July 1, 2009
The first time Tracie Ross told her husband that she was concerned about a spot on his face, Don Ross, RPLS, brushed the idea aside. It was just a typical mole, he thought. She mentioned that it seemed to be getting larger, but Don wasn’t worried. He was only 35 years old, and he felt fine.
A few more months passed, and Tracie wouldn’t let the subject drop. Finally, in December 2006, Don decided to see a doctor to reassure his wife that all was well. Except that it wasn’t. A standard biopsy of the mole revealed that Don had malignant melanoma.
“It was a shock,” Don says. “You see some of those pictures of hideous moles that indicate skin cancer. Mine wasn’t like that. I’d never even heard of melanoma until I was diagnosed, and then I found out it’s one of the most aggressive forms of skin cancer.”
Battling CancerMelanoma is a cancer that begins in the melanocytes, which are the skin cells that make the brown pigment called melanin. While it is less common than basal cell and squamous cell skin cancers, it is far more serious and can be deadly if it is not caught early. The American Cancer Society estimates that more than 68,000 new cases of melanoma will be diagnosed in the United States in 2009; of those, approximately 8,650 (13 percent) will result in death. According to the American Academy of Dermatology, melanoma accounts for 77 percent of all deaths from skin cancer.
Dr. Lisa Hitchins, Don’s dermatologist, was determined to keep Don from becoming a statistic. She immediately referred him to The University of Texas M. D. Anderson Cancer Center, which is regarded as one of the foremost cancer treatment centers in the world. There, surgeons removed the melanoma along with some of the surrounding tissue and performed a sentinel lymph node biopsy (removal of the first three lymph nodes to which the cancer was likely to spread). Pathology revealed cancer cells in one of those lymph nodes. Don was at stage III--an advanced stage of melanoma. A second surgery was performed to remove 53 additional lymph nodes. “I always thought of skin cancer as basal cell carcinoma, where they just keep taking little pieces of skin,” Don says. “My incisions started behind my ear and went down my neck, across my shoulder and chest. It was a major ordeal.”
The experience was also a sobering reminder of his mortality. “The thought that I might die went through my mind,” Don admits. “At the time, my son was 3 years old, and every time I looked in his eyes, I wanted to cry.”
Don resolved to fight. His wife, friends, family, co-workers, clients, doctors and medical team were a constant encouragement. “Their support and prayers really pulled me through,” he says.
The surgeries were successful, and Don was declared cancer-free. But that was just the beginning of a new battle. “I’m a workaholic, so I went back to work a week and a half after the surgeries,” he says. “But to get full motion back, it took almost three months. I was fortunate that I was working in an office; if I would have been in a field position, that would have all been lost time.”
Additionally, Don has had to make time for frequent checkups. Every three to four months, he visits his dermatologist, his surgeon and his oncologist for skin exams, blood work, X-rays and CT scans. Since melanoma can also occur in the eyes, he sees an ophthalmologist every six months for eye exams.
His daily routine has also changed--he now views sun protection as a first priority. “Before going outside, I apply an SPF 45 sunscreen on any exposed skin, and I reapply it frequently if I’m out for an extended period,” he says. “I wear jeans or long pants all the time. I wear an Australian cowboy hat to shield my face and neck, and I always wear UV-protective sunglasses. I also check my own skin daily for any new lesions or moles.”
It’s a safety routine that he wishes he had implemented years ago. “I am a Texas registered land surveyor and an ACSM-certified hydrographer and have always had HSE [health safety and environmental] toolbox talks about everything other than sun protection,” he says. “Each day, our field surveyors are exposed to the sun. We teach them about dehydration, sun stroke, snakes, etc., but in most cases, sun protection, skin care and skin cancer identification are hardly, if ever, mentioned. Yet being out in the sun day after day puts us at risk for several different types of skin cancer, including basal cell carcinoma, squamous cell carcinoma and malignant melanoma.”
An Ounce of PreventionAccording to Hitchins, sun exposure isn’t the only factor in developing melanoma; genetics also plays a role. Individuals with red or blond hair, fair skin and light-colored eyes are at a higher risk and are likely to develop melanoma at some point in their lives, even without UV exposure. The presence of moles is also a risk factor. While most moles are benign and will never cause problems, a person with numerous moles is at a higher risk of developing melanoma. In some cases, moles that have been benign for years can unexpectedly develop melanoma.
“If you already know that you’re at risk of developing melanoma, then you certainly need to take extra precautions,” she says. “It’s very important to be proactive by protecting your skin and eyes, checking your skin daily and getting full-body skin exams and eye exams once a year. If something stands out to you and doesn’t look right, it probably isn’t right, so you’ll want to get it checked out.”
Hitchins also cautions against taking the idea of nonmelanoma skin cancers too lightly. “While melanoma is a serious form of skin cancer, we shouldn’t overlook the basal cell and squamous cell types,” she says. “The most common is the basal cell. It’s local, and it destructs where it is. But the squamous cell can metastasize into the lymph nodes, lungs and liver; people can lose their voice box or die of squamous cell carcinoma. And the same exposure that can give you basal cell [cancer] can give you squamous cell [cancer]. So it’s very important to be cognizant of that and protect yourself from the sun on a daily basis.
“The more preventive you are--the more you watch yourself and the earlier you catch it--the better your survival rate.”
For his part, Don is grateful that he finally took his wife’s advice to see a dermatologist. “Other than the mole appearing on my face, there was no other indication that I had anything wrong or unusual,” he says. “Had I not gotten it taken care of in a timely manner, it could have spread throughout my body and I wouldn’t have known until it was too late.”
Since his initial surgeries, Don has needed one additional surgery to remove another small spot that appeared in 2008. Fortunately, that one was caught early. Because individuals previously diagnosed with melanoma are at an increased risk of developing additional melanomas, Don will have to remain vigilant. But the experience has given him a renewed appreciation for life--particularly since his family has recently grown to include triplets.
He has also become an outspoken advocate for skin cancer awareness in the surveying and construction community. “I would encourage everyone do your own research to learn about skin cancer, take the necessary precautions to avoid sun exposure and have your skin examined regularly,” he says. “It just may save your life.”
For more information about skin cancer risk factors, prevention, detection and treatment, visit the American Cancer Society at www.cancer.org.
Melanoma often develops in a pre-existing mole that begins to change or as a new mole. It is estimated that 20 to 40 percent of melanomas arise from an atypical mole. It is important to be familiar with the moles on your body and perform regular self-examinations of your skin. When looking at moles, keep in mind the ABCDEs of melanoma detection:
• Asymmetry. If you could fold the lesion in two, the two halves would not match.
• Border. Melanomas often have uneven or blurred borders.
• Color. Melanoma typically is not one solid color; rather, it contains mixed shades of tan, brown and black. It can also show traces of red, blue or white.
• Diameter. While melanomas are usually greater than 6 millimeters (about the size of a pencil eraser) when diagnosed, they can be smaller. If you notice a mole different from others or one that changes, itches or bleeds--even if it is smaller than 6 millimeters--you should see a dermatologist.
• Evolving. A mole or skin lesion that looks different from the rest or is changing in size, shape or color.
It is important to realize that a mole may have some of the characteristics described above and not be a melanoma. A biopsy is often necessary to distinguish an atypical mole from a melanoma.
Source: The American Academy of Dermatology ( www.skincarephysicians.com/SkinCancerNet/melanoma.html ). Used with permission.