Surviving with skin cancer: A way of life
August 14, 2013
8/5/2013 - FORT EUSTIS, Va. -- "In my 20s I didn't think much of it, it was like a joke..."
According to the Skin Cancer Foundation, skin cancer is the most common type of cancer. In the last three decades, more people have had skin cancer than all other cancers combined, and more than 90 percent of non-melanoma skin cancers are associated with ultraviolet radiation from the sun.
Nancy Carlson, a military spouse, now knows that skin cancer is no laughing matter. She has had more than 30 basal cell carcinoma lesions removed, endured numerous treatments and visits a dermatologist every six months. She knows firsthand the sun's UV radiation can do damage that will last a lifetime.
"This can happen to anyone," Carlson said. "It doesn't matter if you have dark pigmentation or light like me."
Although Carlson now protects herself from the sun, this was not always the case; the UV damage to her skin started at a young age.
"I grew up in the '70s, and we really didn't use sunblock back then," she said. "As a child, I was at the pool all the time and would just burn; my friend's father always called me 'Red'."
Maj. Kristen Toren, McDonald Army Health Center chief of dermatology, explained that over time, UV radiation could cause skin damage that may not immediately be noticed.
"Everyone has to be careful about sun exposure," she said "Even intermittent exposure, especially if experienced early in life, can lead to damage that unfortunately won't be seen until later."
Years later, Carlson recalls how she realized she had skin cancer.
"During spring break from college, I was looking at a magazine article about skin cancer and suddenly it dawned on me [that] I have that," she said. "I went to the dermatologist, he removed [the cancerous basal cell lesion] and said not to worry about it."
Unfortunately, Carlson did have to worry about it; the lesion grew back.
"I was working as a new nurse and the place the lesion had been removed from started to ooze. It leaked through my white uniform," she said. "A patient noticed and asked about it. When I pulled the shirt back to show him, he said 'Oh my goodness, you need to go see a doctor.' The lesion was the size of a quarter, which is big for a basal cell. Since then I have had a couple of them a year and it's gotten progressively worse."
Toren explained that it's important for a patient to be closely monitored after a skin-cancerous lesion is removed.
"Once we know a person has had one, there is a chance more could develop," she said. "In most cases, second or third lesions develop within the first few years. We watch closely in the first year and the patient has yearly follow-ups."
Although Carlson has only had basal cells, there are three types of skin cancer: melanoma, squamous cell carcinoma and basal cell carcinoma. Fortunately, Toren said there are ways to detect skin cancer cells, known as the "ABCDs" of melanoma.
A is for asymmetry; the color difference from one side of the lesion to the other.
B is for borders; moles should have smooth borders.
C is for color irregularity; black, red, blue -anything not a typical brown color.
D is for diameter; a mole should not typically be bigger than a pencil eraser.
"When it comes to squamous cell carcinoma and basal cell carcinoma, you're looking for lesions that are red and crusty on sun exposed areas of the skin, such as the face, scalp, ears, forearms and chest," said Toren. "Lesions can look like an ordinary pimple, bug bite or ingrown hair, but it does not go away. If it's there more than a month it should be evaluated."
If a person suspects they have skin cancer or notices anything out of the ordinary, Toren said they should contact a doctor.
"Get evaluated by your primary care doctor and they will make a referral to dermatology if it's something to worry about," said Toren. "The standard treatment is procedural intervention to make sure the atypical cells are removed or destroyed. There are various methods to ensure the skin cancer is gone."
Throughout her lifetime, Carlson has experienced most of the skin cancer treatment methods.
"I think I've had every type of procedure that's out there," she said. "I've had [two kinds of topical skin treatments], surgical removal of lesions as well as having them burned, scraped or frozen off."
Although she has had many treatments, Carlson thought the topical ones were the worst.
"I [spread the treatment] on my face; it's a topical cream that reacts where you have damaged skin cells," she said. "My whole face reacted, it was dreadful, it was bright red like I had been burned in a fire, I had scabbing, really bad peeling and my face was swollen."
Because Carlson has been through so much, she is now adamant about sun protection.
"When I go to water country I wear [special] long sleeve shirts [that have UV protection], I have a big umbrella I use at my kids' soccer games, I try and protect myself more and I make sure my children always have sunblock on," she said.
Toren provided some additional sun protection tips.
"The best rules of thumb are to put sunscreen on 30 minutes in advance, apply about one ounce and reapply every two hours," she said. "Also try to avoid the high peak UV times of the day, 9 a.m. to 4 p.m., and use sun-protective clothing."
Skin cancer is a huge part of Carlson's lifestyle. Despite using sun protection, she will have to see a dermatologist for the rest of her life.
"Every six months [I see a doctor], but if I spot something I go sooner," she said. "I've had to deal with this for so long I can't imagine what life would be like without [cancer]. It's just something I deal with."
The sun can cause damage that will last a lifetime. Having skin cancer has been, and continues to be, a way of life for Nancy Carlson, but she hopes it doesn't have to be this way for everyone.