March 19, 2014

Will This Image Finally Persuade Me to Wear a Cap and Use Sunscreen?

This lovely photo was taken last night, after I spent most of the day undergoing surgery after surgery after surgery at a skin cancer center. I'll be sporting the huge bandage for at least two months, probably longer. 

Last weekend, I bought a new suit so that I'd look reasonably spiffy for my granddaughter's wedding a week from Saturday. I'm looking forward to participating in the ceremony; she asked me to escort her foster mother down the aisle. With my recent Parkinson's setback, I was thinking I might use my cane to be on the safe side. Now, with this latest development, I'm thinking maybe I should wear a Civil War soldier's uniform rather than a suit.

Here’s What Happened
Years ago, my internist recommended that I see a dermatologist regularly since I’m fair skinned and was spending lots of time outside on my bike. So, I started getting an annual skin checkup. About five years ago, he biopsied a spot on my cheek, found basal cell carcinoma, and removed the cancer. It was a quick, simple procedure, and the slight scar soon faded away.

A few months ago, when another biopsy showed a spot of skin cancer on my forehead near the hairline, I expected another quick and easy procedure. This time my dermatologist recommended that I see a doctor who performs Mohs surgery.

In this procedure, skin (including the carcinoma) is removed in very thin layers. Each layer is then viewed under a microscope for signs of cancer. The process continues until a layer shows no cancer. This approach allows the surgeon to remove the cancer while saving as much of the surrounding healthy skin as possible.

Ever the optimist, I arrived at the surgeon’s office at 10am, thinking I’d have one quick surgery and be home in time for lunch. Ha! I left his office at 4pm after four surgeries. Each time, they biopsy the surrounding skin for signs of cancer, and each biopsy takes about an hour.

Usually after surgery for skin cancer, the wound is stitched back up and heals in few weeks, often without scarring. But this option would have been difficult -- and somewhat hazardous -- in my case, since the “excavation site” was pretty big  -- about 3 x 1½ inches.

The surgeon suggested “natural healing,” and I agreed. This choice involves some minimal stitching around the wound, after which the surgical process ends.

A special thin occlusive bandage is placed on the wound to promote healing. A temporary layer of gauze padding goes on top of that, adding protection and pressure to minimize bleeding.

Scar formation is a dynamic process that begins immediately and continues for months. I’ll be wearing this large bandage for at least two months. And I’ll end up with a scar.

But the Prognosis Is Good
My surgeon said the risk of recurrence for this cancer is less than two percent. And melanomas in this area virtually never spread to other organs.

My six hours spent in the skin cancer center were surprisingly pleasant. So were Dr. Montemarano and his excellent surgical technician Brandy.

Nevertheless, I’m not anxious to repeat the experience. If and when the snow storms end and the warm sun shines, I’ll be ready with cap and sunscreen.

Melanoma and Parkinson’s
Every year, about 68,000 Americans receive melanoma diagnoses, and another 8,700 die from it. Recent studies suggest that people with Parkinson’s have an increased risk of developing skin cancer.

The June 2011 issue of the journal Neurology reported evidence that men with Parkinson’s are twice as likely to develop melanomas than men without PD, and that women with Parkinson’s are one and a half times more likely to develop melanomas than their non-PD counterparts.

This PD-melanoma link is unusual, because people with Parkinson’s have a lower-than-normal risk of developing most cancers.

Lucky me. I’ve had prostate cancer since 1994, and now a second melanoma.

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