On July 13th I went to a yoga class and came home with basal cell carcinoma.
Well I guess technically the skin cancer probably went to class with me, I just didn't know it.
I was busy trying to impress my boyfriend (aka keep my arm from shaking while side planking), and he was apparently not looking up or down but instead using a spot on my back as his drishti focal point.
We had a conversation like this after class: "hey what's that on your back?" Me: "What? Where? That? That's just a freckle, it's been there forever." "No it hasn't. That's new. Me: "Oh, well then it's probably psoriasis." "It doesn't look like psoriasis." Me: "What are you a doctor? I'm sure it's fine."
And then I forgot all about it, because that's how I roll, and because I'd just had a skin check a few months ago.
The next morning he sent me this text:
That's a hard one to ignore.
So I didn't. I called my doctor and explained what I saw, and was in his office in a gown three days later.
*Hayri is the first name of my dermatologist (Dr. Hayri Sangiray of the Dermatology Center of Richmond), and also my friend's husband.
So if you've never had a full body skin cancer screening, you should (*but maybe not by a friend's husband). Don't get me wrong, he's fantastic. But by 'allover body scan', they mean all. over. body. scan. I was really only there for him to look at the one spot on my back, but he's a professional so before I knew it, he was doing his job. Thoroughly.
But I wasn't ready. I was sitting on the table, kind of slumpy like, as in not using my best yoga posture. Holy stomach rolls I wasn't ready for anyone else to see.
I jumped up, because everything looks better standing up. Even skin cancer.
And that's exactly what he said after he saw it. "Oh yeah, that's definitely skin cancer."
The rest was a blur because at the time I was getting ready to say goodbye to my boy (as I wrote in a previous post):
My dog is failing fast. His legs give out when he least expects it and he hits the floor. Hard. All the carpet runners, pain meds are not enough anymore.
In the midst of this, I have a doctor’s appointment. For a spot on my back I would have happily ignored for years if not for the insistence of someone who arguably has both a healthier knowledge and a heartier fear of cancer than I do. I’m barely listening at the appointment. I’m so used to hearing ‘that’s a barnacle, a mole, a scratch, psoriasis, eczema’…I’m not prepared for “that’s definitely skin cancer” and completely preoccupied thinking about Wags and the decision I know is looming.
I can’t process anything except he’s saying it’s no big deal and asking do I want him to remove it now. Sure; I won’t have the bandwidth to deal with this later. Also, it’s cancer and I want it gone yesterday. It’s over quickly. They tell me not to worry, and I don’t.
A few weeks later I got a phone call with the results. And I started to worry. A little.
Basal cell carcinoma with positive margins, which meant another surgery. We're lucky enough to know the best melanoma oncologist in town. Who said "have Mohs surgery" and gave me a name. That name wasn't in my network, but the 2nd name he suggested was.
And Mohs, Mohs has a 99% cure rate. Where do I sign?
But it wasn't that simple. They saw my labs and said I was a great Mohs surgery candidate because this was a particularly aggressive, infiltrative type. Then they changed their minds after checking my insurance (a bronze high deductible plan). Maybe that wasn't as much a factor as I imagine. I hope not.
Mohs surgery is the best option, especially for skin cancers on sensitive areas like your face or ears. But the skin on your back is tougher and way easier to suture. And let's be honest, would you rather have a scar on your back or your face? Back all day long, right? I agreed, and then somehow became a regular excision surgery patient during my consultation (I'm sill not sure how that happened).
But I didn't love the cavalier attitude about the scar. I heard a couple of things that made me say the infamous 'wait, what?', starting with "I love this girl. She don't care how she looks." Wait, what? Who said I don't care how I look? I mean I know I might not LOOK like I care, but I definitely care. At least a little. And then "that area of your back is what we call the shawl zone. You can just cover it with a shawl." Wait, what? What am I a hundred? Who wears a shawl? Also we live in Richmond, VA where summer lasts 9 months of the year, how is a shawl even a thing here?
And really, I wasn't worried about a scar, I just wanted the 99% cure rate.
I know in the grand scheme of things a basal cell carcinoma is nothing. It's the common cold of cancers. The splinter of broken limbs.
For a pasty Irish girl who spent way, way too much time in the sun, I'm stunned I got off this easily. I grew up in the days when Coppertone SPF 4 was the strongest sunscreen you could buy. And we only used that after we were already sunburned rock lobster red.
On days when we weren't, we used baby oil w/ iodine in it, and when we lived at the beach (again, pasty Irish girl living at the beach - who's idea was this?) we used tanning oil whose bottle read "like a million tiny prisms amplifying the suns rays" and "strictly for the professional tanner." That seemed wise.
But we really didn't know any better way back then. We do now, so if you haven't had a skin cancer check, you should. It should be as routine as your dental cleanings, flu shots and mammograms (and you better be doing all those too). But don't think you'll know skin cancer when you see it.
You probably won't.
Those pictures you see on line and in your dermatologist's office? (do NOT click here unless you want to be completely grossed out). Those tend to be extreme. Mine was small, bigger than the head of a pin, but smaller than a pencil eraser. And it was brown, like a million other freckles I have. Not black, or red, or irregular in size or shape. It looked like an everyday, run of the mill freckle.
Only it wasn't. And if I wasn't pressed to act by someone who cares about me, it would still be growing (rapidly) into my back. I accidentally saw the finished product they dug out (which I totally regret).
It was substantial.
What I could see pre-surgery was a flat round spot somewhere between the size of this popcorn kernel and this Reese's Pieces (I still have leftover Halloween candy). But the hunk of flesh I saw suspended in liquid in a jar on the counter post-surgery, that thing was giant. Longer than my index finger, and way wider/deeper.
A wedge of flesh that made me feel more than a little swimmy. My black and white photo makes it look pretty tame (you're welcome. Also it is really hard to take a picture of your own back), and as far as surgery scars go, it is tame.
The common cold of cancer was kind to me. I did expect it to be a neat tidy little perfectly straight incision. In reality it looks angry and red, a slash across my shoulder blade, like I was in a bar fight.
Admittedly I might have stretched it sooner and farther than I should have (I avoided yoga as long as I could), but there was no way I was getting out of this "check engine light" experience without a mark.
And I'll take it.
At a time when I know far, far too many people diagnosed with cancers of all sorts, my road was an easy one, so I'm embracing my scar. I won't wear a shawl. I might make up a cooler story as to how I got it. I will definitely encourage everyone I know to see a dermatologist every year for a full body scan, to do monthly self checks (here's what to look for) and to know their risk factors: (my answers in sunburn red):
Tanning beds -- your risk increases an insane amount just by doing this once. (yes - sadly I went to college in the 80's when this was a big thing. We were not woke.)
Sunburns - especially if you've had 5 or more (ding)
Have a history of skin cancer (well now that's a check)
Have family members who've had skin cancer (nope. phew.)
Are holy moley -- as in you have lots of moles, especially big ones (oh yeah)
Are the proud owner of freckles. (I'm Irish, so of course I am)
Have lovely fair skin you shouldn't try to tan and when you do it burns or freckles (again, hello Irish people)
Sport light eyes, are a blonds have more fun, a ginger or have light brown tresses (yes, grrrr)
Spend lots of time at high altitudes -- that mean's you skiers. (not really - yay me!)
Hang out in tropical places (I spent all my summers at the beach)
Spend most of your weekdays inside and then get TONS of sun on weekends (uh-oh...we were beach weekend warriors all through our 20's and some of our 30's)
Are outside a lot -- this pretty much applies to anyone who ever played an outdoor sport and/or watches kids play outdoor sports (yep - farm girl, beach girl, walk/run outside girl)
Have an autoimmune disorder (sh#t, so far I'm 11 for 13)
Have a rare genetic you'd-know-it-if-you-had-it condition like XP or nevoid basal cell carcinoma syndrome (this was pretty much a freebie, but no)
Deal with illness(es) that weaken your immune system, (well, I have an autoimmune disorder but it seems like we already counted that)
Are the recipient of a transplanted organ (nope)
Use medications that lower your immune system (most meds for autoimmune disorders do this. Drat.)
Take a prescription whose side effects include making you more sensitive to sunlight (not now, but I was on the pill for YEARS and have had about 8,000 sinus infections that required antibiotics).
Final tally: 14 out of 18.
Not ideal. So I need to be vigilant, especially about those monthly self exams. Here's a great list of what to look for when you do yours (which you're going to start doing from now on, right?)
So along with all the other things you need to talk to your kids about, add this. Remind them (often) to wear sunscreen, keep it handy, seek shade, and avoid the midday sun hours. Talk to them about their risk factors, and make sure they get an annual skin check.
I'm not above adding sunscreen to every care package I send, and it's become a regular in the are-you-taking-good-care-of-yourself line up of questions I ask my college kids. "Did you wear sunscreen?" They hate hearing it, but I hope it sinks in. It's so hard to get them to listen sometimes, isn't it? The struggle is real.
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