May is National Melanoma month. Every single day, one person dies every hour in the United States from this deadly type of skin cancer. I was almost one of these statistics.
On January 3rd I sat in the doctor’s office as she walked around me with a magnifying glass. I had no idea what I was about to hear. “Sharon”, she said, beckoning her nurse from the other room. “You need to schedule Mr. DiMaggio for emergency surgery.”
Wonderful. I still had no idea why. This was the first Monday of the new year, and I was ready to give it my all. You know, the New Year. Still, the urgency in the doctor’s orders surpassed her urgency to tell me what was going on.
“You have melanoma, ” she said, turning to me. “I need to tell you….” she hesitated, and grabbed a pen and paper, sketching something she understood but went over my head. “There are four stages. One and two are curable.Three and four are not.” She scribbled it on a pad. I felt the blood drain from my face. This part I got. Suddenly, in the beat of a drum, I had a fifty-fifty chance of having incurable cancer.
I am fifty, never smoked a cigarette in my life, and I had cancer. Not just a cancer, but one which was even bringing up past Seinfeld episodes where Jerry dated the dermatologist. Suddenly, I wasn’t laughing.
I was rushed into plastic surgery, where an extremely talented plastic surgeon remained cool, calm and collected while removing a chunk of my ear. “Ten days,” he said. I had to wait ten days to get the results of the biopsy. This was a lie, I knew. He didn’t want to tell me what he already knew over the phone and he couldn’t see me before ten days.
Ten days later, yes, the biopsy came back positive, and another ten days later, I had half my ear removed.
“Do you really need to do this?”, I asked, as I felt him magic-marker the incision points.
“If I don’t do this, it will come back with a vengeance and you’ll be dead in a few years.”
That was the deal breaker.
I thought that was it. We shook hands, I thanked him, and he said, “You’ll be fine.”
Then the nurse walked in with a clipboard. “Do you have a preference for an oncologist?”
No, I really don’t. But if I’m fine, why do I need one? Because I am the cancer patient, and I am making my way down the great cancer assembly line. One doctor identifies it, one removes it, then you get passed to the oncologist to see if it spread.
Now I get it. I told her to book me with any one of them.
Why Doctors Are Missing This Cancer
When I read articles on melanoma, they invariably come with gross photos. I always said, “Good gravy, who wouldn’t see that growing on them?”
Actually, four doctors and at least as many nurses missed mine–despite four trips to the doctor’s to have my ears checked. One nurse even cleaned them. Still, no notice of a melanoma. How could this be? This is the disease of the decade, the new kid on the block, and no one told me I had it. The scab on my ear wasn’t a scab at all; it was a tumor and a very dangerous one. Why aren’t the doctors telling me this?
If a trained professional is missing it, how are we supposed to ‘get it’?
To be safe, the answer is simple: You need to go to the dermatologist. MDs can’t spot this. Should, but don’t. You can’t see the oddball mark. Doctors don’t. Hairdressers should, but don’t. And the nurse cleaning my ears had no clue.
Those magazine photos? Blown up fifty times.
In my case, my sister Karen, a nurse herself, said, “get that checked.”
“Oh, it’s just a scab.”
But for whatever reason, I listened to her. I made my appointment. But not everyone has the luck, fortune and chance to discuss melanoma while pulling wishbones over the Thanksgiving table with their nurse sister.
What if hair dressers were trained to spot melanomas? Why aren’t GPs identifying this? Or at least why didn’t mine? How many others are being missed?
Oh, too much sun? Maybe. But when we were kids, SPF was unheard of, sunburns were common, and girls used baby oil as suntan accelerant combined with those reflective screens. Yes, that is a big, big part of it: Damage from yesteryear, when we were young and unaware.
But melanoma can occur internally, in nostrils, under finger nails. It can look like a bruise. In my case, I had been injured at the site. I bled and two months later a scab appeared, like a strange scar. Then a dot. And it got larger. Blood under the skin? Certainly doctors didn’t say anything. Wouldn’t they have told me?
Why It’s Deadly
There’s a few types of skin cancer, but melanoma kills more people than the other kinds.
And this is the part people don’t get: Scratch yourself and you bleed. Melanoma needs that blood to metastasize. The cancer is situated on your blood where it readily and freely travels throughout the body through your super highway called the blood stream. Suddenly, the victim doesn’t have one cancer, but ten, with ten cancers ganging up on you all at once, spread from head to toe on the lazy river we call the lymph system and blood stream. Spreading to parts unknown, with such ease and speed other diseases must be jealous.
When this occurs, the average life span is–sit down–6 to 8 months. Tops. You don’t know what hit you. That small beauty mark just became as deadly as all those cigarettes across all those years.
There is the construction worker who noticed something on his shoulder and was dead four weeks later. Ditto the secretary who noticed something on her cheek and went to the doctor. Another casualty.
All true stories.
Or the melanoma that was removed, but reappeared under the girls hairline only to be discovered after it was too late.
It is a tricky disease, a thief in the night, robbing its victims of a fighting chance.
It is not the size of the tumor, but the depth. The level of invasion. I was one quarter of one millimeter from being in the danger zone. Not a comforting place to be.
So when I left the last surgery,the next appointment was the oncologist. Here they take five vials of blood and test liver function, proteins and more to determine if lymph node biopsies and chemo are necessary. Waiting for those results was the longest two hours of my life.
Where do we go from here?
Like every cancer, early detection is key. The dermatologist is your best friend. Just go. They check you head to toe looking for things you can’t identify. Truthfully, neither can your GP.
-Everyone should go to a dermatologist at least once a year for a full body check. Do NOT count on your doctor to spot this. And don’t count on your own eyes: melanoma appears behind ears, under hair lines, and other hiding places. Use a dermatologist. You simply need another pair of eyes.
-use SPF all the time. In the shade, in the morning, all four seasons. I dread when I see convertibles go by, ditto sun roofs.
- never use tanning beds or get sunburns. One burn doubles your chances;
-avoid sun during the infamous 10-2. Yes, I know, difficult. At least where a hat.
-melanoma looks dark, but is tri-colored with irregular boarders
-other less deadly cancers are basal cell and squamous. Not usually as invasive but there are risk factors that can make them deadly.
Some of these can be flesh colored and extremely difficult to see. It could appear as nothing more than a dry patch of skin. True: a small patch of dry skin.
Because melanoma is so deadly, removal of a portion of the body part is standard. Usually one centimeter north and south, or more, depending on invasion depth. No questions, chop-chop-chop.
Squamous and basal cell are treated by Moh’s surgery, where a doctor removes tissue, examines it under a microscope, and keeps removing until all is clear. Moh’s surgery is tissue preservation-based, whereas melanoma surgery is radical.
There are some great new drugs being developed. One drug will completely halt the melanoma. In some patients, the cancer completely disappeared. But not in all patients and not forever. This is being experimented with, and hope may be coming.
I am telling my story for one reason: Education. It happened to me. I am, alas, a cancer survivor, and thanks to my sister Karen. If she hadn’t been there for me, I would not be here right now.
It is the c word. Cancer. It injects fear in us like the theme from Jaws.
Do yourself one favor, and see a dermatologist today. Another two people died of melanoma while writing this.
by Richard DiMaggio