Dakota Beacon

            It happened again! On May 6 I underwent my fourth Mohs surgery for skin cancer. The basal cell, located in the middle of my forehead, was easily treated. With eleven stitches visible I confessed to my grandkids that I thought about becoming a unicorn – then I changed my mind.

            Developed by Dr. Frederic Mohs, this surgical procedure was refined over the past seventy years. As the most exact and precise method of tumor removal it minimizes the chance of skin cancer recurrence while reducing potential scarring. It relies on microscopic identification and removal of cancerous growth layer by layer while leaving healthy tissue untouched.

            The very mention of cancer conjures thoughts of deadly malignancies, suffering, and death. However, knowing something about the type of cancer helps a person deal with it rationally. This is particularly true of skin cancer. Unlike internal cancers, skin cancer can be touched and seen thereby reducing the mystery of the unknown.

            I speak from experience. Now is a good time to offer words of encouragement to would-be skin cancer casualties by recounting my own experiences with skin cancer.

            As a young adult I first noticed a red spot on my left temple but promptly ignored it. In about a year’s time the spot changed in texture and appearance becoming scaly and somewhat larger. In the months that followed the spot grew scalier and began to “weep.” It never healed completely, a telltale sign that should have alerted me. In retrospect, I was witnessing the slow transformation of sun-damaged skin (actinic keratosis) into what became basal cell carcinoma. Various keratoses may be pre-cancerous and, if allowed to continue untreated, the keratoses may become cancerous. My case was a textbook example.

            During a routine exam I discussed the spot with my physician. He referred me to a dermatologist and a week later I was in surgery. The surgeon excised the rather large basal cell (not a Mohs procedure) and repaired the wound with a skin graft using skin taken from the area of my collar bone. That was my first, but by no means my last, encounter with skin cancer. Over the years I have had several biopsies and excisions.

            Incurring skin damage was no secret in my case. From 1956 and for the next ten years I lived in or near the Denver, Colorado area, a mile above sea level. At that altitude ultraviolet sun rays penetrate the atmosphere with ease. We Caucasians do not tolerate destructive sunlight passing through the thin atmosphere unimpeded. Such exposure usually damages the skin.

            Once the skin is damaged there are ways to remove the damage before the harm turns cancerous. I have been prescribed topical ointments such as Efudex (controlled chemical burn), Imiquimod (enhances the immune system to target the damaged skin), and photodynamic therapy (“blue light” used to activate a chemical process). When these fail, surgery is necessary.

            There are three types of skin cancer. Basal cell carcinoma is most common. Prompt removal of a basal cell in its early stage is key to minimizing damage and scarring. For my various skin cancers I’ve experienced excision, electrodessication, cryotherapy, and micrographic (Mohs) surgery.

            Squamous cell carcinoma is the second most common skin cancer. In addition to sun damage, squamous cells may also result from burns, scars, X-rays, or chemicals. Treatment is essentially the same as for basal cells. My treatment for squamous was excision. Squamous cells rarely spread to vital organs, but if they do, the results can be serious.

            Melanoma, the least common skin cancer, is also the most serious and can be deadly. As with any suspicious skin blemish, a dermatologist should be consulted immediately. If allowed to progress, colonies of melanoma cells may spread to internal organs. Typically, melanoma is removed surgically.

            Given my skin cancer history, dermatology visits are scheduled every six months. Treatment focuses on identifying and eliminating the damaged skin cells before they become cancerous. Freezing the evident keratoses with liquid nitrogen is routine.

            People with fair skin, blue or green eyes, and red or blond hair run the highest risk for sun damage. Dark skinned, non-Hispanic people are not exempt from skin damage. A serious sunburn incurred by a young person may manifest itself in later years as damaged skin.

            Preventing sun-damaged skin is a year-round task. The Skin Cancer Foundation and the American Cancer Society recommend the following sun safety tips:

            * Limit sunbathing and avoid tanning beds.

            * Avoid sun exposure and use sunscreen SPF (sun protection factor) 30 or higher.

            * Wear protective clothing, especially a broad-brimmed hat.

            During a recent visit to my dermatologist I raised the sun avoidance issue again. Sun is necessary for the body to produce Vitamin D plus it kills viruses and bacteria. What to do? His advice? Moderation in all things because there are tradeoffs. Limit sun exposure to 20 to 30 minutes a day.

            Experience is a great teacher and understanding skin cancer makes prevention a whole lot easier.

Dennis M. Patrick can be contacted at (JavaScript must be enabled to view this email address).