Procrastination, Skin Cancer, Moles, and Melanoma

I am writing this article to stress the importance of taking proper preventative measures, which I did not do, because I messed with a mole for about 30 years until it became a melanoma.

Sometime in my twenties (in the 1960's) a small brown mole formed on my forehead, just above my left eyebrow - this was a flat mole (not raised above my skin). At that time, there was very little information available to the public about sun exposure, moles, and melanoma, and this new mole did not raise any red flags.

There was no change in this mole until I was in my forties, and then it started to enlarge (it still remained flush with my skin, and did not change color). By now, there was much more attention being paid to the dangers of mole changes, and my doctor referred me to a plastic surgeon who excised the entire mole, and sent it for biopsy, which fortunately, showed no sign of cancer.

About ten years later, the mole grew back in the same position on my forehead, and it looked identical (in size and color) to the original one. I assumed, very foolishly, that it was still benign and left it at that. In my sixties, it started to grow again, and again I assumed it was benign, based on the previous biopsy results.

At age seventy, my daughter suddenly asked me "What is that red thing on your forehead, I never noticed it before?" I replied that it was a mole and have had it most of my life, to which she replied, "I think you should check it out." I did not notice the color change because I am colorblind!

A day or two later, independently of my daughter's observation, my wife remarked that the mole had darkened, and I immediately made an appointment with my dermatologist. He initially said it is just a benign black mole and there was nothing to worry about - but then he had second thoughts, and sent a sample for biopsy. Well, the biopsy results came back positive for melanoma!

Off to the plastic surgeon again, but now a section of skin almost covering the whole left side of my forehead would have to be excised, to ensure that no melanoma cells had possibly metastasized - even though the mole was only about one quarter of an inch in diameter. Because of the large excision, and the vascular complexity in the forehead, I had to have outpatient surgery under general anesthesia.

The surgeon grafted a skin flap over the incision, and sent of another sample of the surrounding flesh for biopsy, which showed no metastasis around the mole. He did a great job of hiding the surgical scars in my eyebrows and forehead wrinkles. Healing was uneventful (except for a huge black eye caused by the blood draining downwards around and below my eye). The stitches were removed two weeks later and I was told to use sun block on my left forehead for 8 months whenever I went into sunlight. Three months after the surgery, the scars were undetectable.

Compare this complex surgery to the first mole removal, which was performed in the surgeon's office under local anesthesia. The procedure took about 15 minutes, as only a very small margin of the surrounding skin was removed with the mole - so all I needed was a small plaster covering the wound on my forehead.

My point of this story is that a melanoma can develop very fast, (in my case it appeared to be only a few days) and if not removed in time, it will probably metastasize, and the survival rate from melanoma is low compared to other cancers. Because of my procrastination, self-diagnoses, and denial, I landed up with complicated surgery, and was very lucky that the melanoma had not metastasized.

About eight months before the melanoma surgery, I had to have my prostate removed as a biopsy showed cancer. This cancer was detected in time because I had followed recommended preventative measures, such as having PSA tests and the dreaded DRE examination. Incidentally, DRE stands for "Digital Rectal Examination", and the word "digital" refers to the doctor's finger! For more details on this surgery, which due to post-operative complications, I almost lost my life, see Prostrated by My Prostate in Associated Content.

Prevention:
Do regular self-examinations to see if any new moles or existing moles have changed, and check if skin lesions other than moles look suspicious. If possible, get a family member or friend to check inaccessible areas of your body, including your scalp. WebMD has a slide show showing pictures of precancerous skin lesions and skin cancer.

In addition to self-examination, visit a dermatologist regularly for checkups - besides giving you a head-to-toe examination, he may remove some lesions and moles that he thinks may become precancerous.

I have extracted some information from the National Cancer Institute - mainly about preventing skin cancer:

Skin cancer is the most common cancer in the United States.

Skin cancer can occur anywhere on the body, but it is most common in skin that is often exposed to sunlight, such as the face, scalp, neck, hands, and arms.

Avoid exposure to the midday sun (from 10 a.m. to 4 p.m.) whenever possible. When your shadow is shorter than you are, remember to protect yourself from the sun.

If you must be outside, wear long sleeves, long pants, and a hat with a wide brim.

Protect yourself from UV radiation that can penetrate light clothing, windshields, and windows.

Protect yourself from UV radiation reflected by sand, water, snow, and ice.

Help protect your skin by using a lotion, cream, or gel that contains sunscreen.

Wear sunglasses that have UV-absorbing lenses. The label should specify that the lenses block at least 99 percent of UVA and UVB radiation. Sunglasses can protect both the eyes and the skin around the eyes.

List of sources:

National Cancer Institute, Understand Skin Cancer

WebMD, Precancerous Skin Lesions and Skin Cancer Picture Slideshow