Shortly after I turned thirty, I went to see my primary care provider for my yearly physical. After going over the normal litany of questions and comments that comes with a checkup, he brought something to my attention.
"You know," he said, "you have a few moles, and you're pretty fair skinned," he told me, which I believe is physician-shorthand for "you are one of the whitest guys in history". Both of those things, he told me, put me at greater risk for skin cancer. He then ran down a list of screening questions. Had I ever had a job with lots of sun exposure? Had I ever had bad sunburns when I was younger?
Well... I grew up on a farm, so, of course. And there was that time I didn't put on sunscreen before a three-hour baseball game in 2003. And then the one time I went to Hawaii, I went outside on the second day and thought, "Well, it's overcast... clearly, I don't need any sunscreen." And then there was the time at Virginia Beach I was trying to impress a girl and not only completely failed to do that, but got an incredible sunburn to boot.
He raised an eyebrow. "Even one blistering sunburn in childhood or adolescence more than doubles your chances of developing melanoma later in life," he told me. "You're young, but you should get these checked yearly."
He referred me to a dermatologist- and religiously since then, I've visited every year; through COVID, through night shifts in the ER, I paid my dermatologist a visit every twelve months. And year after year, a clean bill of health.
Two weeks ago, I had my yearly checkup. The doctor and I made small talk; he asked me how the ER was, how my run for the Virginia House of Delegates was going. After a lookover, though, the doc regarded me seriously. "There's a mole on your back we've been keeping track of, and it looks like it's changed a bit. Not a lot... but enough that I think it needs to live in a jar," he said, "and since it's on your back and nobody will see it, let's just get it over and done with."
I shrugged. "Whatever you say, doc," I told him. He said his concern was minimal, but I agreed there was no reason to risk it. So he shaved the mole off, in a procedure that took longer for the lidocaine to kick in for than it did for him to actually remove the mole, put a Band-Aid on me, and sent me on my way.
I was wholly unconcerned, and hadn't given it a further thought... until my phone rang a 8:30pm a few nights later. I glanced at my caller ID, and noticed it was the dermatologist's office calling. "Huh," I thought, "why would the dermatologist be calling me at-"
Oh, no. No.
I answered the phone, hesitatingly. The doctor politely asked me if now was a good time to talk, and I laughed. "Doc, you're calling me at 8:30pm," I said, "I think I better listen to what you have to say."
"Well, we got the biopsy results back," he said, "and unfortunately it looks like you have malignant melanoma."
This isn't anything anyone wants to hear. Not a 38-year old in relatively good health. Not an ER Nurse who has seen over and over again what melanoma can do. Nobody. My heart immediately dropped into the pit of my stomach, and I began to feel woozy.
But the roller coaster of emotions I was on wasn't done just yet.
"The good news it looks like we got it all," the doctor said, explaining though it was Stage 1, it was tiny- 0.35mm. For reference, a pencil tip is about 1mm in size, and a fine pen tip is about 0.5mm. There appeared to be healthy, disease-free skin in each direction from the bit of skin he'd shaved off. Still, protocol said they should take more off- again, even though the pathology report looked like they'd gotten it all, why risk it?
"This isn't anything to lose sleep over," the doctor said, admitting nonetheless that was easy for him to say. "We are very lucky to have caught it as early as we did.”
I thanked the doctor and hung up the phone, still awash in competing emotions. I logged into my electronic medical chart and read the pathology report myself, but it just didn't make sense. I read reports like these every single day about other people... I just couldn't square the one I was reading was about me.
But here's the thing about melanoma. It might've been stable there for years. Or it could have been metastatic in weeks. It just all depends. The bottom line here is that preventative medicine just saved my life. The five-year survival rate for the stage of skin cancer I had, with immediate surgery, is 99.8% or greater. Whereas the five-year survival rate for metastatic melanoma is, according to the American Cancer Society, about 22.5%.
While the standard of care is seeing your primary care provider or a dermatologist, with the proliferation of cell phone cameras, it's easier than ever to do self-checks. Take a picture of your body, of any moles, blemishes, freckles, or other marks on your skin, so you can keep track of them over time. Melanoma can arise from otherwise healthy skin. But changes to a mole can be a sign of melanoma.
Remember the ABCD signs:
- Asymmetry: Irregular shape; one half does not match the other
- Border: Ragged, notched, blurred or irregular in outline; spreading pigment
- Color: Uneven color; shades of black, brown, tan, white, grey, red, pink or blue
- Diameter: Increasing size; melanomas usually grow larger than a pencil eraser
- Other symptoms of cancer or serious skin conditions include broken or bleeding skin that won’t heal after a few weeks of targeted care.
And if you see a mole or spot on your skin that's growing fast, itching, bleeding, or changing color quickly, make sure you get it checked by a dermatologist right away.
And last but not least, I want to again make it clear that preventative medicine saved my life. I have seen cancer ravage more people than I can count. I’ve seen it at its worst. And I certainly haven’t grappled easily with my near miss, especially after seeing so many good people suffer and die other the years for no better reason than they had crummier luck or didn’t have the privilege of being able to access the kind of primary care I was able to. Wrestling with the emotional turmoil over why I’m here and they’re not has not been easy.
It shouldn’t come down to luck. It shouldn’t come down to whether or not I can afford to see a doctor, whether I have health insurance, whether I have the time and ability to take time off of work and drive to my appointment to determine whether or not I can access lifesaving care.
I'm beyond lucky that my melanoma was caught early. It was on my back, and my chances of noticing it before it would have become metastatic were so small, I don’t want to consider it. I'll be waiting to celebrate fully until I get the report back from the surgery in a couple weeks and will have to pay even more strict attention in the months and years to come.
There's a spot in the multiverse where my youngest watches me suffer through a brutal cancer fight that takes me before I can teach my oldest to drive. Where my mother had to wrestle with surviving her own cancer while burying her son from the same disease. But in this universe... I'm beyond lucky.
Spending a few minutes every month checking myself, and making sure I had regular follow-ups, made me a cancer survivor instead.