Skin Cancer Up Close and Personal

By Susan Rutter

Ahh! Fun times in the summer sun!!! Summer and vacation means spending time outdoors in the pool, at the beach, playing tennis, golf, swimming and much more.

However, there is a huge downside to spending all that time in the sun. SKIN CANCER. I speak from experience and have a happy ending but my story could have ended very badly.

I grew up living in the country with a love of the outdoors and sports. Along with my two sisters I spent many hours a day outside riding horses, playing basketball and swimming in the many lakes that were near our childhood home.

This was way before any of us had heard of SPF anything. Forget #45. Where were numbers one, two or three? We did not have sunscreen or even zinc oxide. As a young child I would have welcomed zinc oxide as it is kind of like face paint for a carnival clown.

Needless to say I spent many, many hours, skin unprotected, frying and burning in the sun. This resulted in bright red skin and huge water blisters and a feverish feeling late at night. Followed days later by pealing and itching, layers and layers of skin falling away. Not fun and not a pretty picture. My mother tried her best to keep me in a hat and long sleeves but enough said.

Fast forward to my college years where I continued my love of sun and sports. I majored in Physical Education and became an Elementary P. E. teacher. In my early years of teaching few elementary schools had gymnasiums. Consequently, I continued to spend year after year outdoors, teaching, coaching track and playing sports recreationally.

One tricky thing about sunburn is that you cannot always see it happening and hours later, when it is much too late to prevent, you see the bright red results of a day in the sun. The same thing is true with skin cancer. You do notsee it happening at the time your skin is baking, blistering and pealing, but years and years later the result becomes apparent.

My trouble spot originated just above my upper lip, slightly left of center. One morning as I applied my makeup I noticed a small red spot. Due to the fact that it did not hurt and more importantly, I was able to cover it with makeup, I ignored the problem. Over time, the spot became crusty but I used concealer to hide it and continued to ignore it. The spot became increasingly difficult to hide and it began to bleed. At that point I made an appointment with a dermatologist.

With just a quick look, before any test or a biopsy, the doctor was sure it was cancer. He had obviously seen many cases before. To be certain, a biopsy was performed and the diagnosis was basal cell carcinoma, which is the most common type of skin cancer. Melanoma is less common, but more dangerous because advanced melanomas have the ability to spread. If not found early, the cancer cells can spread through the bloodstream and lymphatic system to form tumors in other parts of the body.

Basal cell carcinoma begins as a single point in the upper layer of the skin and slowly enlarges, spreading both along the surface and downward. The tumor often extends beyond what is visible. Although basal cell carcinoma can be locally destructive, it is extremely rare for it to matastasize.

Just days after my biopsy results I underwent a specialized procedure for the removal of skin cancers called the Mohs Micrographic Surgery. The procedure is named after the originator of the technique, Dr. Frederick Mohs.

The surgery begins with an injection to numb the area. This was the most painful part of the procedure as the upper lip is an extremely sensitive area. The visible portion of the tumor is removed and a thin layer of tissue is taken from the surrounding skin. The removed tissue is mapped and sectioned and microscopic slides are made. At this point in the procedure I was bandaged and returned to the waiting room while the slides were examined.

Looking around the room I saw a lady with a bandage on her neck, another lady bandaged on the lower arm and a gentleman with a large bandage on his nose. It was certaintly evident that day that skin cancer is the most common malignant cancer in humans.

Under the microscope, the deep and peripheral margins are examined. If examination reveals the presence of additional tumor the process is repeated until no tumor is found. I went back in for more tissue to be removed, was re-bandaged, and returned to the waiting room once again. After the second surgical stage my margins were found clear.

I was fortunate that the cancer had not spread to the inside of my lip. But, due to the size of the area that had to be removed, I was scheduled for reconstructive surgery with Dr. Rubinstein, a facial plastic surgeon, the following day. That evening I removed the bandage, just to take a peek, and what I saw was a hole the size of a nickel. I did not show the wound to my husband for fear he would faint.

The next morning Dr. Rubinstein performed his magic by stretching the skin on my cheek to cover the nickel sized hole. The facial skin is the same texture and a better color match than using tissue from behind the ear which has a more waxy texture.

With a rather large bandage that could not be missed due to the location, I returned to work. Healing progressed quickly but my first follow up visit revealed a problem. After the surgery, Dr. Rubinstein had sent a sliver of tissue to the lab for evaluation. This is not routine but for some reason he decided to do so. Thank you Dr. Rubinstein!

The lab test revealed cancerous tissue was still evident. The Mohs procedure was not totally successful. So it was back to the dermatologist for more slicing and dicing. At this point the cutting was extremely close to the lip, but again, the painful part was the numbing injections. With a small incision in the shape of a banana the tissue was removed and again I was off to the surgical center for a repeat performance by Dr. Rubinstein, my hero.

The most difficult part of the next two weeks was not being able to play tennis due to sweating into the wound. In no time, the stitches were removed and I was back to my routine. I treated the area with a cream to reduce scaring.

Six years later the scar is not that noticeable and for the most part I forget about it completely. But, what I do not forget to do is use sunscreen, Shade #45, check my skin regularly and I see my dermatologist at least twice a year and more often if I see anything unusual develop.


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