Diagnosis: Skin cancer
Come summer, the sun plays a starring role — blazing at the beach, lengthening our afternoons, luring us to exercise outside. But the truth is, that big, yellow ball is present 365 days a year, so we’re almost always in its spotlight. Stepping outside unprotected for a few measly minutes might seem harmless, but the damage adds up: UV rays are linked to 90 percent of nonmelanoma skin cancers and 65 percent of melanomas, the deadliest form of skin cancer. In fact, skin cancer is the most common cancer in the United States, with 1 million cases diagnosed annually. And melanoma is the second most common cancer among women age 25 to 29.
In spite of the scary statistics, we’re not suggesting you live in a cave. Our job is to arm you with the facts and encourage you to stay safe. Research shows that reminders do make a difference; 56 percent of people who received a text message to wear sun protection slathered it on, a study by Harvard University Medical School in Boston shows. And protecting yourself truly pays off. Skin cancer is one of the most preventable forms of cancer, according to the American Cancer Society in Atlanta; wear sunscreen with SPF 30 and you’ll be protected from up to 97 percent of UVB rays. It’s also one of the most curable: Detecting melanoma in its early stage gives you a 99 percent chance of beating the disease. Just ask these survivors; their stories will inspire you to safeguard your skin. Want a heads-up to apply sunscreen? Text SELFSKIN to 467467 for four weekly alerts.
The sports enthusiast
Nanette Bercu, diagnosed with melanoma at age 36
Growing up in Southern California, Bercu, 38, was always romping around beneath the rays. “I practically peeled myself a new nose every summer,” she says. At 16, breakouts motivated her to see a dermatologist. Along with her acne, a mole on her lower back caught the doctor’s attention. He biopsied the spot, and when the results came back as atypical (meaning it could progress into melanoma), Bercu’s doctor said her best option was to have the mole cut out. (This diagnosis — dysplastic nevus — became a familiar one for Bercu; over the next two decades, she would have more than 20 other moles removed.) Even so, Bercu wasn’t as committed to daily sun protection in college as she should have been. “I went to school in Rhode Island, where it’s mostly rainy and snowy. Sunscreen didn’t seem necessary year-round,” she says.
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Meanwhile, new moles continued to pop up on her body, and by her mid-20s, Bercu finally became diligent about using sunscreen with a minimum SPF of 30, reapplying several times when outside. “There were more public warnings about skin cancer, and I was getting about three moles removed every year,” she says. By the time she reached her 30s, Bercu, now the creative director of Paul Mitchell Haircare and a mom of two, visited the doc every six months. “As my family grew, I worried about my kids being in the sun,” Bercu says. “I coated us all in sunscreen.” Bercu also began doing triathlons, her UV exposure increasing as she spent countless hours training outdoors. Her doctor started to routinely take pictures of her scalp, breasts, feet, stomach and thighs — known as total body photography — to track new and existing growths. (Bercu has copies at home to do self-exams between visits.) “Nanette is so freckled that you can’t find a patch of pigment-free skin,” says Barbara Hayden, M.D., a plastic surgeon in Santa Monica, California, who has performed all of Bercu’s mole removals since she graduated from high school.
In May 2008, another questionable mole was excised from Bercu’s back. Three weeks later, after a routine check to see how the incision was healing, Dr. Hayden noticed a fresh growth, right above the stitches, that hadn’t been there just weeks before — a major red flag for skin cancer. “It was pin-sized, the tiniest mole I’d ever had removed,” Bercu says. When the biopsy came back as malignant melanoma, “my life flashed before my eyes,” Bercu says. “I thought, I’m only 36.”
Bercu’s doctors said there was a 40 percent chance that the cancer had spread to other parts of her body, so the next step was to test her lymph nodes. (The lymphatic system acts as an internal drainage system for the body; its nodes are like drop-off zones for the “garbage” picked up along the way, including cancer cells.) As she lay on the exam table, neon-colored radioactive dye was injected directly into the melanoma, then made its way to three areas where the cancer might have migrated: both armpits and her groin. (This process is known as lymph node mapping.) “I thought, I’m doomed,” she recalls. “It’s everywhere inside of me.” Days before her 37th birthday, Bercu had a portion of each of the nine possibly affected lymph nodes taken out and tested. The mole and surrounding tissue were also removed, leaving Bercu’s lower back with a zipperlike scar running about 3 inches long and an inch deep. (See photo on previous page.)
Bercu’s lymph nodes were cancer-free, but the painful procedure and ensuing recovery meant she had to do physical therapy to regain motion in her shoulders. After months of rehabilitation, she was able to move normally, although nerve damage slowed her recuperation, and she still has difficulty fully extending her arms. Despite these setbacks, Bercu, ever the athlete, could not wait to begin training again, even though that would mean facing the sun once more. “I choose to continue the activities I enjoy but be smart about sun protection,” she says.
These days, Bercu works out only before 10 a.m. or after 4 p.m., when rays are weaker, and she never goes without sweat-resistant sunscreen with SPF 60. Clothing with UPF (UV protection in fabric) is a staple in her active wardrobe, and she stashes sunscreen everywhere — car, gym bag, even a little compartment mounted on her bike. “Having melanoma was a blessing in disguise,” says Bercu, who gets full-body photos taken every six months and skin checks every three. “I refuse to live like a prisoner to skin cancer.”
Healthy skin how-to
Take cover! On average, you’re exposed to a minimum of 28 hours of sunlight per month, a survey from Proctor & Gamble Beauty in Cincinnati reveals. Sun protection (at least SPF 30 plus UPF-infused clothes) is your most valuable anticancer weapon. “A white T-shirt offers less than SPF 10,” says Gervaise Gerstner, M.D., a dermatologist in New York City.
The sun worshipper
Hedy Gold, diagnosed with melanoma at age 31
As an adolescent, the Bloomfield Hills, Michigan, native basked in the sun every chance she got. “It was like a drug,” says the self accessories director, 39. “I loved the feeling of warmth on my skin, and I was never dark enough, so I always skipped SPF.” During high school, in pursuit of an everlasting glow, Gold walked into a tanning salon and sprang for an unlimited-access membership. (The shocking truth? Every day, approximately 1 million people visit tanning beds, according to the American Academy of Dermatology in Schaumberg, Illinois. That might explain why there are more indoor tanning salons than there are Starbucks or McDonald’s in many U.S. cities, as a study from San Diego State University reports.) Even in the dead of winter, Gold would hit the blue bed several times a month. After graduation, she headed to Arizona State University at Tempe, where she lounged with friends at campus pools in between studying to get straight As. “Lying outside made me feel good, and I thought it made me look good, too,” Gold says. (Tanning may be addictive in the same way alcohol and narcotics are, a study in the Journal of the American Academy of Dermatology finds.)
In 2001, Gold moved to New York City to pursue a career in the fashion industry. “I missed being in the sun so much,” says the naturally fair-skinned, green-eyed blonde (traits that further increase her risk). So she reunited with her beloved tanning beds as often as she could — sneaking in appointments a few times a month — a hobby that cost her hundreds of dollars a year. “I didn’t realize I was putting my life in danger,” she says. “Then I got a major wake-up call.”
A few weeks before starting a new job as an accessories editor at a magazine, Gold flew home to spend time with her family. Her father, a general-practice doctor in Michigan, noticed that a mole on the left side of her face seemed bigger, darker and a different shape than he had recalled; he suggested she get it checked out by a dermatologist — asap. “Honestly, I hadn’t even noticed the mole had changed until then,” Gold admits.
She scheduled an appointment with one of the dermatologists at Juva Skin and Laser Center in NYC the week she returned. Although the mole didn’t look abnormal — it wasn’t unevenly shaped, noticeably large or multicolored — she explained that its size and color had recently morphed. Because of Gold’s detailed description, her doctor elected to shave off a small piece of the growth (a noninvasive method often used to remove a few surface skin cells) so it could be biopsied.
“Her diagnosis was actually good news,” says Michael Bruck, M.D., director of Juva Skin and Laser Center, who removed Gold’s cancer. “It meant that if it was taken out, we’d have a cure. So that’s exactly what I did.” A week after the surgery, which required the excision of about a half inch of tissue and 3 inches of stitches, Gold went to Manhattan’s Bryant Park to attend Fashion Week, where she reviewed several designers’ shows along with her beautifully attired peers. “Everyone was concerned when they saw the large white bandage taped across my cheek,” Gold recalls. “I told my story to anyone who would listen to help raise awareness.” A test of tissue surrounding the growth came back as benign, which confirmed that the cancer had been completely removed.
Now the former tanning junkie, who is expecting her first child this month, wears SPF 30 sunscreen on her face every day (SPF 60 all over if she’s at the beach) and hasn’t set foot in a tanning salon in eight years. (Dr. Bruck, whom she revisited to discuss details for this story, says that Gold’s consistent exposure to UVA light beds on and off for 15 years, coupled with her genetics, puts her at greater risk of developing skin cancer.) “I’m scared to death it will come back,” says Gold, who since her melanoma diagnosis has had six questionable moles biopsied from her calves, thighs and stomach. The most recent, located on the back of her left thigh, was found by Kathryn Frew, M.D., a colleague of Dr. Bruck’s. Upon review, it was labeled as severe dysplastic nevus (an irregular mole that could become melanoma if it isn’t removed) and had to be taken out. “Anything that looks even remotely suspicious I have checked,” Gold says. “It’s truly an ongoing battle.”
Healthy skin how-to
The risk of developing melanoma is 75 percent greater for people who used tanning beds as teens, notes the International Agency for Research on Cancer in Lyon, France. “The machines are particularly dangerous because they emit UVA rays, which penetrate deeply and are less likely than UVB to cause a burn. You get damage without realizing it,” Dr. Mark says. A ray of hope: The FDA has given a report to Congress proposing that clearer warning labels be placed on all tanning beds, stating that consistent use of the device may lead to skin cancer.
The doctor turned patient
Elizabeth Tanzi, diagnosed with melanoma at age 37
Dr. Tanzi, 39, codirector of the Washington Institute of Dermatologic Laser Surgery in Washington, D.C., spent most of her college days cramming for exams in the dark confines of the university library. But six consecutive spring break trips to popular hot spots in Florida, Mexico and Jamaica sizzled her milky-white complexion year after year. “I’d get a large dose of sun exposure really quickly,” admits the native of Long Island, New York. “I should have paid better attention to my skin.” (Brief yet intense tanning time significantly increases one’s chance of developing melanoma, and even one blistering burn in childhood can dramatically increase the DNA damage that may lead to skin cancer.)
Postgraduation, she hung up her diploma and put away her bikini. “I became vigilant about staying out of the sun,” Dr. Tanzi says. “If I was going to be outside for several hours, I’d slather on sunscreen, hide under a hat and umbrella and wear capris to cover my legs. I was very careful not to burn.”
In 2007, while expecting her second child, a small mole on Dr. Tanzi’s right calf caught her eye. “As a doctor, I knew it wasn’t unusual for moles to darken during pregnancy because a surge in estrogen can enhance pigment,” she says. About six months later, after she’d given birth, she decided the mole had to be checked out. “It looked normal, but it had really changed in appearance,” she says. “Still, I definitely wasn’t thinking cancer.” That same week, in one of her office’s exam rooms, Dr. Tanzi performed her own biopsy, removing a tiny piece of the suspicious mole along with another larger mole on her left leg. The next night, while at home with her family, she received a voice mail from Carmen Myrie Williams, M.D., a dermatologist in Washington, D.C., who had reviewed the skin samples, urging Dr. Tanzi to return her phone call as soon as possible.
“I listened to the message, hung up the phone, looked at my husband and said, ‘I have melanoma,’” Dr. Tanzi recalls. “I just had a gut feeling. I was trembling and kept repeating, ‘I can’t believe it. I can’t believe it.’” At first, Dr. Tanzi suspected the worst-case scenario: advanced melanoma. And she was convinced that the second, larger mole was the culprit. To her surprise, the normal-looking growth on her right leg was an early-stage melanoma, whereas the more irregular one on her left was a basal cell carcinoma, skin cancer that is not considered life-threatening. “In an instant, I went from being a dermatologist who routinely diagnoses skin cancer to a patient with so many questions and concerns,” Dr. Tanzi says. “Having melanoma is frightening on multiple levels, because once it forms, it can spread quickly and be very difficult to treat.”
The next day, Dr. Tanzi’s colleague Martin Braun, M.D., a dermatologic surgeon in Washington, D.C., cut out her melanoma — a procedure that required a wide incision and left her with 17 stitches, a 3-inch scar and achiness for weeks. Fortunately, the lab results of the skin surrounding the tissue came back as clear of cancer. Three weeks later, she returned to Dr. Braun to have the basal cell carcinoma removed, too.
Dr. Tanzi says that her personal experience has given her a heightened sense of urgency when it comes to testing her abnormal-looking moles. “I think about dealing with a recurrence constantly. But as a mother of two toddlers, I try to be brave for my kids and move past the fear,” she says. Self-exams every three to six months (a colleague checks hard-to-see parts such as her back) and biopsies of anything that appears even remotely suspicious are now standard practice. To date, she has taken off a total of 18 lesions, mostly from her legs and back.
“I tell patients to get to know their moles,” Dr. Tanzi says. “Being able to see your body every day is an advantage that your derm doesn’t have.” She also preaches a proactive yet stern antiaging message to her young clientele. “I have thirtysomethings come in for Botox or other skin treatments, but they still tan, whether at the beach or in tanning beds,” she says. “I explain that there’s no point in targeting lines now if they’re just going to end up with a scar on their face from having skin cancer removed.” If they still don’t seem to be listening, she shares her own ordeal to make the consequences of lifestyle choices clear. And when it comes to being the bearer of potentially devastating news, such as a diagnosis of skin cancer, she believes her experience with the disease has made her more empathetic. “I spend a lot of time talking to patients about long-term prognosis,” she says. “Because I know firsthand that fear of the unknown can be unbelievably overwhelming.”
Healthy skin how-to
Schedule regular checkups — with your doctor and yourself. Ongoing dermatologist visits (every 6 to 12 months if you’ve never had skin cancer) plus monthly self-exams are key. Look for growths that have changed shape, color or size and for ones that bleed or itch. (See the A-through-E guidelines, page 56.)
If you’ve had precancers or skin cancer, your doc will most likely increase the frequency of in-office visits to every three months. “The number-one risk for melanoma is a prior melanoma,” says Kenneth Beer, M.D., a derm in West Palm Beach, Florida. “It could occur much later — 5, 10 or 15 years in the future.” When a mole on the right side of your body mirrors in location one on your left (or vice versa), the growths might be abnormal, says Neal Schultz, M.D., a dermatologist in NYC. (For example, you could have growths that reside in the same spot on both sides of your stomach.) Skin cells with a great deal of DNA damage send a signal to other cells via the bloodstream, indicating that something isn’t right; the result can be “twin” abnormal moles.
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