In Which I Panic Over a Minor Skin Lesion

I’ve always loved being outdoors. I have numerous hobbies and interests but my favorites all happen outside. Hiking, paddling whitewater, running, and mountain biking are on the list. I’ve always known that I was at risk of skin cancer, being of ruddy complexion with blond hair and grey-blue eyes, and favoring spending my free time outdoors. These are all risk factors. It comes with the territory.

I’ve had a number of moderately severe sunburns over the years, including a few on my entire upper body. The worst burns have been associated with trips to Florida, a place where I find I can barely even tolerate winter sun, let alone the glare of a sandy beach in July or August. I remember the shock the first time I realized it was possible to get a sunburn on my scalp, sometime in my twenties, after my hair started to thin. Florida sun can burn any part of my body.

A few years ago I had some “pre-cancerous” moles removed so I’ve been more aware of the risks since that time. I began taking more precautions. I increased my use of sunscreen, started wearing hats, and a couple of years ago, even started wearing long sleeves when on the water paddling or at the beach. All of this was apparently too late. Last year I got a bump in my scalp just above my right ear. It grew up quite rapidly and I mistook it for acne. After a few weeks I realized it was probably something more permanent, however it seemingly stopped growing after the initial rapid expansion so I concluded that it was probably just a mole or a keloid scar as I have had acne there over the years many times, so I put off going to the dermatologist. That, of course, was a mistake.

Finally, I recently decided that as someone approaching 40, I had been neglecting my personal health a little too much so I made some changes to my lifestyle. I stopped drinking daily to lower my cholesterol (they are related for me), refocused on cross training for better all-around fitness, and started making doctor’s appointments to address ongoing issues with back pain, and of course, the small bump in my scalp. It had been worrying me for a couple of months because it often looked red and irritated and appeared to swell up with physical activity, overheating, or alcohol consumption. These were signs that it was well vascularized, which is to say that the body decided it needed a lot of blood flow to that location, one of the warning signs of cancer. Since cancer by definition is uncontrolled cell growth, cancer requires a lot of blood flow to feed the growth. This was quickly biopsied and determined to be a basal cell carcinoma. This is a type of cancer.

A basal cell carcinoma is a cancerous growth that has resulted from damage to the genome of epithelial (or similar) cells. Skin is an example of epithelium. These are basically cells that grow in a layer and are found on the external and internal surfaces of the body. I knew that basal cell carcinoma is rarely fatal, and rarely undergoes metastasis - the process of cancer cells detaching and spreading to remote parts of the body. I know several people who have had basal cell carcinomas and lived to tell the tale with only minor inconvenience. The cancer must be removed, because if it is not, then it will simply keep growing, but it is not a cause for panic.

The problem is, when someone tells you that you have cancer and uses that actual word then you tend to panic. Soon I found myself thinking about that thing growing on the side of my head as if it was a living parasite, sucking the life out of me through my temporal region. Then I thought of the sun as an enemy, trying to kill me. Down with the sun!

Next I thought, what if the dermatologist and pathologist are wrong, and it’s actually melanoma, a much deadlier form of cancer? Since I was not able to get an appointment quickly to see my usual dermatologist, they scheduled me with “the kid.” He is a new doctor to the practice and from the looks of things is just out of his residency. When he collected the biopsy specimen, another older doctor actually had to sign off on his order. Maybe he made a mistake through inexperience?

Then I started thinking about risk factors. Does your risk of melanoma increase if you’ve had a basal cell carcinoma? All of these things spiraled through my head. This lead to a state of near panic the night before the procedure to have it removed.

To make matters worse, I had put off completing my income taxes and now the due date would be the day after the procedure. Since the doctor had told me to bring someone with me to drive me home, I concluded that I would be sedated and possibly in pain after the procedure and I didn’t want to be up against a midnight deadline in that condition, so I stayed up very late the night before the procedure, a ball of worry, struggling with my taxes, first panicking when I thought I owed a significant amount, then relaxing a little when I finally realized I had missed several thousand dollars of deductions. I managed to get this done by midnight but was still not sleepy.

The next phase was a lengthy rumination on life and death, considering that it had been a good life although I had not traveled nearly as much as I had expected or hoped to. I also had the feeling that I had made very little of a mark on life, influencing too few people positively or in a way that would be memorable, regretting the negative influence I might have had, the offenses I had given, etc. I regretted leaving no offspring, creating no great works of art or literature, and not having been more productive. I've always been an underachiever and as usual I felt keenly at a loss to explain how I could waste so much opportunity. Soon I was in a very dark state of pondering the meaning of life, the briefness of our time on earth, and whether or not there is an afterlife.

Eventually I started suffering from the effects of my insomnia, being hit by waves of paranoia, which happens if you live alone for a long time and stay up for too many consecutive hours without rest. I imagined something behind me walking around the house, always just out of sight when I looked over my shoulder. I imagined demons in the garage and things stalking me around corners, but there were only the cats.

The final straw that allowed to relax a bit was an imaginary scene of the doctor cutting into my head and realizing to his panic, that something was terribly wrong and the lesion had been completely misdiagnosed, and that he didn’t know what it was but it was terrible. Shortly an Alien from the Ridley Scott movie burst from the side of my head in a shower of blood! I started laughing and realized I needed to get some sleep.

All of this over a minor cancer, probably the least dangerous type of cancer you can have, and not something that is life threatening. I probably could have let it go another year without removing it, not that it would have been a good idea. By the time I went to bed, it was after 2 am. The appointment was for 8:20 am. Nice! Forget about cancer, procrastination kills.

And now I’m sitting writing under the influence of hydrocodone. Although I’ve had some skin surgery before, I did not recall it being so unpleasant. I feel like I’ve been hit in the side of the head with a baseball bat. The skin is pulled very tight due to the stitches and the wound is swollen and throbbing, but I can be assured they got everything because the procedure they used (Mohs Microsurgery) included an onsite biopsy to ensure that the entire carcinoma was removed. Now I just have to live with the recovery process for the minor wound, and the worry about recurrence, and the worry about other spots appearing, and the worry about the risk of melanoma since both types of cancer essentially have the same risk factors. I still have to go back to work tomorrow, still have to pay my bills, still have to mow the lawn. But I will recover and I will get to go back outdoors to have my fun and take enjoyment from my small, simple, ephemeral existence.

I know none of this was worth the worry, but when I heard the word “cancer,” it had an effect on me that was all too predictable and somewhat irrational, yet I found my response uncontrollable. I knew I was overreacting, but I couldn’t help myself. Now I feel pathetic for thinking about a minor skin lesion the same way someone with say, lung cancer, or malignant melanoma would feel. It’s not as serious of a condition, it is not life threatening, and I have no justification to sit around contemplating my mortality and feeling sorry for myself. That said, I can tell I’m still integrating the knowledge that I’ve had actual cancer and time will tell how I deal with it.