In previous blogs I described my challenge of having a squamous cell carcinoma, a type of skin cancer. I also described my experience, having Mohs Surgery, the most effective procedure (statistically) to remove all cancer cells. My procedure was on June 19, 2007. I will post photos of my healing scar at about three months post-surgery.
Yesterday I got my bill from Dr. Ting, my dermatologist and surgeon. Holy guacamole! Who would think it so costly to have a few cells removed from a cheek? I have a large deductible on my medical insurance. As cancers go, my experience hasn't been bad, but. . . .
Last night Dr. Ting phoned me. When I noticed his number on my caller I.D., as the phone rang. . . .well, I'm familiar with the drill by now. I have another squamous cell carcinoma on my opposite cheek this time, underneath my eye.
My original purpose for seeing Dr. Ting was to have unsightly--albeit small--precancerous bumps removed. My desire was to beautify myself.
So far, every time I leave Dr. Ting's office, I look beat up and patched up. I've been waiting for my last procedure to heal, along with the tiny wounds I have from removed skin tags, warts and moles, that Dr. Ting likes to call "barnacles of wisdom." And now I need another cut that requires a surgical flap to cover the small crater that is created by the excision of the cancer cells.
I feel a bit foolish. There's a good chance that the application of nitrogen--which is far less invasive and far less expensive--could freeze the cancer cells off my face completely. My face would look a whole lot better, and my finances wouldn't take such a hit.
What if doing nothing is all I need to do? Would these cancers really spread? I've opened Pandora's box and can't seem to close it.
Dr. Ting says that if it were his daughter or sister with skin cancer, he would recommend Mohs Surgery. I believe him but can't help notice that with nine Mohs Surgeries, he's making over $20K in one day, and I feel stuck without a choice.
To be fair to Dr. Ting, I'm leery of doctors in general. I wouldn't have him as my doctor if he hadn't demonstrated skill, patience and kindness for me as his patient. But what if we discover a third cancer? We haven't even begun to work on my neck and back. Dr. Ting tells me that Mohs Surgery would not be necessary on areas other than my face. He could simply make a cut.
He has suggested a chemical peel to me many times as a preventative measure. The cost: $500. Not a moneymaker for him. I am researching the side effects of the chemical peel, and when my face has healed, I will probably take that step. At that time I will describe the procedure and post before and after photos.
To be continued. . . .
Showing posts with label skin cancer. Show all posts
Showing posts with label skin cancer. Show all posts
Friday, July 13, 2007
Wednesday, July 4, 2007
The Word on Sunscreen
My goal for this blog entry was to give basic advice on using sunscreen:
1. How does sunscreen work?
2. What ingredients do I look for?
3. What are some recommended brands of sunscreen?
There are some differences of opinion on this topic, so I’ll give very basic information.
Sunscreen protects the skin from ultraviolet light, which can cause sunburn. Ultraviolet (UV) light can produce long-term damage, such as premature skin aging and skin cancer.
The ingredients to look for in sunscreens are titanium oxide or zinc oxide, which reflect the UV light. Avobenzone and oxybenzone (sometimes called “helioplex”) absorb the UV light.
The American Academy of Dermatology recommends using a sunscreen with a minimum SPF (Sun Protection Factor) of 15. After finding cancer cells and precancerous cells on my face---see The Word is Squamous and Squamous Part Deux---my dermatologist wants me to wear SPF50. SPF indicates the time a person can be exposed to sunlight before getting sunburn with a sunscreen applied relative to the time they can be exposed without sunscreen. Say what?
For instance, someone who would burn after 12 minutes in the sun would expect to burn after 2 hours (120 minutes) if protected by a sunscreen with an SPF of 10. However, the effectiveness of sunscreen depends upon how often you apply it, what type of activity you’re engaged in, and what type of skin you have.
If that doesn’t confuse you, here’s another school of thought. Research has shown (one bit of research) that a population known to have worn sunscreen actually had more incidents of skin cancer than the average population. It is suggested that some of the ingredients in sunscreen can cause cancer.
Others believe that while sunscreen blocks UV rays, it also prevents the skin from absorbing vitamin D—which is vital in the body’s utilization of calcium.
The pro-sunscreen group, which includes dermatologists and the Skin Cancer Foundation, suggests that everyone wear sunscreen beginning at the age of six months. Use of sunscreen is recommended for all races, including African-Americans. Use of sunscreen is also recommended on overcast and cloudy days.
I wonder why so many people get skin cancer nowadays. Is it because we live longer? I also wonder if thousands of people have skin cancer and live their lives without knowing it. Maybe the cancer only spreads once it’s cut or aggravated in some way. Obviously, some skin cancers spread vigorously, dangerously and fatally. But I wonder about the tiny ones, like the squamous cell carcinoma that I had removed. What would have happened if I’d done nothing? It was teensy, but I had it removed anyway. I still wonder....
I played in the sun as a kid. I got a pretty good suntan maybe two or three summers of my young adult life, when I still had time to lie in the sun. One summer, while getting ready for my 20th high school reunion, I had at least 10 visits to a tanning bed. I think that using the tanning bed caused my skin cancer.
Http://www.skincancer.org says that all sunscreens should have the Skin Cancer Foundation Seal of Approval. Here’s a list of effective sunscreens, approved by the Skin Cancer Foundation.
I tend to be sensitive to cremes. I had to remove the first sunscreen that I tried (Coppertone Water Babies), because the scent bothered me. I now see that this brand contains none of the required ingredients that block UV rays. Yet, the front of the bottle says, "No. 1 Pediatrician Recommend Brand." I now use unscented Neutrogena Healthy Defense Daily Mosturizer SPF 45 with helioplex. My dermatologist says this is a good one. Yet, today I read the active ingredients and there is no titanium oxide or zinc oxide.
The Neutrogena brand has no seal from the Skin Cancer Foundation, but it has a seal from the American Cancer Society, and it says, "The American Cancer Society (ASC) and Neutrogena, working together to help prvent skin cancer, support the use of sunscreen. The ACS does not endorse any specific product. Neutrogena pays a royalty to the ACS for the use of its logo."
Maybe this is Neutrogena's explanation for not using titanian oxide or zinc oxide, as the Skin Cancer Foundation is a separate entity from The American Cancer Society. Hmmmm. Maybe I'd better find yet another sunscreen that is unscented, with all of the recommended ingredients.
This is what I choose to do with this information: I keep a hat and some sunscreen in my car at all times. I will avoid getting a sunburn at all costs. I’d rather protect my face with a hat, but I will use the sunscreen in moderation. If I go for a walk, I’ll probably just wear a hat. If I’m spending time at the beach or on the golf course, I’ll put sunscreen all over, and mine will be SPF45 or 50.
1. How does sunscreen work?
2. What ingredients do I look for?
3. What are some recommended brands of sunscreen?
There are some differences of opinion on this topic, so I’ll give very basic information.
Sunscreen protects the skin from ultraviolet light, which can cause sunburn. Ultraviolet (UV) light can produce long-term damage, such as premature skin aging and skin cancer.
The ingredients to look for in sunscreens are titanium oxide or zinc oxide, which reflect the UV light. Avobenzone and oxybenzone (sometimes called “helioplex”) absorb the UV light.
The American Academy of Dermatology recommends using a sunscreen with a minimum SPF (Sun Protection Factor) of 15. After finding cancer cells and precancerous cells on my face---see The Word is Squamous and Squamous Part Deux---my dermatologist wants me to wear SPF50. SPF indicates the time a person can be exposed to sunlight before getting sunburn with a sunscreen applied relative to the time they can be exposed without sunscreen. Say what?
For instance, someone who would burn after 12 minutes in the sun would expect to burn after 2 hours (120 minutes) if protected by a sunscreen with an SPF of 10. However, the effectiveness of sunscreen depends upon how often you apply it, what type of activity you’re engaged in, and what type of skin you have.
If that doesn’t confuse you, here’s another school of thought. Research has shown (one bit of research) that a population known to have worn sunscreen actually had more incidents of skin cancer than the average population. It is suggested that some of the ingredients in sunscreen can cause cancer.
Others believe that while sunscreen blocks UV rays, it also prevents the skin from absorbing vitamin D—which is vital in the body’s utilization of calcium.
The pro-sunscreen group, which includes dermatologists and the Skin Cancer Foundation, suggests that everyone wear sunscreen beginning at the age of six months. Use of sunscreen is recommended for all races, including African-Americans. Use of sunscreen is also recommended on overcast and cloudy days.
I wonder why so many people get skin cancer nowadays. Is it because we live longer? I also wonder if thousands of people have skin cancer and live their lives without knowing it. Maybe the cancer only spreads once it’s cut or aggravated in some way. Obviously, some skin cancers spread vigorously, dangerously and fatally. But I wonder about the tiny ones, like the squamous cell carcinoma that I had removed. What would have happened if I’d done nothing? It was teensy, but I had it removed anyway. I still wonder....
I played in the sun as a kid. I got a pretty good suntan maybe two or three summers of my young adult life, when I still had time to lie in the sun. One summer, while getting ready for my 20th high school reunion, I had at least 10 visits to a tanning bed. I think that using the tanning bed caused my skin cancer.
Http://www.skincancer.org says that all sunscreens should have the Skin Cancer Foundation Seal of Approval. Here’s a list of effective sunscreens, approved by the Skin Cancer Foundation.
I tend to be sensitive to cremes. I had to remove the first sunscreen that I tried (Coppertone Water Babies), because the scent bothered me. I now see that this brand contains none of the required ingredients that block UV rays. Yet, the front of the bottle says, "No. 1 Pediatrician Recommend Brand." I now use unscented Neutrogena Healthy Defense Daily Mosturizer SPF 45 with helioplex. My dermatologist says this is a good one. Yet, today I read the active ingredients and there is no titanium oxide or zinc oxide.
The Neutrogena brand has no seal from the Skin Cancer Foundation, but it has a seal from the American Cancer Society, and it says, "The American Cancer Society (ASC) and Neutrogena, working together to help prvent skin cancer, support the use of sunscreen. The ACS does not endorse any specific product. Neutrogena pays a royalty to the ACS for the use of its logo."
Maybe this is Neutrogena's explanation for not using titanian oxide or zinc oxide, as the Skin Cancer Foundation is a separate entity from The American Cancer Society. Hmmmm. Maybe I'd better find yet another sunscreen that is unscented, with all of the recommended ingredients.
This is what I choose to do with this information: I keep a hat and some sunscreen in my car at all times. I will avoid getting a sunburn at all costs. I’d rather protect my face with a hat, but I will use the sunscreen in moderation. If I go for a walk, I’ll probably just wear a hat. If I’m spending time at the beach or on the golf course, I’ll put sunscreen all over, and mine will be SPF45 or 50.
Monday, June 25, 2007
Squamous Part Deux
On Tuesday June 18, Dr. Ting removed the tiny carcinoma from my left cheek. The procedure only required one pass--to remove cancerous tissue to be examined under the microscope. When Dr. Ting returned from the lab, he asked me if I wanted to see the incision ("excision" is more precise). I normally prefer to be involved in my own care as much as possible, but I didn't have the heart to see the results.
A soft paper cloth draped over my face caused me the most discomfort. The purpose of the cloth was to keep the wound sterile. Feeling smothered is a personal quirk of mine, but it was no big deal, and no pain whatsoever was involved otherwise.
Stitching the wound required more time than anything else, partly because the skin needed further cutting to compensate for the gap made by the vacant hole. Dr. Ting made some sketches of potential cuts he could make as part of Mohs procedure that I previously described.
Here are Dr. Ting's sketches:
Holy guacamole, Batman! Can't you just spackle the hole, instead of making it bigger?
I'm usually a control freak about my medical care. But since my dismay about getting my face cut made it difficult for me to picture minimal scarring, I asked Dr. Ting to do what he thought best. Mohs procedure is a bit bizarre. The idea of making a relatively big incision in order to keep scarring to a minimum is hard to grasp. You can judge for yourself whether you think it works or not by viewing the photos below.
The biggest problem in dealing with skin cancer has been the inconvenience of the surgery and the $2000-deductible I have on my medical insurance policy. Once I removed my bandage a few days later, I looked like Frankenstein's distant, distant cousin.
Day 6 before my office visit:
I suffered no discomfort, getting the stitches removed. I had opted not to take antibiotics for this procedure. And when I found out that the topical antibiotic ointment was $48 a tube, I did not buy the prescription. I kept the wound very clean and used the topical ointment that Dr. Ting gave me.
Day 6 after the removal of my stitches:
In two weeks I return to Dr. Ting to get more moles and precancerous bumps off my skin that are typical to baby boomers who worshipped the sun when we were young, especially here in California.
If anyone reading this gets skin cancer, I'd try not to worry. A melanoma is more likely to cause problems than a squamous cell carcinoma or a basal cell carcinoma. Early detection of all of these is the key. It is definitely time to wear a hat when I go for a hike, play a game of golf, or work in the yard.
Dr. Ting swears by sunscreen with an SPF rating of 50 or higher. He also recommends that I get a chemical peel to remove other recancerous marks on my face. I will research both these topics and post what I decide here on this blog.
A soft paper cloth draped over my face caused me the most discomfort. The purpose of the cloth was to keep the wound sterile. Feeling smothered is a personal quirk of mine, but it was no big deal, and no pain whatsoever was involved otherwise.
Stitching the wound required more time than anything else, partly because the skin needed further cutting to compensate for the gap made by the vacant hole. Dr. Ting made some sketches of potential cuts he could make as part of Mohs procedure that I previously described.
Here are Dr. Ting's sketches:
Holy guacamole, Batman! Can't you just spackle the hole, instead of making it bigger?
I'm usually a control freak about my medical care. But since my dismay about getting my face cut made it difficult for me to picture minimal scarring, I asked Dr. Ting to do what he thought best. Mohs procedure is a bit bizarre. The idea of making a relatively big incision in order to keep scarring to a minimum is hard to grasp. You can judge for yourself whether you think it works or not by viewing the photos below.
The biggest problem in dealing with skin cancer has been the inconvenience of the surgery and the $2000-deductible I have on my medical insurance policy. Once I removed my bandage a few days later, I looked like Frankenstein's distant, distant cousin.
Day 6 before my office visit:
I suffered no discomfort, getting the stitches removed. I had opted not to take antibiotics for this procedure. And when I found out that the topical antibiotic ointment was $48 a tube, I did not buy the prescription. I kept the wound very clean and used the topical ointment that Dr. Ting gave me.
Day 6 after the removal of my stitches:
In two weeks I return to Dr. Ting to get more moles and precancerous bumps off my skin that are typical to baby boomers who worshipped the sun when we were young, especially here in California.
If anyone reading this gets skin cancer, I'd try not to worry. A melanoma is more likely to cause problems than a squamous cell carcinoma or a basal cell carcinoma. Early detection of all of these is the key. It is definitely time to wear a hat when I go for a hike, play a game of golf, or work in the yard.
Dr. Ting swears by sunscreen with an SPF rating of 50 or higher. He also recommends that I get a chemical peel to remove other recancerous marks on my face. I will research both these topics and post what I decide here on this blog.
Sunday, June 10, 2007
The Word Is "Squamous"
Two days before my 59th birthday, my telephone rings at 8 a.m. When I see my dermatologist's caller I.D., I assume his staff is contacting me. I've recently had session two of moles and other weird thingies removed from my face, mostly for cosmetic reasons. I don't want my grandchildren to see an old witch when they look at my face.
After session one, everything was benign. I haven't thought twice about the lab work from session two until I hear my doctor's voice on the line. He says that one tiny bump on my face has come back positive. "Remember that one bump that I thought looked suspicious?" he asks. I remember. He says I need to come in and have it cut out. No big deal.
What could be difficult? Nothing really, except that he will excise some skin, freeze it, and send it to the lab. We will then wait for the lab results before sewing me up or before cutting deeper. If he cuts more, he will freeze more cells and send them to the lab, and the procedure will repeat until there is no sign of cancer.
He asks me to look up "Mohs surgery" on the Internet. Hmmmm. I've been looking forward to this year's birthday. I'm not sure how to feel now. Once I Google "Mohs," it becomes difficult to be optimistic. I read that the physician makes an oblong incision, plenty long to get all the cancer cells. Nothing significant on someone's forehead or arm, but my tiny lump is on my cheek, near the smile crease that goes from my nose to my mouth.
I call the doctor back and talk to his staff. "I need to know what kind of cancer this is," I say. "The doctor told me to look up "Mohs surgery. He did not say what kind of cancer it is." The nurse says: "Squamous cell carcinoma." "Isn't this worse than basal cell carcinoma?" I ask, trying my best to pump her for info that will give me some peace of mind. She seems noncommital.
I find out that both basal cell and squamous cell carcinomas are usually 100 percent curable if treated right away. Squamous cells may metasticize more quickly, but basal cells go deeper and may be more disfiguring. In my case I'm more concerned about potential disfigurement--I think. I request the name of a plastic surgeon.
When Dr. Ting calls me with some surgeons' names, I ask to schedule an extra appointment to discuss my options, face to face. Is surgery a must? I don't want to be disfigured. I love Dr. Ting. He fits me in two days from now. I've decided that once I do everything possible to insure success, I will put this topic out of my mind. I'm feeling more in control as I pursue more information.
Meanwhile, I find infinite sources on the Internet indicating that the Mohs procedure provides the highest assurance of complete cancer removal but preserves a maximal amount of normal tissue.
I go to my consultation two days later. Dr. Ting draws an incision on my face as plan A. He will do Mohs procedure on eight different people on my big day, and I'm second in line. I like the order. He can warm up on number one, but still be fresh during my turn.
Below is the squamous cell carcinoma on my left cheek. What you see started as a tiny thing before it was cut and sent to the lab a few weeks ago. Note: I cropped away my face like they do in the medical journals--to display these silly cancer cells.
Dr. Ting erases the ink and draws plan B, in case there are lots of cancer cells. He tells me that the plastic surgeons will charge $6,000 to stitch the hole closed. This fee is obscene. Why would one human overcharge another human to do an hour's work when this procesure is not optional?
Dr. Ting looks like an Asian Doogie Howser. He credits his consistent use of sun screen for his youthful appearance. (He reminds me to put on my SPF50 before I step outside.) He has performed Mohs technique many times; he is confident that the scar will not be a problem for me. I believe him. I decide to count on him. June 19th. I will say so long to "squamie" and update this topic.
After session one, everything was benign. I haven't thought twice about the lab work from session two until I hear my doctor's voice on the line. He says that one tiny bump on my face has come back positive. "Remember that one bump that I thought looked suspicious?" he asks. I remember. He says I need to come in and have it cut out. No big deal.
What could be difficult? Nothing really, except that he will excise some skin, freeze it, and send it to the lab. We will then wait for the lab results before sewing me up or before cutting deeper. If he cuts more, he will freeze more cells and send them to the lab, and the procedure will repeat until there is no sign of cancer.
He asks me to look up "Mohs surgery" on the Internet. Hmmmm. I've been looking forward to this year's birthday. I'm not sure how to feel now. Once I Google "Mohs," it becomes difficult to be optimistic. I read that the physician makes an oblong incision, plenty long to get all the cancer cells. Nothing significant on someone's forehead or arm, but my tiny lump is on my cheek, near the smile crease that goes from my nose to my mouth.
I call the doctor back and talk to his staff. "I need to know what kind of cancer this is," I say. "The doctor told me to look up "Mohs surgery. He did not say what kind of cancer it is." The nurse says: "Squamous cell carcinoma." "Isn't this worse than basal cell carcinoma?" I ask, trying my best to pump her for info that will give me some peace of mind. She seems noncommital.
I find out that both basal cell and squamous cell carcinomas are usually 100 percent curable if treated right away. Squamous cells may metasticize more quickly, but basal cells go deeper and may be more disfiguring. In my case I'm more concerned about potential disfigurement--I think. I request the name of a plastic surgeon.
When Dr. Ting calls me with some surgeons' names, I ask to schedule an extra appointment to discuss my options, face to face. Is surgery a must? I don't want to be disfigured. I love Dr. Ting. He fits me in two days from now. I've decided that once I do everything possible to insure success, I will put this topic out of my mind. I'm feeling more in control as I pursue more information.
Meanwhile, I find infinite sources on the Internet indicating that the Mohs procedure provides the highest assurance of complete cancer removal but preserves a maximal amount of normal tissue.
I go to my consultation two days later. Dr. Ting draws an incision on my face as plan A. He will do Mohs procedure on eight different people on my big day, and I'm second in line. I like the order. He can warm up on number one, but still be fresh during my turn.
Below is the squamous cell carcinoma on my left cheek. What you see started as a tiny thing before it was cut and sent to the lab a few weeks ago. Note: I cropped away my face like they do in the medical journals--to display these silly cancer cells.
Dr. Ting erases the ink and draws plan B, in case there are lots of cancer cells. He tells me that the plastic surgeons will charge $6,000 to stitch the hole closed. This fee is obscene. Why would one human overcharge another human to do an hour's work when this procesure is not optional?
Dr. Ting looks like an Asian Doogie Howser. He credits his consistent use of sun screen for his youthful appearance. (He reminds me to put on my SPF50 before I step outside.) He has performed Mohs technique many times; he is confident that the scar will not be a problem for me. I believe him. I decide to count on him. June 19th. I will say so long to "squamie" and update this topic.
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