Wednesday, May 1, 2019

Love Your Skin (Skin Cancer Awareness Month)

I hope you'll forgive this break from the dirty stories for a public service announcement. I promise I won't make a habit of it. Since it's Skin Cancer Awareness Month, I thought it was a good time to come clean about something.

I'm normally a very private person and I don't usually talk about my trials and tribulations—actually, I go a long way to avoid it. However, if sharing my experience helps someone, any discomfort I feel will have been worth it.

Skin, in all its glorious shades, is sexy. Skin cancer isn't. I know firsthand, because last fall I was diagnosed with basal cell carcinoma (BCC) on the right cheek of my face. On the bright side, if you have to get skin cancer, this is definitely the kind you want. It's generally localized to the spot where it occurs, doesn't spread, and is highly treatable.

For most of my life, I've had a mole on my right cheek. Truth be told, I have moles everywhere. The vast majority are flat and just look like a large freckle. This one was the same shade as my normal skin tone and about the diameter of an eraser head, but somewhat flat like a coin. It hadn't ever been all that noticeable.

Over the last year or so, I noticed it had gotten significantly larger, more amorphous is shape, and several shades pinker than my normal skin tone. I decided to have it checked out and asked my primary care physician about it. He referred me to a dermatologist.

Even though I knew something wasn't right about the mole, I really didn't think it was skin cancer. I had this misconception that skin cancer was dark in color—brown or black—and this was pink.

My biggest concern was that it had become rather unsightly and I was wondering how much it would cost to have it removed, because I didn't think my insurance would cover any part of a purely cosmetic procedure. This definitely goes in the "be careful what you wish for" category.

The dermatologist took one look at it and said, "Oh yeah, that's got to come off."

Initially, I was quite pleased. She was going to remove it without me trying to convince her it was medically necessary. Yeah, there might be a bit of a scar, but it couldn't look as bad as the mole.

Right there in her office, on my first visit, she performed a shave biopsy, where she basically sliced off the entire mole from the top layer of my skin. First, she had to inject the mole several times with a numbing agent, which wasn't a big deal. It just felt like a few pin pricks.

I didn't feel her cutting off the mole at all. There was quite a bit of bleeding, though, and she had to cauterize the wound. Again, I didn't feel this, but I did smell it. A squeamish person may have had a problem with it. Thankfully, it didn't bother me.

I left the dermatologist's office with instructions to wash the wound with mild soap and water, coat it in petroleum jelly, and change the bandage daily. Honestly, I felt pretty good about the whole thing. I did wonder how sore my face was going to be after the numbing agent wore off, but it was practically pain free.

The biggest problem I had was finding the right size bandage to cover the wound. Then I had a problem with the bandage adhesive, which I'm apparently sensitive to. It irritated my skin so much I had to stop using them, but I kept the wound clean and coated in petroleum jelly.

For a week, I went about business as usual, then I got a call from a guy at the dermatologist's office. He told me that the biopsy showed it was basal cell carcinoma.

I didn't know what that was at that point, so naturally I asked, "What does that mean?"

He said, "It's skin cancer. We have to make an appointment for you to come back."

Somehow, I held it together long enough to make a follow-up appointment. I'm not going to lie, after I hung up, I kind of fell apart. Like I am most of the time, I was in front of my computer, so I immediately Googled "basal cell carcinoma."

I calmed down a bit as I read, but I slowly came to grips with the fact that it meant there was probably going to be more cutting into my face. I also saw that my fair skin and green eyes placed me in the highest risk group for this type of skin cancer. I had a pretty good pity party going on for a couple days.

The wound from the biopsy had just barely healed by the time I went back to the dermatologist and met with the surgeon. He's actually the husband of the dermatologist who removed my mole. They have a practice together. Isn't that sweet? I'm being serious, not sarcastic, I promise.

He told me that what they usually do in cases like mine is cut out a certain amount of healthy tissue around the BBC, then elongate the incision so they can close the wound. For me, that meant a pretty wide area and therefore a pretty long incision. He actually drew on my face with a marker so I could see what it would look like.

Again, as I looked in the mirror, I managed to stoically absorb the fact that I'd have a fairly long scar down the side of my face, about two and a half inches long. That was kind of a small miracle, because usually I tear up quite easily when I'm upset—which is really annoying when I'm angry. I know it was vain and it could have been something so much worse, but I wasn't thrilled about the idea of having a long scar on my face.

The surgeon, who is a very affable guy, was jovially confounded that I didn't have any wrinkles in which to conceal the scar. How's that for irony? He must have not relished the idea of mutilating my face, because he did something very un-surgeon-like and offered a nonsurgical option that would be just as effective—radiation treatment.

I thought, aloud, "Great. Radiation sickness. Hair loss." How much did I really not want a huge scar on my face?

But then he explained that it would be radiation localized to the area on my cheek where the BCC was. He said there might be some skin irritation and hair loss at the site, but I should otherwise be okay. However, it meant about twenty-five daily treatments. I agreed to have a consultation with a radiation oncologist, so I guess that was how badly I didn't want a big scar on my face.

The earliest appointment I could get with the radiation oncologist was coincidentally on election day, when the future of our health care system hung in the balance. Luckily, I'd voted early.

One of the first questions the radiation oncologist asked me was if I spent a lot of time in the sun. I said that I didn't. I'm a writer and spend most of my time inside on my computer.

Then he asked me if I went to tanning salons. The answer to that should have been plainly obvious by the paleness of my skin. But again, I told him that I'd never been to a tanning salon, which is true.

I'll admit, in my teens, I did lie out a few times and try to get the perfect tan. I was in Miami with all the beautifully tanned people and my complexion leaned more towards my mother's pale German/Irish coloring. Thankfully, I get bored easily and didn't have much patience for sitting around baking in the sun.

I have had a few bad sunburns in my lifetime—completely by accident. I'll also admit that I wasn't conscientious at all about wearing sunscreen. I rode around in a convertible throughout my twenties without any real sun protection. Also, I was in a couple marching bands, marching around in the hot summer sun. I may have worn a hat, but I don't remember using sunscreen.

As I got older, I became more appreciative of my pale complexion and more mindful about wearing sunscreen. But I wasn't as diligent about it as I should have been.

Anyway, the radiation oncologist thought I was a good candidate of radiation therapy. Since I was younger than most of his patients, he thought I should have a lower dose of radiation over a longer period of time. That worked out to be thirty-six treatments.

He also said there was an infinitesimal chance that, years down the line, I might develop another type of cancer at the site that could spread elsewhere in my body. But that the chances were worse than winning the lottery. More like losing the lottery, if you ask me. Regardless, I agreed to start treatment as soon as possible.

To be honest, I had another little pity party on the car ride home, because this isn't the first monkey wrench the universe has thrown at me—not by a long shot. At some point you need to shout into the ether, "What the fuck?!" I mean, I must have been a horribly vain and selfish creature in a previous life, because I'm certainly learning humility in this one.

A couple of days later, I went to the facility where I'd receive my treatments, so they could map the treatment area. That meant lying down on a table beneath the machine that would deliver the radiation, so they could draw on my face some more and take measurements that would go to physicists who'd calculate the proper settings for the machine.

The following Monday, my treatments started. It's rather humbling going to a place called The Cancer Care Center every day and seeing people who are clearly in much worse shape than you. I'll also say that everyone I dealt with there, all the technicians and staff, were exceedingly friendly and did everything they could to make the process as easy as possible.

The treatments themselves where rather uneventful. They only lasted thirty seconds, but there was the drive there, the drive back, and waiting around for the treatment. All told, it was about two hours out of my morning Monday through Friday—with some minor adjustments in the schedule for Thanksgiving and Christmas.

In the treatment room, I had to lie down on a metal table, turn my head so the cheek with the BCC was facing up, and they taped my head down—mostly, so I remembered not to move, I think. Then they brought the machine down close to my face and placed a pad on my cheek to limit the depth of the radiation. Once that was all set up, they left the room and the machine made a lot of noise for thirty seconds. I didn't feel a thing. There was absolutely no pain. Afterwards, they came in and released me.

After the first treatment, the technician told me I'd have to cover my face whenever I went outside. I couldn't use sunscreen or any other products on my face, because it might irritate my skin. I was only allowed to wash my face with unscented soap. She recommended that I get a big floppy sunhat.

So, I went to the nearest Walmart, thinking I'd find a sunhat in their accessories department. There was nothing! All they had were knit hats and scarves. There were a few of those little girly baseball hats that wouldn't work at all. They didn't even have bandannas large enough that I could use as kerchief.

Thinking I was missing something, I approached a woman near the handbags with her two little boys and asked her if they kept the sunhats somewhere else. She said no. Apparently, even in Florida, by November they'd switched out all their summer stuff for winter-ware. There are maybe two days a year that it's cold enough to wear knit hats and scarves. And then people would laugh their asses off if they saw you dressed like Nanook of the North.

She agreed that it was stupid and kindly suggested a couple other stores I might try. However, I wasn't in the mood to go all over Timbuktu looking for a sunhat, so I went home and found the perfect thing on Amazon. Two days later, I had a sunhat. Say what you want about Amazon, but it's damn convenient sometimes.

Every week, I had a check-up with the radiation oncologist after my treatment on Thursday to monitor my progress. There was no noticeable difference the first couple of weeks, then my cheek started getting pink. They gave me something called Aquaphor, which is basically petroleum jelly, to put on my cheek after every treatment to try to reduce the irritation. However, I had to make sure my face was clean before the treatment or it might interfere with it.

My cheek got pinker and pinker until it was a bright scarlet red. Even though it looked like someone had punched me pretty hard in the cheek, it didn't really hurt at all. It made my father a bit uncomfortable whenever he went out with me in public, because he was afraid people would think he'd smacked me around. I told him that if anyone said anything, I'd tell them the truth.

Still, when we went to see the Nutcracker ballet—one of his favorite things—in early December, I cheated a little and tried using cover-up on my cheek. It didn't work very well. It just looked like I was trying to hide that someone had beaten me up.

By the time I went with my father, my aunt, and my uncle to see the Aquaman movie, my skin had become so chapped that it broke open. I didn't want to risk getting an infection on top of everything else, so I didn't try to use makeup. Thankfully, no one asked what had happened to my face.

I debated showing pictures and decided to go ahead a do it. If anyone else has to go through radiation treatment for skin cancer, they might want to know what it can look like and how it can heal. I'll warn you, the first one isn't pretty. As bad as it looks, there wasn't much pain. The skin was just a little sore. I didn't think to take a picture of the mole before it was removed. The dermatologist did, but I'm not asking her for a copy.

Last day of radiation treatment.
Four months later.

I had my last treatment on December 28th. I kept up the regime of washing my face with unscented soap and applying the petroleum jelly, and the skin gradually healed until I just have a faint mark on my cheek.

I'm happy to report that at my three-month check up with the radiation oncologist, he was pleased with the way the treatment site looks. Hopefully, I'll never have to see him again. However, regular skin cancer screenings with the dermatologist are now part of my life.

The point of this long story is for me to implore you to wear sunscreen whenever you go outside during the day. Always. Especially if you're fair-skinned, have blond or red hair, and/or have blue, green, or grey eyes. It may not stop you from getting skin cancer, but it sure can't hurt and it just might prevent it.

I know it's a hassle. Trust me, I made all the excuses. I didn't want to take the time. I didn't like the heavy, greasy feeling on my skin. Let me tell you, it's a much greater hassle going to daily radiation treatments. And having to put petroleum jelly on badly chapped skin feels much worse than sunscreen.

Don't be like me. Love your skin before it's too late and use sunscreen. Just make it a part of your daily routine. And if you do notice any unusual growth or if a mole changes in appearance, get it checked out immediately. The earlier you catch these things, the better. Regular skin cancer screenings with a dermatologist are also a great idea.

All the best,

Ria :)
Twitter: @RiaRestrepo


  1. Fair skinned and green eye here, I slap on suncream the minute I feel heat in the sunshine. I'm glad your treatment went well. Thanks for sharing.

  2. I am fair skinned, and have hazel eyes, which lean more to brown, but my body is covered in freckles and moles. My mom had skin cancer, and I can't tell you how many times I wondered if it would be wise to go to a dermatologist and have my entire body checked. Thank you for sharing this. I think it's important to share these experiences to make others aware.

    Rebel xox

    1. Thank you. Yes, getting a skin cancer screening definitely can't hurt--especially for us fair-skinned, moley people. :)

  3. Hi Ria thanks for sharing this. It must have been a big shock to find you had the BCC, but it looks like the treatment worked well. Your description of radiotherapy is just the same for mine (for breast cancer). Fingers crossed this is your last encounter with cancer xx

    1. Yes, thankfully, it did turn out well. I hope your breast cancer treatment was just as successful. Take care! :)

  4. A very precise and thorough report Ria. I have had three operations for the removal of skin cancer in recent years and reading this has been a great help to me. The last occasion, which was on my back was in February. The other two 'incisions' as the hospital likes to call them were on my cheeks. A sort of matching pair. I never had a mole just an ordinary spot which never went away and then gradually the skin changed around them as you so accurately described. My first scar on my cheek was rather large and took a while to heal. I eventually requested having some injections which helped the healing process as well as rubbing in some cream for weeks and weeks. In England things take a long time to happen. You go to your GP who then writes to the hospital saying you should be seen by a specialist. After about three months you see the specialist who then arranges a date for the operation. This is all free of course on the NHS, National Health Service. The well off and rich can go private. The first time I went they took a biopsy and photographs but since then they must have improved their ability to spot a basal cell carcinoma because a quick look seemed to be enough to recognise it.
    The one on my back was just an itch and then one day my wife said 'you ought to have that looked at.' I'm glad I did. Like you I was never a sun worshipper but I do remember as a boy not putting on sunscreen or wearing a hat. I only think I suffered from sun burn twice back in the 1960s. I am 66 now. I've been wearing a summer hat for years and putting on suncream for at least the least thirty years. Sorry for rambling on a bit.

    1. Unfortunately, it seems some people are more susceptible to it than others. I'm sorry to hear about all your troubles with it. Take care! :)

  5. Thanks Ria. You take care too.