General Medicine

One Doctor's Confession: Basal And Squamous Cell Skin Cancers Are NOT Benign

I have made a resolution for 2014: I will never, never, never again call basal and squamous skin cancers "benign" cancers.

Why would I make such a strange commitment? The explanation is simple:  I spent 4 hours on New Year's Eve sitting in the surgeon's chair getting a skin cancer taken off my nose. Nothing about the experience fits the "benign" label so many professionals, including yours truly, have used:  routine; easy to treat; nothing to worry about.  Friends, after this experience, which left me looking like a tall, white-haired Rudolph the Reindeer, I am here to tell you these cancers are not to be trifled with, and are worth every effort you can make at preventing them by reducing exposure to UV radiation.

This was the second time in the past 6 months that I had surgery for one of these "benign" cancers. The first time was difficult enough (see my earlier post), so when I saw a small growth that progressed over time, I made it a point to get to the dermatologist to get it removed. He did. That part was fairly simple. But a week later I got the call: "You need to see a Moh's surgeon. You have an aggressive basal cell carcinoma."

Moh's surgery is a technique usually done by a dermatologist to treat skin cancers that may be in certain locations or particularly difficult to treat by more traditional surgery. During the procedure, the doctor takes out the area around the tumor, looks at it fairly quickly under the microscope, then determines whether or not more "cuts" have to be made. That process continues until the cancer is no longer visible in the tissue examined under the microscope. Occasionally plastic surgery may be needed to close the defect if it is particularly large.

Having now gone through this twice, I assure you I will never again call skin cancer "benign." It may be relatively benign compared to some other cancers (unlike them, properly treated it usually will not return), but the experience of having them removed is anything but benign.

So what advice do I have to offer you about skin cancer prevention and treatment?

One of the more disheartening aspects of skin cancer prevention has been the inability to get people to take the "safe sun" message seriously. Research continues to show us that there is a high prevalence of tanning bed use particularly among young women. Sunburns for children remain frequent, as they do for adults. People don't use sunscreens properly. They don't wear wide brimmed hats. They don't avoid the sun during peak hours. They don't seek shade, even on the beach when a beach umbrella can be very helpful.

The list goes on, but you get the idea: you need to take these suggestions seriously or otherwise you too could well face "the knife."

At least I have a sort of excuse. When I was younger, we didn't appreciate the relationship between sun exposure and skin cancer. We didn't have sunscreens. We thought sunburns were a fact of outdoor life, and that a good tan was a healthy thing. We no longer have those excuses. We do know the relationship between the sun and skin cancer. We do have sunscreens that work when used as directed. We don't have to get burned if we go outdoors, and we know that a tan is the skin's damage reaction, not a sign of health. We know that tanning beds increase the risk of skin cancers.

There are too many people out there-especially young people-who think this won't happen to them. The problem with skin cancer is that it can take decades to develop. By the time you realize the risk, it is likely too late to prevent what is going to happen as you age.

The other message that I have is particularly pertinent for those of you in the older crowd but applies to everyone: We have advice on when you should see a doctor about a skin lesion, but I am going to repeat the simple, straightforward recommendation of a colleague of mine who is very knowledgeable about skin cancer: If something changes on your skin, check it out.

It doesn't have to be a big change. It can be a small change. It doesn't have to be black, or purple, or irregular or large. If it is new, go find out what it is. My little lesion was a small (3 mm) red dot. Not much. But it was new, and kept getting larger. I can't imagine what it would have been like if I had ignored it further. Deeper cuts? Further surgery? Who knows? If you don't know what that thing is on your skin, go to your health professional and find out-and do it early. Don't wait to see how big it can grow.

So here we are: I hope all of you will have a happy, healthy and successful New Year. I hope the resolutions you make at New Years will stick with you for the year, especially if they concern your health and well-being. And if you do happen to have a little room on that list, I hope you will make an effort to be sun smart and sun safe. If you do see something on your skin that concerns you (or concerns someone you know who cares about you and wants you to get it checked out), find out what it is. Don't hesitate to "get it done" when it comes to a lesion on your skin. Time is the enemy of simplicity when it comes to skin cancer and its treatment.

As you move through the year, I hope you will remember the simple advice to be safe in the sun. If you are careful-especially when you are younger-you may well not have to face the future that I am now personally anticipating with multiple visits to doctors and probably more lesions to be removed.

It really comes down to the time worn adage: If I knew then what I know now. But what we didn't know then what we do know now. Be smart, and take care of yourself-including your skin. Excuses no longer exist.



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