A pale pink, half-moon shaped scar sits above my left breast as a reminder of my youth spent at Jones Beach with more baby oil than sunscreen, doing more baking than bathing. My scar is from having MOHS micrographic surgery, after basal cell carcinoma was found in a biopsy of a mole.
Basal cell carcinoma is one of several types of nonmelanoma skin cancers, which are the most common forms of skin cancer in the United States. According to a study in the "Archives of
Dermatology", as of 2006, there have been 3.5 million cases a year in 2 million American people.
Pick the First One
When I received my diagnosis, my dermatologist (and the office manager and secretary) went
out of their way to reassure me that the type of carcinoma I had was not bad, easy to treat, and not to worry. So I spent hours pouring over internet articles until I felt that, should the need arise, I could diagnose and remove several moles; at least I learned about three
groupings of skin cancers, which include:
- Basal cell carcinoma is a nonmelanoma type that develops in the lowest layer of the epidermis (the top-most level of your skin), can be raised or flat, look pink or
red, and have a pearl-like sheen. These pop up in areas that get the
most sun exposure, like your head and neck. Basal cell carcinoma grows
slowly and is not likely to spread to the lymphatic system or other
remote body parts; though it can spread to the bone and nearby tissue if
left untreated for a long time.
- Squamous cell carcinoma is a nonmelanoma type that affects the flat, scale-like cells that are higher up in the epidermis. This type is most common in the sun-exposed body part—the head, neck, eyelids, ears—just like basal cell carcinoma. Unlike basal cell carcinoma, this type of cancer can spread to other parts of the body.
- Melanoma refers to a skin tumor that can be benign like a mole or a life-threatening malignant tumor. It forms in the pigment-making cells in the lower epidermis and can spread anywhere on the body. Melanoma is far more serious than the basal cell carcinoma I was diagnosed with, and I would not detract from it by discussing it here without neither having (very gratefully) never experienced it nor conducted significant research to write about it. You can read more at the American Cancer Society website.
It is posited that all this nonmelanoma skin cancer is due to an increase of people joining our "leisure society”—all our technology has gotten us out of the office and kitchen and onto beach, or tanning salon. While skin cancers used to be most prevalent in the fifty-and-over group, more
people under 40 are being diagnosed at this time. However, these things take time. It is likely that the cancer I was diagnosed got its start a couple of decades ago.
At 14 I was Shapash (the Phoenician sun goddess), and would have donned tin foil to achieve a deeper and darker skin had it not taken up so much space in my beach tote. Now I own
sunscreen with numbers higher than 50, wear rash guards at the beach, and possess an array of 1950's-style wide-brimmed hats.
I am someone who takes just about everything personally, and was very angry about my skin cancer until I learned that there are many factors that can put anyone at risk such as being fair skinned, spending lots of time in the sun, UV exposure from tanning booths, and radiation (in
treating other forms of cancer).
Fix It But Don’t Forget It
I started getting my “beauty marks” examined in my mid thirties—around the time when they stopped being ‘cute freckles’ and started to appear more dark in color and appear in more unusual places, like the bottom of my feet. I learned the term mole when I had one removed and examines a couple of years ago and when the results came back normal, I assumed all
mole removals would go that way: One less mark on my skin, a week of a red mark from the laser and back to my life.
That’s why when I got the message from my dermatologist’s office, while on a tennis vacation
in Sarasota, Florida (yes, I see the irony), I mad a note to call back when I got home and did not give it another thought.
When my dermatologist told me the results of the biopsy, I wanted it taken out of my body right then and there, and was willing to help her do it. I was given an appointment for MOHS surgery, an in-office procedure, for the following month. Other treatments include curettage and desiccation, radiation, Cryosurgery, and creams that attack cancer cells or improve
immune cell growth.
MOHS micrographic surgery is the most effective treatment (a 98% cure rate), where the surgeon carefully removes a small piece of the tumor and examines it under a microscope
and then painstakingly repeats this (cutting and microscopic examination) until all of the basal cell carcinoma is accurately located and removed. This eliminates the guess work about how far and wide to extract cells, ensuring that very little of the healthy tissue will be removed and scarring is minimal.
My husband went with me the day of the surgery, not only for moral support, but also because I
am notorious at “skipping out” on important things that scare me or that I do not like to do. My surgeon, a lovely, petite Asian woman around my age, explained everything that was going to happen and then numbed the left area of my chest. She then drew a circle around the area with a marker and began dig and root around in the area on top of my breast. At least it felt like digging. My chest was truly numb but the surrounding area interpreted her movements like a gardener taking a trowel to dry soil. I couldn’t really see what she was going, mostly due to the
dentist-office-like light glaring towards my chin; but really, would you want to look?
She then covered it up with surgical bandage and tape and told me take a walk and grab a coffee with my husband while she examined it, and then would know if she would need to remove more. It was a beautifully sunny and warm September morning, and we strolled
around Bay Ridge Brooklyn chatting about the small things in life and in a marriage that make avoiding the bigger things wonderful: We should get the oil changed in the car soon, how much nicer the laundry smelled now that we switched detergents, how beautiful some of the gardens were that we passed and I really want to plant more on our balcony this Spring.
When we returned, I was told she had to remove a little more and then I was done. We went back to the office, she completed her work, sewed me up and sent me home with some basic instructions like keeping the area dry and wear a sports bra 24 by 7 for a few weeks to
help prevent scarring (her theory being the weight of my breast would drag the chest tissue down). I am a good patient and have healed nicely, though I was convinced something was wrong when months afterward I could still feel a twinge in the area and my body reject the soluble stitches.
Basal cell carcinomas like to make return appearances, often in the same place. Statistics show that as many as half the people diagnosed with basal cell carcinoma can expect another
occurrence somewhere else on their skin within five years.
I no longer lie at the beach pretending to achieve a golden hue (I always went from shades of lobster to medium rare and right back to pale anyway). I still play tennis obsessively, and snorkel at any opportunity given. I also don all the creams and clothes necessary to make sure
that I can do both of these activities for as long as possible and do them with as much of my skin in tact.