In Dallas, where I grew up, it’s warm most of the year, and my family was the kind that lived outdoors—hiking, camping, playing soccer, going to the beach. Back in the seventies, few people paid much attention to the risks of sun exposure. Even when I was in my 20s, it was still the thing to be tan. But by then we were more aware of the dangers of skin cancer, so my friends and I took what we (mistakenly!) considered to be a precaution—we went to tanning parlors. After we’d achieved our “base tans,” we would lie by the pool for hours and get darker and darker. I didn’t think about it much, but in the back of my mind, I figured that, yeah, I might have some things on my face when I was older—say, in my 60s or 70s—but who would care what I looked like then?
The Cold Sore That Wasn’t
Five years ago, shortly after I turned 40, I developed a strange bump on my lower lip. It got worse, then seemed to improve, then got bad again. I was busy with my finance job and with my daughter, Lexi, who was 4 at the time, so it took me six months to have it looked at. Although my dermatologist said it wasn’t a cold sore and even speculated that the growth might be precancerous, she didn’t want to biopsy it because cutting into my lip could leave me with an ugly scar.
That really upset me. You know how most people look in the mirror and see 10 things they hate, but one feature (their eyes, maybe) that they like? Well, I have frizzy-curly hair, freckles, and other features I’m not thrilled with, but my full-bow lips were the one best thing about my looks. So we agreed she would freeze off the sore, which would cause the least damage. It healed nicely.
Two years later, however, it was back. Really worried, I went to a new top-ranked dermatologist, also pointing out a rough spot near my nose and a flaky patch on my cheek. He wanted to biopsy all three. I was especially hesitant about my lip, but he said, “Why take chances> If you don’t catch it early, you could lose your whole lip.” He did a skillful job on the biopsies and they didn’t look bad after healing, but he called a week later to say that all three were cancerous: basal cell carcinoma for the lip and the rough red bump, an early squamous cell carcinoma for the flaky patch.
Under the knife—and the microscope
The best treatment for facial skin cancer is Mohs surgery, which has the highest cure rate and leaves the least scarring. The doctor removes the visible tumor and a thin bit of surrounding skin, then checks the sample microscopically for cancer cells. If any are found in the surrounding tissue, another layer of skin is removed, and so on, until no more cancer cells can be detected.
My first surgery was for the rough red bump; I was called back only once. After that healed, I had the second surgery, on the flaky patch, and I was called back twice. I was then feeling more confident about my lip. Sitting in a waiting room full of patients, I was the first to be called; hours later, I was the only one still there. I had to go in four times, and after the last one, I started crying, not sure how much of my lip was left.
I went straight from the Mohs specialist to a surgeon my dermatologist had recommended to reconstruct my lip. We had met previously and discussed some options, but that afternoon he just asked how many times I had been called back. I said four, and next thing I knew, I was under anesthesia. Later, as I was leaving, he said, “If it doesn’t match, I’ll fix it.”
I had no idea what he meant, but when I got home, I realized I had a bandage on my chest as well as one on my face. The doctor had taken skin from my chest and grated it onto my lip, an option we’d never discussed. Even after healing, my lip was grotesque—a think lump with pale, freckled flesh sew onto it. I looked like a patch work quilt. I covered it with a bandage for three months. Finally, a plastic surgeon trimmed the graft down and then, in a second surgery, basically created a new bottom lip by rolling skin from the inside out. Now I have a smile that’s back to maybe 90% of what it once was.
A sunscreen convert
A couple of weeks ago, I went to the dermatologist with another red rough spot, and he told me that even if I never get any more sun exposure, I’ll be dealing with the damage that’s already been done for a very long time. But at least I can avoid adding to the problem—now, finally, I’m really careful about sun protection. On ordinary mornings when I’m going to work, I slather a SPF 30 moisturizer, topped with a SPF 25 powder, on my face, neck, and chest. I use SPF 50 or 75 at my daughter’s soccer games, and I also wear a visor. At the beach, I wear shorts and a top, sit under an umbrella, and set my iPhone to remind me to reapply sunblock every 30 minutes.
If only there could be a way for me to contact my 20-year-old self and say, “Hey, it’s not an easy road—there will be all these treatments, and the pain and scarring, and it’s going to happen in 20 years, not 40 or 50.” Sometimes I’ll see a young woman who’s very tan, and it just makes me cringe. I’m not about to start telling strangers what to do, but I’m glad to think that at least for my friends and family, who know what I’ve been through, I’m a great sun-protection billboard.
Source: Good Housekeeping June 2013, Jenny Hanlon, as told to Catherine Clifford