skin

I'm sometimes told that I have good skin for my age. What people mean by that is that I'm relatively unlined and unwrinkled. But that's just an accident of facial geography - the placement of bones, features, etc, hasn't created any deep lines.

But beneath the surface - and increasingly on the surface - my skin isn't 'good'. It's damaged, from a typical sunburnt Australian childhood of the 1960s-70s (and typical unaware early adulthood in the sun). And this week I was diagnosed with my first skin cancer. I'm sure it won't be my last.

I have a strong family history of melanoma, all on my paternal Irish side. My father had a melanoma above one eye which recurred two years after it was removed. (He died within the year, though of 'old age' rather than melanoma.)

My father's 'double' cousin (my grandfather's brother was married to my grandmother's sister) died of melanoma at age 80.

The daughter of another of my father's cousins (ie my second cousin once removed) developed melanoma 18 months ago, aged 43. Hopefully it was removed early enough.

Because of all this, I've been very skin-aware in the past decade. For a few years I went to a dermatologist to have my anxieties checked out - she'd occasionally freeze a pre-cancer on my nose or cheek. But three years ago she said I could rely on my GP, so I have. About once a year I'd go with a short list of strange warty things or scaly bits of skin on various parts of my body (legs, face, back) - mostly she said these were solar keratoses (mine didn't look nearly as bad as the photos in all these skin cancer websites).

Every so often, I'd find something odd on my skin, usually while in the shower, and my blood would run cold with fear. I've lost track of the number of times I've asked co-parent to take a close look at something I couldn't twist round to see. But I'd managed to get to the point where I'd tell myself to stay calm and wait it out - the dermal-strangeness was sure to disappear.

In January, I got into a hot shower and felt a stinging sensation on the back of my thigh - when I put my hand there, there was a small raised lump, a bit like a mosquito bite. I took note of it. But within a few days, I'd forgotten about it.

In early April, staying with friends in Adelaide, I got into a very hot bath and felt the same stinging sensation in the same place - and the same raised, scabby spot.

Two days earlier my oldest sister had rung to tell me she was going to have a BCC removed from her nose - as it had "tentacles", she had to have this done in hospital, under sedation.

Her news concentrated my thoughts. I decided to go and see my GP about the thing on my thigh, hoping she'd say once again it was a harmless solar keratosis.

I also had a thick scaly patch on the bridge of my nose which was bothering me. When I saw my GP, she told me she didn't know what the thing on my leg was but she wasn't concerned - she was more concerned that the nose scaliness could be a BCC. So she referred me to my dermatologist again.

I reminded the dermo about my family history and accordingly she looked all over my body with her magnifying glass, occasionally pausing in a tension-producing way to look closely with what I assume is an ultra-violet (or infra-red?) light. There was something in the small of my back (again, almost impossible for me to see clearly) which she wanted me to keep an eye on. Then she froze the skin on my nose, saying it was an "age wart". And she said she'd "shave off" the thing on my leg and send it for biopsy, which she did there and then. She spoke about doing a further excision or using a cream if it turned out to be ... well, she didn't specify, but I assumed she meant a BCC.

In the intervening week, I thought about it a couple of times. Without forming this into a clear statement in my mind, I knew it was something different from what I'd had before. And I knew that BCCs usually appear on the face and ears. A friend of ours had a rapidly-growing SCC removed from her chest a couple of years ago and that thought crossed my mind.

On Tuesday I was supposed to ring for the result. I didn't. I was occupied, but I also thought to myself that if I didn't ring and they didn't ring, that meant it was okay, so I could ring tomorrow.

At 5.30pm the phone rang - it was my dermatologist.

"You have Bowen's disease".

What's that?

"Squamous cell carcinoma in situ".

We spoke for a few minutes. About three times she said that because she had shaved it off, nothing further had to be done. I had that feeling you get with specialist doctors that they are seeing the textbook or case history in their mind's eye, rehearsing all the options but then coming to their concluding diagnosis.

She asked about the 'pimple' on my back (or whatever it is) that she'd asked me to keep an eye on and said to come and see her in six weeks if it's still there and said as a general rule I should now have an all-over check once a year.

When I put down the phone, I was shaking. 'Carcinoma' is  a scary word.  How could she be sure it was all out?

I've calmed down since then. I've read a couple - just a couple - of websites and they're reassuring. It seems that almost by definition, this SCC was self-contained.

But the lasting feeling is that my hyper-vigilance is not hyperchondria  - it was probably only a matter of time till my skin manifested its damage in a malignancy and I'm sure there are more to come - hopefully minor ones. I have to find a position of mental balance where I keep up the vigilance but don't freak myself out too often. It's hard because I have a lot of moles and increasingly a lot of tiny 'growths' and irregularities in skin surface - there's a lot to keep tabs on.

I've decided I'm going to see my GP again when my thigh and nose have healed (they're currently both scabby), to discuss it with her. Then I think I'll go back to the dermatologist, even though she didn't suggest it. I need reassurance (all the definitions of Bowen's disease talk about it being flat and scaly, but mine was raised and wart-like) ... and I've noticed another mark on my cheek which I want her to check.

Comments

[Jody]

I'm glad it's gone now, and I hope you find yourself re-adjusting and feeling okay again soon.

Carcinoma just isn't a pleasant word.

I have to be vigilant, too, and have worked myself into a real tizzy too often. It's hard to figure out the right attitude about it all.

[Jennifer]

Scary. I know so many people who have had skin cancers removed, including most of my paternal aunts and uncles. I'm off for my own check this morning, wish me luck!

[Susan]

That's a good plan--between the GP and the dematologist, hopefully they'll give you both good guidance and reassurance to find the balance you need. (Lots of melanoma in my family, and lots of beach/sun, too, so I know a bit of this anxiety myself.)

[Mikhela]

We are so unsuited to this climate, aren't we? Sounds like a very scary chain of events. I'm in co-p's position - LG is very moley so I'm always being asked to give my opinion on this or that small bump.

[Kerryn]

I've got a family history too, not of melanoma, thank God, but of multiple solar keratoses and BCCs -- my mum and my nan both had their faces quite badly hacked about by the surgical removal of BCCs, as well as countless slushings. Like you, I took a particular concern to the dermatologist -- last Wednesday, my 55th birthday -- and she said the spot I was worried about was nothing, but the little itchy patch at my left temple was ("I'm 99.9 per cent sure") a BCC requiring plastic surgery and possibly a skin graft. So I know how you feel, because I've had exactly the same kind of week!