Tuesday, November 04, 2014

Skin Cancer

Skin cancer is in the news again, thanks to Hugh Jackman who had his third basal cell carcinoma (BCC) removed within a one-year period.  The photo that Jackman posted along with his announcement convinced me of only one thing:  he's gorgeous even with skin cancer.  I, on the other hand, was not so Hollywood-ready.

"I'm ready for my closeup, Mr. DeFrankenstein."

Last October, while living in Miami, I went to a dermatologist for what I initially thought was either a pimple or an oil deposit due to my wearing reading glasses more frequently while on the computer.  The "pimple" turned out to be a BBC on the right side of my nose.

BCC is the most common form of skin cancer; an estimated 2.8 million are diagnosed annually in the U.S. alone.  BCCs are rarely fatal, but can be highly disfiguring if allowed to grow (do yourself a favor: do NOT look this up on the internet - it will horrify you).  One in five Americans will develop skin cancer in the course of a lifetime, and about 90% of non-melanoma skin cancers are associated with exposure to UV radiation from the sun.  Mine fell into that 90% group.  The tricky thing was that there was no way of telling how long it had been there.  Initially, the dermatologist said that it looked fairly recent and that I caught it in the early stage.  But as she was extracting the cells from my nose, she commented on how deep the roots were, which would suggest it had been there for a longer period of time.

Black dots circle the location.
Another tricky thing about BCCs (they are very tricky, after all) is that they appear, disappear, then reappear in much worse form.  Even between the time I made the initial appointment and met with the doctor, mine began to disappear.  When I went in for my consultation, the dermatologist marked on my nose where the BCC was located, then took a picture of it with my phone so that she would be able to find it again should it disappear completely before I went in for the removal.  It's this disappearing phase that erroneously convinces patients that what they have is more like a pimple and not cancer. During this phase, the cancer is spreading to more cells underneath the skin - growing to then show itself again in a larger and worse physical display.

Day 6 following surgery
Initially I was told by the doctor that as BCCs go, mine was placed in a great location.  She'd be able extract all of it without leaving too much of a scar, and that the little scar that would show would fall into an existing crease already in my nose to minimize it even being seen.  This sounded perfect, but was then hard to believe after I took one look at myself in the mirror.  It wasn't just the stitches, but the swelling and the asymmetry of my nose - more evident in the photo to the left.  I was convinced that my nose would be forever crooked with a big scar.

For a few months, it was all I concentrated on.  Perhaps because in most places in the country, people (friends and strangers alike) would politely ignore a facial deformity of any kind so as not to make you feel uncomfortable or insecure.  Not so Miami.  I was kinda proud of the fact that I went on with my daily life despite looking like Joe Frazier the morning following the "Thrilla in Manila".  Kevin and I went to a showing of Pilobolus two weeks after my surgery and met an acquaintance in the theatre lobby who was very quick to ask if I had run into a door.  After all, the "sexiest place on the planet" is all about being sensitive to people's feelings.

October 4, 2014
It wasn't until I was looking at photos from our wedding that it struck me, and not even immediately.  Almost a month after the fact, that I realized that the scar actually did heal very well and no longer shows up in photos.  Almost one year to the day, the scarring has completely healed and my nose symmetry is right back where it started.  I seriously doubted it would all heal.  But Dr. Barba did a good job, despite my initial fears.  I was a fairly verbal patient and frequently complained about my healing process, despite everyone telling me how good she was and that I was in "great hands".  And while I will never be Hugh Jackman or any other Hollywood-type, I think I look pretty good, all things considered.

All of this is, of course, to tout the importance of sun protection - be it sunscreens, clothing, hats, and even time-monitoring.  Just being aware is the first step.  I can preach it now because I am more cautious about it now.  I sunscreen every day, wear ball caps when necessary, and stand in the shade when possible.  It took some time, but I finally crossed that line between wanting to look healthy vs wanting to be healthy.  There is a difference.  And while there still might be more BCCs that pop up in my future (and Hugh's too), I will be more confident that the process will work, with patience.