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Dr. Len's Cancer Blog

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Dr. Len Says: When It Comes To Skin Cancer, Do As I Say, Not As I Do

by Dr. Len May 14, 2013

So May is skin cancer awareness month. No time like the present to come out with the news: I have been diagnosed with skin cancer.

There really isn't much special about that, since it is a distinction I share with over 2 million Americans who have a skin cancer removed every year. Fortunately, for most, it is a cancer that is not of particular concern since most can be removed. But even those "simple" surgeries--as I have learned from my own experience--can be a bit problematic.

Occasionally it helps to find some humor in difficult situations, and this is one of those times. And since I am generally pretty open about what goes on in my aging body--in an effort to help others understand that they are not alone on some of these issues--I have to hold myself out as an example of what NOT to do when it comes to taking care of yourself.

You see, I am supposed to know this stuff about skin cancer. I know the risks, I know how to prevent it, I know what it looks like, and I know what we are supposed to do when we see a suspicious lesion. Not only do I know these things, I talk and write about them frequently. I am supposed to have a certain level of expertise about skin cancer. In fact, this very month if you happen to be in a doctor's office and they have a closed circuit program from CNN's Accent Health, you will see my smiling face telling you what you need to know about skin cancer.

And if you look closely at my chin in that segment, you will see the little nodule on the left hand side that I chose to ignore--until some friends of mine would not let me ignore it any longer.

This little bugger showed up about a year ago, and I thought it was related to an inflammatory skin condition that I had developed about the same time (which interestingly resolved the minute the darn thing was removed. Don't ask me why, I just know it happened). It got larger and smaller, and if I shaved over it, it bled.

So let's see: a new lesion that didn't go away despite my best efforts. Something that continued to get irritated and would bleed. Maybe even getting a little larger over time. Looked just like the pictures they show you as a doctor, which suggests a basal cell carcinoma. So, Dr. Len, what was your first clue?

Maybe I was just a bit too busy. Maybe I had seen enough of doctors and hospitals over the past year. Maybe my problems with wound healing from my prior surgeries gave me pause. Maybe one of my wonderful colleagues had written a paper that skin cancers were less common in people who took the same type of blood pressure medicine that I take. Maybe, maybe, maybe...

Fortunately, I have friends who know a thing or two about skin cancer. And as luck would have it, I was at a meeting a couple of weeks ago that was also attended by some of them; dermatologists and experts in removing skin cancer with Moh's surgery. While I sat at a committee table deliberating what I thought were some important issues at this meeting, I got a tap on the shoulder from one of those friends, who motioned me outside. I was greeted by a group of five dermatologists who pointed and wagged their fingers at me and said, essentially, that the thing had to come off. In short, I had become the focus of their intervention.

Of course I told them I would get it taken care of. But they are my friends, and they know me. So they took it upon themselves to contact one of their colleagues who called me that Monday evening and had me in her operating chair the next morning. And off it came: a nice sized basal cell with a hole in my chin that was artfully sewn up.

So there I was, Mr. Dr. Expert, with a big bandage on my face. But the cancer was gone, the margins were clean (that's one of the advantages of Moh's surgery: you know on the spot with frozen sections if they get all of the cancer removed). I did have some minor issues with the incision later in the week, but those got taken care of. The stitches are out, the scar will heal/shrink, and my face looks the same as it always did--well, no worse anyway.

And the real irony of all this? One week later I was standing in the halls of Congress in Washington with some of those very same colleagues welcoming members of Congress and their staffs to a presentation on the importance of--you guessed it--finding skin cancer early and sun safe behavior! There I was, with a nice fat bandage on my face. You can't dream some of this up...

Like many of you, I always try to understand what happens to me when it comes to my health--or perhaps I should say "unhealth." But there was no secret here: I grew up in an era where sunscreen just didn't exist. And as a young man I worked summers as a swimming teacher/lifeguard at a camp, where the goal was to get burned early and as tan as possible to "protect" myself from the sun. Word to the wise: that's a myth.

This is not to say that I don't take safe sun behaviors seriously now--as I have for a number of decades. I use sunscreen regularly, wear a wide brimmed hat, and seek the shade when at the beach or some other sunny place. I certainly don't burn and I don't tan either (I can't imagine what would happen if I came back to work from vacation and had a sunburn. Probably the same thing that would happen if I was found smoking a cigar!!!!). But the damage had been done a long time ago, when I was young--and that's a message all of us should heed, kids, teens, and parents alike.

So I will take my experience and hopefully be the better and the healthier for it. I will continue to educate and cajole about being safe in the sun

Listen to the warnings, be safe in the sun, and get your health professional to examine any suspicious lesions--especially those that change. You don't want to follow in my footsteps on this one, my friends. You can easily be smarter than me when it comes to taking care of yourself and your skin. My lessons come with a new vigor, a new commitment--and a new scar to show for it.


5/15/2013 4:03:59 PM #

Gregory Pawelski

Ironically, I was writing about this Mohs surgery a couple of months ago, about it being okay in seniors aged 90 years or older. This surgical technique has more than stood the test of time. Developed by Dr. Frederick Mohs in the 1930s, Mohs micrographic surgery has come to be embraced over the past decade by an increasing number of surgeons for an ever-widening variety of skin cancers.

Even your story about your tap on the shoulder from one of your friends is ironic. For thirty years, my doctor-brother would host a family dinner from his side and his wife's side of the family on the Sunday between Christmas and New Years. At one of those dinners, my brother's daughter, who was a physician herself studying dermatology at Duke, tapped my dad on the shoulder and virtually explained the same thing to him for a lesion she saw on his head.

I happened to be listening and made an appointment for dad to see a rousing dermatologist in our community (loves Las Vegas). And the lesion was taken off his head and it was cancerous (dad was 80 years old). I had both mom and dad checked out by this dermatologist ever since. Good advice! Even patients with melanoma who see a dermatologist just once are more likely to be diagnosed earlier with less invasive disease.

Gregory Pawelski

5/20/2013 3:11:11 AM #

Alieen Stewart

I truly like to reading your post. Thank you so much for taking the time to share such a nice information.
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Alieen Stewart

6/3/2013 8:17:39 AM #

Ian Katz

As someone observing from Australia which has a huge issue with skin cancers, I can not see the necessity for specialist and the Mohs surgery for the management of most skin cancers. In Australia, most BCC's and SCC's (>80%) are managed easily and efficiently by family physicians/GP. This does not have to be specialist care and certainly not Mohs in the vast majority of cases, even melanoma in situ

Ian Katz

7/23/2013 6:27:19 AM #

Dermatologist Doctor in Chandigarh

hi Alieen, Melanoma cancer needs special care.

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About Dr. Len

Dr. Len

J. Leonard Lichtenfeld, MD, MACP - Dr. Lichtenfeld is Deputy Chief Medical Officer for the national office of the American Cancer Society.