Lessons from a diagnosis of skin cancer

Lessons from a diagnosis of skin cancerI have been diagnosed with skin cancer.

There really isn’t much special about that, since it is a distinction I share with over 2 million Americans who have a skin cancer removed every year. Fortunately, for most, it is a cancer that is not of particular concern since most can be removed. But even those “simple” surgeries–as I have learned from my own experience–can be a bit problematic.

Occasionally it helps to find some humor in difficult situations, and this is one of those times. And since I am generally pretty open about what goes on in my aging body–in an effort to help others understand that they are not alone on some of these issues–I have to hold myself out as an example of what NOT to do when it comes to taking care of yourself.

You see, I am supposed to know this stuff about skin cancer. I know the risks, I know how to prevent it, I know what it looks like, and I know what we are supposed to do when we see a suspicious lesion. Not only do I know these things, I talk and write about them frequently. I am supposed to have a certain level of expertise about skin cancer. In fact, this very month if you happen to be in a doctor’s office and they have a closed circuit program from CNN’s Accent Health, you will see my smiling face telling you what you need to know about skin cancer.

And if you look closely at my chin in that segment, you will see the little nodule on the left hand side that I chose to ignore–until some friends of mine would not let me ignore it any longer.

This little bugger showed up about a year ago, and I thought it was related to an inflammatory skin condition that I had developed about the same time (which interestingly resolved the minute the darn thing was removed. Don’t ask me why, I just know it happened). It got larger and smaller, and if I shaved over it, it bled.

So let’s see: a new lesion that didn’t go away despite my best efforts. Something that continued to get irritated and would bleed. Maybe even getting a little larger over time. Looked just like the pictures they show you as a doctor, which suggests a basal cell carcinoma. So, Dr. Len, what was your first clue?

Maybe I was just a bit too busy. Maybe I had seen enough of doctors and hospitals over the past year. Maybe my problems with wound healing from my prior surgeries gave me pause. Maybe one of my wonderful colleagues had written a paper that skin cancers were less common in people who took the same type of blood pressure medicine that I take. Maybe, maybe, maybe…

Fortunately, I have friends who know a thing or two about skin cancer. And as luck would have it, I was at a meeting a couple of weeks ago that was also attended by some of them; dermatologists and experts in removing skin cancer with Moh’s surgery. While I sat at a committee table deliberating what I thought were some important issues at this meeting, I got a tap on the shoulder from one of those friends, who motioned me outside. I was greeted by a group of five dermatologists who pointed and wagged their fingers at me and said, essentially, that the thing had to come off. In short, I had become the focus of their intervention.

Of course I told them I would get it taken care of. But they are my friends, and they know me. So they took it upon themselves to contact one of their colleagues who called me that Monday evening and had me in her operating chair the next morning. And off it came: a nice sized basal cell with a hole in my chin that was artfully sewn up.

So there I was, Mr. Dr. Expert, with a big bandage on my face. But the cancer was gone, the margins were clean (that’s one of the advantages of Moh’s surgery: you know on the spot with frozen sections if they get all of the cancer removed). I did have some minor issues with the incision later in the week, but those got taken care of. The stitches are out, the scar will heal/shrink, and my face looks the same as it always did–well, no worse anyway.

And the real irony of all this? One week later I was standing in the halls of Congress in Washington with some of those very same colleagues welcoming members of Congress and their staffs to a presentation on the importance of–you guessed it–finding skin cancer early and sun safe behavior! There I was, with a nice fat bandage on my face. You can’t dream some of this up.

Like many of you, I always try to understand what happens to me when it comes to my health–or perhaps I should say “unhealth.” But there was no secret here: I grew up in an era where sunscreen just didn’t exist. And as a young man I worked summers as a swimming teacher/lifeguard at a camp, where the goal was to get burned early and as tan as possible to “protect” myself from the sun. Word to the wise: that’s a myth.

This is not to say that I don’t take safe sun behaviors seriously now–as I have for a number of decades. I use sunscreen regularly, wear a wide brimmed hat, and seek the shade when at the beach or some other sunny place. I certainly don’t burn and I don’t tan either (I can’t imagine what would happen if I came back to work from vacation and had a sunburn. Probably the same thing that would happen if I was found smoking a cigar!). But the damage had been done a long time ago, when I was young–and that’s a message all of us should heed, kids, teens, and parents alike.

So I will take my experience and hopefully be the better and the healthier for it. I will continue to educate and cajole about being safe in the sun.

Listen to the warnings, be safe in the sun, and get your health professional to examine any suspicious lesions–especially those that change. You don’t want to follow in my footsteps on this one, my friends. You can easily be smarter than me when it comes to taking care of yourself and your skin. My lessons come with a new vigor, a new commitment–and a new scar to show for it.

J. Leonard Lichtenfeld is deputy chief medical officer, American Cancer Society. He blogs at Dr. Len’s Cancer Blog.

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  • Ian Katz

    As someone observing from Australia which has a huge issue with skin cancers, I can not see the necessity for specialist and the Mohs surgery for the management of most skin cancers. In Australia, most BCC’s and SCC’s (>80%) are managed easily and efficiently by family physicians/GP. This does not have to be specialist care and certainly not Mohs in the vast majority of cases, even melanoma in situ. This is a huge waste of money.

    • Charles D Rosenberg

      With all due respect, this comment from my colleague in Australia is preposterous and dangerous; I have had the opportunity (as a Mohs surgeon) to clean up incredibly mismanaged tumors which have, not infrequently begun with a FP out of his depth. My job then becomes both eradicating the tumor AND not letting on to the patient how poorly served he was by his PCP. For starters, I removed and repaired a BCCA defect today of 12 sq in on the neck…a local PCP had “successfully’ removed it 6 years ago. Moreover,even when it was obvious it had recurred, he was told repeatedly not to worry about it.

      Yes, without a doubt there is a problem with overutilization of sophisticated techniques in my field for what should be straightforward tumors; our organization is addressing that with strict guidelines and reimbursement recommendations.

      • Ian Katz

        My Mohs colleague says my comment is preposterous and dangerous and then totally agrees with me by saying there is a problem with overutilization of sophisticated techniques.

        It’s all about training FP – there has been a huge effort in the last 20 years to train GP/FP in Australia to manage the vast majority of skin cancers and the same should happen in the USA.

        Most BCC’s on the neck, even 12 sq in, do not need Mohs. Was the patient offered staged excisions (very simple and easy to do), Aldara, or PDT. Even superficial BCC that go to margins on histology very rarely recur due to the tissue healing response as long as the clinical lesion is fully excised

  • meyati

    I agree with Ian. A little intellectual curiosity would be way more valuable. I had my stage one atypical BCC for almost 30 years. It looked like a little pimple -doctors said that maybe it was a cyst. Mine never bled. My current doctor had it removed. By then it was stage 2. Before the stitches could be removed, new tumors popped up. The rescission was horrible because the surgeon cut out hunks of my nose and part of my lip. I sent in an article-I consider the lack of curiosity a part of gender discrimination. They said that I wanted a perfect blemish free face. My brother is a marine-and he is at stage one, because nobody talked about his vanity or beauty-and cut them out. Nobody believes that atypical BCC is often treated by removing the underlying bone, as BCC is one of the more brutal bone drillers. I don’t understand it, but about 50% of the medical staff I meet treat me with anger because when they ask what the recommended treatment is-removal of the bone in my right upper sinus, the eye, the nose, and right cheek bone. The nurse navigator that was supposed to help me, walked off, saying-Face transplant, face transplant. I live in New Mexico-where desperate women have driven into an ER parking lot and removed their own leaking breast implants or whatever. I should have done that at least 10 years ago-removed the thing with a buck knife. Instead I opted to sit naked in front of strangers-dermatology residents and let them exam me. One male student asked why they couldn’t remove this thing under my nose. One female resident backed him up that if nobody was sure what it was-they should see. They received the woman’s vanity lecture. They didn’t have sun block when I was young-not really until the late 1980s. I didn’t do anything wrong. I don’t smoke, I don’t drink, I ate healthy food, had lots of exercise, wore a hat.

  • Constellation

    Thank you so much for sharing this. It MATTERS.

  • Sam DeReign

    Like you, I rarely wore sunscreen as a child. I would spend hours at the pool or waterslide and come home with paralyzing burns. My skin would itch so terribly that I would wake up in twitching fits. In my mind, burning was just a normal part of life. It never occurred to me that the skin is an incredibly important organ – not to mention the largest – and it needs just as much love as what’s on the inside. Today at 27, I’ve undergone five biopsies and had three dysplastic nevi removed. I go to the dermatologist every 6-12 months for a routine exam. I think my derm is a little biopsy-happy, but I suppose I’d rather have anything suspicious cut off me now than worrying about it later. I would encourage everyone to have an annual skin exam just for peace of mind, especially if you have fair skin. At the very least, have a loved one check your back and scalp. Also, don’t forget your nail beds and soles of your feet. Skin cancer is easily detectable and preventable as long as you don’t ignore the warning signs!

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