— LET INGA TELL YOU:
It’s a cruel twist of fate to be lucky enough to live in the Sunbelt but not be able to go out in it.
After Olof’s four surgeries for in situ melanoma (the less serious form that hasn’t penetrated below the top layers of skin) and my surgery for malignant melanoma (the type that has) we asked our dermatologist where we’d ever be able to go on vacation again. She replied, “Oregon in the winter?”
Both Olof and I are of Northern European extraction, the preferred hosts for skin cancer. When I was growing up, not only were there no effective sunscreen lotions, but girls slathered themselves with a concoction of baby oil and iodine (early self-tanning product) then reflected sun right onto their faces with homemade aluminum foil sun reflectors. (Do not try this at home!) It is no wonder that in addition to malignant melanoma, I’ve had five Mohs* surgeries for squamous cell carcinoma on my face and hands.
Regardless, I still walk on the beach every day, even in summer. But no matter how hot it is, the only part of me that is exposed to the sun might be my fingernails. And usually not those. Bikini-clad teens roll their eyes at me like “What’s the point?” From under the six-inch brim of my sun hat, I try to beam back, “You have no idea what that tan is going to cost you.” I’ve often thought I should get a beige beach-walking burqa made that says “Cautionary Tale” on the back.
The current theory is that melanoma comes from bad sunburns of one’s youth. I certainly had plenty of those. The first warm weekend of spring, usually Memorial Day, I’d get absolutely fried. But if that theory were true, my skin cancers should have been on my back where I got the worst of it, happily snoozing on my stomach in the warm sun after a long East Coast winter. But all my skin cancers have been on my face and forearms.
Now, my theory is that what got me is all those weekend youth soccer and baseball tournaments in places that seem to have some unwritten law that there can be no shade within 100 yards of a youth athletic field. Despite a hat and heavy doses of sunscreen, and sometimes even a shade umbrella, I’d still get cooked on my face and forearms, the only places not covered.
It goes without saying that we have made our dermatologist a wealthy woman. In fact, every time Olof has an appointment with her, he’ll announce, “Well, time to make Dr. X’s Mercedes payment!” But given melanoma’s 100 percent fatality rate if not treated, better that she gets a nice car then we get dead.
Having personally known four people who have died of malignant melanoma, I’ve always been diligent about scheduling skin cancer screenings. So I was genuinely surprised to suddenly see what looked like a slightly raised freckle on my forearm. It didn’t look anything like the grody melanoma pictures you see in doctors’ offices. But it met four of the five markers for melanoma: it was asymmetric, had an irregular border, was a little darker than freckles usually are, and most importantly, it hadn’t been there before.
I called my then-dermatologist immediately. Sorry, they said, first available appointment is five weeks. I couldn’t get in with any other dermatologist any earlier as a new patient. “Everybody thinks they have melanoma,” soothed the receptionist at one.
When I finally did get in five weeks later, my dermatologist wasn’t initially impressed but biopsied it anyway. Eight days later, she called me on a Wednesday night, biopsy results in hand, and said, “You’re having surgery tomorrow.” The chunk they took out of me felt like a full arm-ectomy. “I hope you realize you just saved your own life,” the surgeon assured me. I tell the grandtots that the big Z scar on my forearm was from an altercation with Zorro. That I lost.
Of course, after this surgery, co-workers flocked to my office to consult on suspicious bumps or freckles. “Does this look like melanoma to you?” they’d want to know. I’d review the five classic signs of melanoma with them and then implore them to schedule an appointment with a dermatologist.
It’s been 13 years since that surgery so I’m cautiously optimistic that whatever ultimately does me in is not going to be melanoma. But since May 22 is The National Council on Skin Cancer Prevention’s Don’t Fry Day, it seemed like a good time to mention it. I’m always happy to see that my five young grandchildren are slathered with sunscreen and wearing floppy hats when they’re in the sun.
As for that disfiguring scar? Don’t care. I’m here playing with the grandkids.
*Note: During Mohs surgery, thin layers of cancer-containing skin are progressively removed and examined until only cancer-free tissue remains.
— Inga’s lighthearted looks at life appear regularly in the La Jolla Light. Reach her at email@example.com
— The ABCDEs of Melanoma
Any changes — in size, shape, color or more — can tip you off that you should see your dermatologist. Look for:
A — Asymmetry: Asymmetrical shape mole or growth
B — Borders: Uneven borders (for example, scalloped or notched)
C — Color: More than one color
D — Diameter: Melanomas usually are larger in diameter than the eraser on your pencil tip (¼ inch or 6mm), but they may sometimes be smaller when first detected.
E — Evolving: Common benign moles look the same over time. Be on the alert when a mole starts to evolve or change in any way – or appears where there wasn’t one before.
— Prevention is Key
The Skin Cancer Foundation believes that prevention is the key to reducing skin cancer incidence and recommends the following year-round prevention guidelines:
• Seek the shade, especially between 10 a.m. and 4 p.m.
• Do not burn.
• Avoid tanning and UV tanning booths.
• Cover up with clothing, including a broad-brimmed hat and UV-blocking sunglasses.
• Use a broad spectrum (UVA/UVB) sunscreen with an SPF of 15 or higher every day. For extended outdoor activity, use a water-resistant, broad spectrum (UVA/UVB) sunscreen with an SPF of 30 or higher.
• Apply 1 ounce (2 tablespoons) of sunscreen to your entire body 30 minutes before going outside. Reapply every two hours or immediately after swimming or excessive sweating.
• Keep newborns out of the sun. Sunscreens should be used on babies over the age of six months.
• Examine your skin head-to-toe every month.
• See your physician every year for a professional skin exam.
Source: The Skin Cancer Foundation, skincancer.org