I got sunburned as a kid. A lot. The price? Count my surgery scars: One, two, three, four, five…keep going.
By Julie Bain
Ladies Home Journal
My Skin Cancer Story
When I was a kid my favorite place on earth was a crystal-clear lake in northern Minnesota where we visited family friends every summer. My friend Barbie and I were the same age, wore the same cat-eye glasses, and loved Archie comics, the Beatles, and being in the water. We’d wolf down breakfast, then dive into the icy water and scramble onto our blow-up air mattresses to let the sun warm us. We’d have lunch on the dock and beg the older kids to take us out on the speedboat in the afternoons. We’d stay outside all day long, and while Barbie’s skin took on a golden glow, mine would turn hot pink and freckly.
My mom warned me about getting burned. But it wasn’t cool to wear a T-shirt or a hat. And the tanning lotions we had then were designed to enhance your “deep, dark tan,” not keep you from getting one. Whatever protection they offered washed right off in the water anyway. At night we slathered Noxzema on our burns, and when our skin started to peel, we thought that was kind of cool.
By my teen years, having a tan was every girl’s goal, and my summers were less about having fun in the water and more about fitting in on dry land. We would “lay out” for hours coated in baby oil, our hair sprayed with Sun-In in the hopes of transforming ourselves into beach babes. I wanted to look like my older sister. She was tall and tan and young and lovely — the girl from Ipanema. Except she was from Iowa. And all the boys did sigh when she walked by. I knew I couldn’t be tall and blonde like her, but I thought if I could just be tan, not white and splotchy with freckles, the boys would like me, too.
I had no idea how dangerous those sunburns were. But now I know.
My first skin cancer was diagnosed in my mid-20s, when I was living in Dallas. I had to practically bully the doctor to biopsy the crusty, scabby little spot on my left thigh that never seemed to heal. He said it was probably nothing because supposedly I was too young to have skin cancer. But it was a basal cell carcinoma. And it was the first of many.
After that diagnosis I wised up and got out of the sun. Still, the damage had already been done, says Cap Lesesne, MD, a plastic surgeon in New York City who has seen a lot of sun-ravaged faces in his 26 years of practice. “If you fry your skin until you’re 25,” he says, “and then limit your sun exposure after that, the damage will be apparent when you hit your 50s, in the form of wrinkles, dark spots, precancers, and even cancerous lesions.”
But people still love to tan. As a result, cases of skin cancer like mine are up 300 percent since 1994, according to the Skin Cancer Foundation. In fact, there are more new skin cancers each year than cases of breast, prostate, lung, and colon cancer combined.
Even if you were a total sun goddess in your early years, though, it’s never too late to start wearing sunscreen and hats and avoiding the sun, says David Kriegel, MD, director of the Manhattan Center for Dermatology and a member of the LHJ Medical Advisory Board. “The prevention you do, even in midlife, can significantly cut down on the number of skin cancers you’ll get when you’re older.”
Yes, I’ve been a sun avoider for a long time now. I slather SPF 30 moisturizer on my face every morning, rain or shine, winter, spring, summer, and fall. I walk on the shady side of the street, and I’m the queen of fabulous fedoras. I’ve embraced my Scottish-Swedish whiter shade of pale. And yet I keep getting these freakin’ skin cancers!
My tally so far?
1. The one on my thigh, which was taken care of by a simple excision and a Band-Aid. I wish they’d all been that easy.
2. A suspicious spot on the left side of my forehead that appeared in my late 20s. It was a basal cell. A surgeon removed it, and it was deemed to have clear margins.
3. A year or so later the scar tissue on my forehead became inflamed: basal cell again. (Sometimes tumors have hidden deep roots, like a tree, and grow back.) My dermatologist said I should have Mohs micrographic surgery, a special procedure for certain kinds of tumors. I spent all afternoon at a hospital in Dallas while they removed layer after layer from my forehead, analyzing each for cancer cells till I got the all clear. Then they bandaged my quarter-size open wound and I drove to my brother-in-law’s plastic surgery office, where he artistically pulled the whole thing up into my hairline. Ouch!
4. Oops, another basal cell on my left arm (all those years of driving in my red convertible in Dallas?). Simple excision.
5. In my late 30s I moved to New York City, and in 2002, when my dermatologist found a superficial basal cell carcinoma on my chest, we treated it with one of the new chemotherapy creams (Fluorouracil). It took weeks and made an ugly open wound for a while, but eventually it went away without a scar.
6. In 2004 the scar on my left arm developed an angry red spot, and I knew what that probably meant. A biopsy proved it: The tumor had recurred. My derm referred me to Dr. Kriegel, who had been one of the first Mohs surgeons in New York. The fairly big excision left an inch and a half scar across my deltoid.
Are we done yet? Afraid not. A few months ago I had a skin exam with a dermatologist I hadn’t seen before. I asked about a spot on the right side of my scalp, just above the hairline, that had been bugging me. Sometimes it would fall off, like a scab, but it always grew back. She thought it was nothing to worry about, but I wasn’t convinced.
7. I asked Dr. Kriegel to take a look at it. He did a biopsy, and it turned out to be a squamous cell carcinoma, the type that can be a little more dangerous than the basal cell kind. My first, and a bad milestone. Then, a weird coincidence: A few days after I got this diagnosis, a cab driver told me his mother had died of a squamous cell skin cancer that had metastasized. It can happen. Yikes!
Dr. Kriegel recommended that I have Mohs surgery. Since I do occasional TV appearances and was worried about how this was going to affect my face and hair, I decided to go to plastic surgeon Dr. Lesesne for a second opinion (since he’s treated about 3,000 skin cancers), and in the course of his exam he noticed another suspicious spot on my forehead. It just looked like a patch of scaly, dry skin. But I had Dr. Kriegel look at it and he did a biopsy.
8. Yep, it was yet another basal cell. A pretty big one. Damn! Two more Mohs surgeries needed? On my face? What did I do to deserve this? Oh, right.
Maybe, just maybe, since I’ve stayed out of the sun for the past 20 years now, this could be the end of my skin cancer list? Somehow I doubt it.
Skin Tips
Three Things I’ve Learned That You Should Know:
1. Trust your instincts.
If a spot on your skin is changing, doesn’t seem to heal, bleeds sometimes, or is just bugging you, make an appointment with a dermatologist to check it out. It doesn’t matter if it looks nothing like the lesions you see on the skin cancer websites. Mine never did. “I always tell patients that skin cancers don’t read textbooks,” says Dr. Kriegel. “Patients know their skin. There are times when I look at a lesion and it really looks okay to me. But the patient pushes me a little bit, I biopsy it — and it turns out to be a malignancy.”
2. Get a second opinion
I had two new tumors on my forehead and scalp. How big a scar would the surgeries leave? Would they have to shave my hair? My whole head? Would I end up bald and disfigured? A second opinion just seemed like a smart idea. It’s good to find out if there’s a different approach, or to confirm that the approach you’re getting is the right one. Your insurance should cover it, and don’t worry; your doc won’t be offended. “A patient should never feel uncomfortable about getting other advice,” says Dr. Kriegel. “It’s not a slight to the physician; it’s just responsible health care.”
3. Consider a plastic surgeon
I requested that a plastic surgeon sew up the wounds after the Mohs surgeries on my forehead. Mohs surgeons close many of the wounds themselves, but they also work regularly with plastic surgeons, especially when the cancer is on your face.
You may want to see a plastic surgeon if your skin cancer is on the eyelids, near a tear duct, over a motor nerve to the forehead or the mouth, if it involves the lips or requires reconstruction of the nose, says plastic surgeon Dr. Lesesne.
Also, bear in mind that if you’re in your 20s or 30s, your skin isn’t as pliable as when you’re older, says Robert M. Schwarcz, MD, a New York facial cosmetic surgeon who often works with Dr. Kriegel. “The closure may be more complex when the skin doesn’t move as easily, and a plastic surgeon can help.” Ask for a plastic surgeon who does repair for Mohs regularly, he suggests. Otherwise the Mohs surgeon might be the better candidate to close you up. “Many of my Mohs surgery colleagues do unbelievable closures,” he says.
Scary Skin Cancer Facts
Basal cell carcinoma is the most common type of skin cancer, with about 2.8 million diagnosed in the United States each year. It’s rarely fatal but can grow and become disfiguring if not treated.
Squamous cell carcinoma is the second most common form, with about 700,000 cases diagnosed each year, resulting in approximately 2,500 deaths. Between 40 and 50 percent of Americans who live to age 65 will have either of these non-melanoma skin cancers at least once.
Melanoma is the most dangerous type of skin cancer. Cases of melanoma increased 45 percent between 1992 and 2004 and continue to rise, especially among people under age 40. Nearly 124,000 new cases were diagnosed in the United States in 2011. Women under 40 have a higher probability of developing melanoma than any other cancer except breast cancer. The survival rate for patients whose melanoma is detected early, while the tumor is still confined to the epidermis, is about 99 percent. The survival rate falls to 15 percent for those with advanced disease. There were nearly 9,000 deaths from melanoma in 2011. That’s why skin exams and prevention are so important.
The Skin Cancer Foundation educates the public and physicians on all things skin cancer related. For resources on self-exams, diagnosis, treatments, and more, go to www.skincancer.org.
What Is Mohs Surgery?
It’s a specialized surgical technique in which the surgeon removes a layer of cancerous skin and then analyzes it in the lab (while the patient waits) to see if, and where, there are still more cancer cells that need to be removed. Then he repeats this, removing more layers as needed and analyzing each one in the lab till all the cancer is gone with the minimum amount of tissue removed. The whole process can take hours — but it is effective.
“Mohs surgery provides you with the smallest possible scar and the highest cure rate,” says Dr. Kriegel, who is also director of the division of dermatologic and Mohs surgery at Mount Sinai Hospital in New York City. Basal cell or squamous cell tumors that are large, are on your face, or have recurred after previous treatment are often good candidates for Mohs surgery.
