Weekly newspaper of Three Rivers, California, and Sequoia-Kings Canyon National Parks

POST SURGERY: Do you think anyone will notice?

A smart resolution: Visit the dermatologist

John Elliott


I don’t usually make New Year’s resolutions but here’s one worth considering, especially for those folks over 50. Like most of us of that age and older, we spent a lot of time outdoors before sunscreen became required attire. 

If that’s you, then you are at risk for basal cell carcinoma.

When I first noticed a small spot on my nose seven years ago, I really didn’t give it any serious thought. The seasonal pattern was always the same. 

In the winter months the skin around the spot would flake away and it disappeared. In the summer, a small scab would form at the same site — sometimes it would flake off and bleed a little but it was never anything more than a minor annoyance.

I mentioned the spot to my doctor during an annual checkup in 2012. He said typically these types of skin disorders weren’t serious and were slow growing. He advised me to keep an eye out for changes and, for peace of mind, I should make an appointment to see a dermatologist.

I took that to mean don’t sweat it; get to it when you get to it. The last thing I needed with my healthcare policy was another medical bill.

So I did some research on the web to see if I might get a clue as to what I should do. There are a ton of good medical websites, and once you get by the disclaimers, there’s lot of pertinent information to help anyone make an informed decision on just about any illness or condition.

For basal cell carcinoma, I recommend taking a look at the Mayo Clinic site. It’s written so the layperson can understand the terminology and it’s well organized.       

Definition— Basal cell carcinoma is a type of skin cancer. It begins in the basal cells — a type of cell within the skin that produces new skin cells as old ones die off.

Basal cell carcinoma often appears as a waxy bump though it can take other forms like in my case. I got tired of being asked, “What’s that on your nose?”

Now that I have been diagnosed and treated, I see potential problem sites on others in greater numbers than I ever thought possible. Where you notice the potential trouble sites are areas often exposed to the sun, like on the face or neck.

Skin cancer specialists think the basal cell carcinomas are caused by long-term exposure to ultraviolet radiation from sunlight. Avoiding the sun and using sunscreen may help protect against developing basal cell carcinoma.

Symptoms— A general warning sign of skin cancer is a sore that won’t heal or that repeatedly bleeds and scabs over. The basal cell type may also appear as:

—A pearly white, waxy bump, often with visible blood vessels, on the face, ears, or neck. Individuals of darker complexions might have brown or black bumps.

—A flat, scaly, brown, or flesh-colored patch on the back or chest. Over time these patches can grow quite large.

—More rarely, a white, waxy scar. This type of basal cell carcinoma is easy to overlook but may be a sign of an invasive and disfiguring cancer called morpheaform basal cell carcinoma.

I think the biggest stigma for me was coming to terms with the fact that I might have cancer. Cancer of any type is scary, especially when untreated.

So here’s the good news. I call this type of cancer “cancer with a little c” because it is easily detected and there are some highly effective treatments that can eradicate those basal cells from the body’s system.

Treatment— Even if you don’t suspect you have a trouble spot but have never seen a dermatologist, make an appointment to see one. They can give you a once-over that could possibly point out a site or two to keep an eye on. 

If you get a clean bill of health, that peace of mind is well worth your co-payment on your insurance. (You have insurance, right? If not, open enrollment through Covered California continues until February 15, and there are some seriously affordable plans.) 

Do not make the mistake of avoiding the doctor, especially if you suspect you have a potential trouble spot. If you need help financially, or don’t have a regular doctor, start by making an appointment at Family Healthcare Network in Three Rivers.

During my appointment with the dermatologist, they removed a small cell sample of my spot for a biopsy. Within a week or two, they called to tell me the labs had come back positive. I had basal cell carcinoma and I was advised to make an appointment in the next few weeks for the outpatient surgical procedure to have it removed.

Mohs surgery— There are at least a few options for surgical treatment but I am convinced that Mohs technique was the way to go in my case. The Mohs surgery is a precise technique where layers of skin are progressively removed and examined while you wait in the chair until only cancer-free tissue remains.

In other techniques, the patient must return for another check-up or more surgery to ensure the cancer is no longer present. The Mohs can, in almost 100 percent of the cases, tell you right then and there.

Some patients don’t like the Mohs technique because it often involves a bigger area that is excavated and can cause greater scarring. My site on my nose needed 24 stitches to close because after the first go-around there were still cancerous cells present. The doctor went in for a second time to dig deeper.

Herein lies a critical reason not to put off the checkup or the procedure. As the cancer spreads it can work its way deeper into some serious bone or tissue. That’s when the little c can become a big C.

In all honesty, the surgery was pain-free but the huge bandage on my face and nose drew a lot of attention. I had dozens of people telling me I should say I was in a bar fight and “...you should see the other guy.”

After 10 days, I was back to feeling normal and training for the Maui Marathon that I was signed up to run a month later. It wasn’t too big a deal. 

As it turned out, my 30 percent share of the cost on my then-Anthem Blue Cross policy hurt much worse than the procedure.

The downside to being diagnosed and then treated for basal cell carcinoma is that once you have had it you have a 40 percent chance of developing it again at the same or another site. Now more than ever, we all need to be vigilant and proactive about our health.

Among your New Year’s resolutions, please make one to visit a dermatologist. Cheers to you and yours, and have a happy, healthy, and worry-free 2015!