed to grow. (Rogers, Howard. “Your new study of non-melanoma skin cancers.” Email to The Skin Cancer Foundation. March 31, 2010)
Regular daily use of an SPF 15 or higher sunscreen reduces the risk of developing squamous cell carcinoma by 40 percent and the risk of developing melanoma by 50 percent. (Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinoma of the skin: a randomized controlled trial. Lancet 1999; 354(9180):723-729. Green A, Williams G, Logan V, Strutton G. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol 2011; 29(3):257-263)
Sustaining five or more sunburns in youth increases lifetime melanoma risk by 80 percent. (Wu S, Han J, Laden F, Qureshi AA. Long-term ultraviolet flux, other potential risk factors, and skin cancer risk: a cohort study. Cancer Epidemiol Biomar Prev; 2014. 23(6); 1080-1089)
Indoor tanners have a 69 percent increased risk of early-onset basal cell carcinoma. (Ferrucci LM, Cartmel B, Molinaro AM, Leffell DJ, Bale AE, Mayne ST. Indoor tanning and risk of early-onset basal cell carcinoma. Journal of American Academy of Dermatology. 2011)
Individuals who have used tanning beds 10 or more times in their lives have a 34 percent increased risk of developing melanoma compared to those who have never used tanning beds. (Colantonio S, Bracken MB, Beecker J. The association of indoor tanning and melanoma in adults: systematic review and meta-analysis. J Am Acad Dermatol 2014; 70(5):847-857.e1-118. doi: 10.1016/j.jaad.2013.11.050. Epub 2014 Mar 12)
People who first use a tanning bed before age 35 increase their risk for melanoma by 75 percent. (29.Lazovich D, Vogel RI, Berwick M, Weinstock MA, Anderson KE, Warshaw EM. Indoor tanning and risk of melanoma: a case-control study in a highly-exposed population. Cancer Epidem Biomar Prev 2010 June; 19(6):1557-1568)
For more information, please visit: http://www.skincancer.org/skin-cancer-information/skin-cancer-facts.