Avoiding cancer by the hair of my skinny-skin-skin

I was nineteen years old the first time I was diagnosed with skin cancer, my dermatologist called me on Christmas Eve to give me the news and the day after Christmas I had two chunks of my forehead taken out, the larger leaving a small, round scar on my hairline. Since then I’ve had cancery spots cut out two more times, one biggish one from my armpit, the other from the ball of my foot. Every dermatologist I’ve seen has told me that the combination of my fair complexion and genetic make-up means I will most likely get melanoma again before I turn 40. If I’m careful we may find it early on, before it’s even a “stage,” and can treat it by biopsy without having to resort to major chemo or radiation.

Thirty years ago a large research hospital did a longitudinal study to try and determine if there was a genetic marker for melanoma, both sides of my family were involved in that study, both with really high incidents of skin cancer diagnoses. For example: my oldest brother had melanoma cut out of his back when he was 13, my first spots came off when I was 19, my other brother was in his mid-twenties when he had pieces cut off his face. My grandfather died from melanoma, so did an aunt, and countless cousins have had questionable or even cancerous spots cut out. My dermatologist will re-measure and photograph every single mole during my visit, and then compare to last year’s size, color, and location. If anything has changed or looks at all iffy, he pulls out the scalpel and slices that stuff right off. At least I am aware of my inheritance and can take preventative measures.

Okay, so I am genetically predisposed to melanoma. Now what?

Casper the ghost_getting all tan

Well, for starters I make damn sure I don’t double down on an already shitty hand of genetic of cards. I haven’t had a real sunburn since I was in my teens, I haven’t had a tan line in more than a decade; not from a swimming suit, not a gradient on my arms, nothing. I am ridiculously careful with sunscreen application, but mostly, I just stay out of the sun. This does not make me a very popular candidate for a beachy vacation or a pool party, I won’t waltz around in tiny swimming suits, I won’t play beach volleyball, I won’t lounge pool side with giant sunglasses trying to perfect my tan. Instead I stay in the shade, I cower by the umbrellas, I cover up from neck to toes because that is easier than slathering on sunscreen every 2 hours. I keep track of the moles I can see and if anything changes I call my doc for a consult.

At this point I have a love-hate relationship with my skin. I mean, I am thirty-three and my super careful behavior is finally starting to have some visible benefits (besides, you know, the “no cancer this year” thing). I have really great skin, my wrinkles are almost nonexistent and I am routinely mistaken to be in my early twenties, sometimes, even a teenager. (I’m not sure if that is still a compliment, or at what age it no longer is a compliment, but I’ll take it.) I will probably always look younger than my actual age due to my vampire-like actions throughout my teens and twenties, and that’s kind of awesome. (My love of unicorns and Grumpy Cat and baby elephants does not in any way contribute to an adolescent persona. Promise. Ahem.) However, my skin is also really, really sensitive to the sun, I can’t walk (6 houses down the street) to the mailbox in the afternoon without sleeves or sunscreen because my skin literally starts to sting and itch. It’s like I’ve developed an actual allergy to the sun, it is uncomfortable for me to be exposed for more than two or three minutes. I’m sure my pal Darwin would have some Serious Evolutionary Thoughts about this, but for me it is just fascinating, and also a little annoying. I’m on my way to becoming one of those cave fish with bulgy white eyes and translucent skin. But hey, at least Harriet McCaveFish will look like a 22 year-old cave fish, not a 39 year-old one. Small victories, people. Small. Victories.

I’m a little fuzzy on how, exactly, I will be able to survive an Arizona summer, which stretches for eight or nine months of over-90-degree temperatures and nary a cloudy day in sight. (And, like, four months of 100+ degree temps…please kill me now, please!?) I guess I’ll continue to do what I’ve always done, stay inside during the day, stay in the shade if I absolutely must go outside, and spend a hefty percentage of my paycheck on sunscreen and linen pants. I’m such a barrel of fun, you guys. I mean, seriously. Come visit me! You can hang out by the pool, alone, while I work on my Cave Fish eyes. It’ll be grrreeaaaattt!!

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An adult-sized A+. With sunscreen.

For over a decade I have dutifully gone to the dermatologist at least once a year; I track my moles, their shape and coloring; I carefully note if any new ones show up, even the tiny ones; I wear sunscreen like it’s my damn job. My latest check-up earned me a solid A+, which I’ll admit, made me more than a little proud of myself. My doc was most impressed and legitimately surprised that the top part of my forearm and the underside are the exact same hue, which has a lot less to do with winter than it has to do with my always wearing sunscreen or long sleeves. He was shocked that there was not a single tan line on my back or shoulders, not from last summer, or the one before that, or the one before that. It’s not that my skin can’t take a tan, it’s that I go to extreme lengths to keep it from changing color in any way. In fact, in 15 years I think I’ve only had two or three sunburns, and only one of those was so intense it blistered. I just…I’m really really careful. Always.

Here’s the thing, for me, an A+ is not really an “excellent! superb! you’re a dermatological overachiever!” kind of mark; for me it is essential. Almost 30 years ago the major medical research university here did an enormous study on melanoma and whether or not there was some kind of inherited genetic propensity for the disease. The long and short of it (but really, only the short) is that yes, there is a genetic marker for melanoma and it runs in both my maternal and paternal lines and me and my four siblings all have that marker encoded into our DNA. My oldest brother had an enormous hunk of his back cut out at age 13 because it was teeming with cancerous melanoma, my other brother has had basal cell cut off his face, I’ve had bits of both melanoma and basal cell cut out from head to toe, I have lost track of how many aunts, uncles, and cousins (first cousins, not thrice removed, we’re talking close relationships here) have had the same procedures, two have died from melanoma and one is currently in treatment. So, skin cancer. It’s a big effing deal to me.

So. I have super pale skin*, which is what I naturally came with, but I make sure to keep it that way. I don’t wear shorts, I don’t wear tank tops, I rarely wear a bathing suit and I slather on sunscreen and then a few hours later I do it again. If at all possible, I will be in the shade instead of in the sun.

*Seriously, it’s hard to write about this without coming across as some kind of white supremacist; I am just trying to say that my heaven-sent stock color is 80% albino, and here I am at age 32 and that is still, more or less, the case. And for me, that beached whale-parchment-milk colored-sometimes even a little blueish-white skin is a really, really good thing. If your stock color is pinkish, or yellowish, or tan, or brownish, or blackish, or green or orange or blue orpinkortealorWHATEVERCOLORISFINE!! NO SKIN COLOR IS BETTER OR SUPERIOR THAN ANY OTHER SKIN COLOR!!!


What I was thinking would be a quick, possibly pithy commentary on how pasty and alfredo-like my arms and legs look and how for ONCE I got a gold star for it instead of mockery from the Popular Set has quickly divulged into a freaking mine field of political correctness, attempts not to offend, and generally trying to come across as a good human. My point is that overall the healthiest epidermis is the one that has the least amount of damage, and sun is the primary source of damage of skin cells, so the closer your adult skin is to the relatively less damaged skin of your childhood, the better. The fewer traces of sun discoloration, the better. So, as the summer sun warms everything up (at least for those of us in the Northern Hemisphere), remember to protect your skin cells, mmmkay? Your 50-year old future face will thank you for your efforts, I pinky swear*.

*Pinky is a digit on your hand, not some kind of color judgement. For the love, I quit.

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