Although I’ve written previously about the importance of sunscreen and how to choose a good one, I’ve never shared the personal place this advice comes from. I urge everyone to wear sunscreen and take care in the sun not (just) because the experts say so, but because I am your case study for what happens when you don’t.
As a teenager, I considered the sun a beauty tool. Like any L.A. girl, I certainly enjoyed “laying out” in order to “get some color.” You know, boost the vitamin D, shake off the pallor of too many indoor activities, get that golden, sun-kissed glow.
However, even before then, I spent extensive time outside with nary a thought to the presence of the sun. I walked to and from school throughout six years of elementary, rode my bike regularly with friends, spent Saturdays on the soccer or softball field… It didn’t occur to me to mess with sunscreen for such common activities. And if I did, I would have thought of SPF 8 as sufficient.
I suppose if you’d asked me, I would have acknowledged that there was a sun shining above me for most of these activities—after all this was sunny SoCal—but the sun was only there incidentally. Since I wasn’t paying attention to the sun for most of this, it never occurred to me that the sun was paying much attention to me.
Then in my mom years I became an avid walker. It was a great way to share the great outdoors with my ducklings, to socialize, and to get in shape. I always walked fairly early in the day, before the sun was high overhead. It wasn’t hot yet, so why would I need sunscreen?
I lacked respect for our local star and its 173,000 terawatts of energy that reaches the Earth each second. And I’m paying for that now.
My earliest signs of skin damage
In college I went to a dermatologist for persistent acne. Doing his due diligence, the doctor checked my skin all over and flagged several moles on my back for biopsy. I soon was introduced to the word “dysplastic,” which refers to abnormal cells that are not *yet* cancerous but could become so.
And thus began my life-long relationship with dermatologists and a regular cycle of biopsies and removals. After numerous rounds of removing dysplastic moles, my back and abdomen have become a matrix of scars. At least they were only dysplastic.
Until they weren’t.
My first round of skin cancer: squamous cell carcinoma
Eight years ago I felt a small rough patch on my forehead at my hairline. After several weeks of wondering what it might be, I went to my dermatologist, and the biopsy came back positive for squamous cell carcinoma. That’s skin cancer. The real thing.
The good news was that it was small, slow growing, and the forehead is a quick healing spot. I had a ¾” oval of skin removed via a Mohs procedure, which is where a section of skin is removed and the incision left open while the removed section is examined for clear, cancer-free edges. If the edges aren’t clear, then more skin is removed. Fortunately, the initial section was large enough to give clear edges, and so I was sent on to a plastic surgeon for stitching up.
This incision took only five stitches, and other than a slight hiccup due to a hitherto unknown allergy to an antibiotic, the healing was pretty quick. The stitches came out in a little over a week. These days, even I am hard-pressed to find that scar on my forehead.
Whew! I was glad that was behind me.
My second round of skin cancer: Melanoma
But then 18 months ago, I noticed a mole on my ankle that was different than it had been. Red flag #1: any change in a mole.
The mole was now different shades, lighter in some parts and darker than others. Red flag #2: variations in color.
While it was still relatively small, it was no longer round but had become unevenly oblong. Red flag #3: uneven edges.
I showed it to my derm, and my heart sank when she said, “Yeah, that looks like a problem.” Her response was confirmed with a biopsy.
It wasn’t squamous cell carcinoma, or even basal cell carcinoma which is the most common form of skin cancer. This time it was the biggie. Melanoma. The most aggressive and dangerous form of skin cancer. I was scheduled for surgery—another Mohs procedure.
The derm and plastic surgeon both had the same warning: “At your age…”
(Can I pause right here and say that “at your age” is not a phrase I like hearing? It’s not usually a reference to my youthful age anymore, despite how young I feel at heart.)
“At your age, surgeries on the feet and ankles don’t heal quickly.”
“Yeah, yeah, yeah,” I thought. “The one on my forehead healed really quick. If this one takes a bit longer, I can handle that.”
22 stitches later
I went in for the Mohs procedure, and despite the minuteness of the mole (maybe 1/8” in diameter), the derm had removed a section the size of a quarter from my ankle. That shows the great caution that’s taken with Melanoma so as not to miss any.
Again, she left the surgery site open while the removed section was examined for clear edges. And again, this first cut was sufficient. The edges were clear. So far so good. Just as I expected.
Off I went to the plastic surgeon. This is where I started to realize this was not the same scenario as the last time. He told me that the size of the opening combined with the lack of excess skin on my ankle meant that it was on the cusp of needing a skin graft from my thigh, but he’d try his best to close it without a graft. (Grafts = two sites to heal, unmatched skin, more potential for problems.) He would need to make the incision bigger so that he could stretch the skin over it.
He successfully avoided a graft. But it took 22 stitches. I didn’t know 22 stitches could fit on the side of my ankle. The closed incision was the shape of an S. A very large S. About 3” wide and 1 ½” tall. I have nothing against the letter S, but I’m not so fond of it that I’d volunteer to have it stamped across my ankle.
They handed me some crutches and I went home to heal. And there I learned what they meant by ankles taking a long time to heal at my age…
For the first while, my ankle only got bigger instead of smaller. The tidy swoop of stitches contorted and stretched. For the first time in my life I used crutches, because walking on my foot caused my ankle to throb dreadfully. Any flex in my ankle made the skin feel like it was on fire and ripping open. Being upright for any length of time caused my foot to swell because so many of the blood vessels were severed and couldn’t carry the blood out.
My surgery was in January, which even in SoCal gets cold and dreary. None of my long pants had wide enough leg openings to encompass my burgeoning ankle. I was reduced to wearing only leggings, and nabbing my husband’s sweaters to wear over them. There was only one pair of warm shoes I could wear, which happened to have a side zipper I could leave unzipped on my right foot.
I lost track of how much gauze and how many bandages I went through with the daily dressing changes. It was essential to keep the site moist so that it could heal.
All throughout, during our weekly visits, the surgeon nodded sagely. Nothing was wrong. This is what he expected. We just needed to wait.
Six weeks in stitches…and not the laughing kind
It took a month and a half before the incision had closed enough that the surgeon could remove the final stitches. Six weeks. Do a quick search for how long stitches are usually left in, and it’s 14 days max. Which meant, not only do I now have a sideways S emblazoned across my ankle, I also have a perforation of stitch pricks flanking the curves.
But vanity aside, nothing went wrong with the healing process. It couldn’t have gone better. I had no infection, no need for antibiotics, no additional procedures. The surgeon did not seem in the least surprised by the length of healing. This is the best that could have happened, leaving me with this sizable scar.
The aftermath of healing
The doc says eventually the scar will become the same color as my skin. I’m still waiting for that to happen. Scar tape worked wonders to smooth the bubbles in the scar. Even after the scar tape had done what it could, out of vanity I continued to wear it over the scar for a year. Eventually, I stopped caring about the vanity side of it. The scar is part of my story and gives me a purpose. I want to tell others why I have that scar and how they can avoid something similar.
The derm says that scar tissue will absorb UV rays more readily than regular skin, which is the last thing I want, so on any day there’s a chance the scar will see sunlight, I slather it with sunscreen.
Unfortunately, the severing of the blood vessels below the incision still causes swelling in my foot on days where I’ve been standing for long stretches. The nerves too are still super sensitive, and the slightest tap on the area will cause them to overreact as though I’ve been walloped with a mallet. My dog stepped on my ankle in play and you would have thought she was a 150-pound mastiff rather than a sprightly little puppy.
What can I do for my skin
While I am super grateful the melanoma was caught early and successfully removed, it is discouraging to know that I will very likely go through this again. All my skin is irreparably sun-damaged and will show increasing evidence of it over the years. There’s every indication that further cancer will arise, and so “Constant vigilance” is my mantra.
Already this year I found that the skin on my chest looked increasingly weathered. My derm and I decided there was the beginning of mutation happening there, so I went through a round of chemo cream, which involves applying a cream to the area, causing the skin to redden and bubble and peel off. It’s extremely uncomfortable and unsightly.
Now I wear sunscreen daily not just on my face, but also on my neck, chest, backs of hands, and tops of feet, and elsewhere not covered by clothing. I can prevent further skin damage with sunscreen and other crucial sun protection measures such as wearing covering clothing and hats, staying in shade, and avoiding the sun during high UV times of day. And most importantly, continuing to monitor my skin.
When should you wear sunscreen? All the time
I overheard a conversation between my derm and another patient once. She asked if he was wearing sunscreen. He said he hadn’t been to the beach lately so no. She pointed out that the sun was up every day, and he had gone outside just to get to his appointment. Our skin always needs protection from the strength of the sun.
Sunscreen is needed every day. Not just when we’re outside for a long time, not just when it’s hot or bright, not just when we’re at the beach or the pool. It’s the UV rays, not the heat, that causes skin damage. Just this past weekend, my daughter came home from her track meet glowing red. She’s usually quite careful about wearing sunscreen (as you might imagine, she had a compelling front row seat to my ankle saga), but because the day was overcast and cold, she hadn’t applied any.
If it’s healthy skin color you’re looking for, the best routes are eating nutritious food, getting plenty of sleep, staying hydrated, exercising regularly, and laughing often. For my reasons why, check out my article on these 5 Life Habits for Healthy Skin. The sun is not a beauty tool.
Employ the critical sun protection measures as well: wearing hats and sunglasses, seeking out shade, avoiding the sun from 10:00 am -2:00 pm, and wearing protective clothing with a UPF (ultraviolet protection factor) above 30.
What you should do with my story about skin cancer
1. Wear sunscreen every day.
My whole purpose in sharing with you my gnarly experiences is to convince you of one thing: wear sunscreen every day. Even if it’s cloudy or cold, even if you’re only walking to your car and back, and even if you have naturally high levels of melanin in your skin. (BTW, tattoos offer no protection from the sun and can be even more susceptible to damage and also can hide changes in the skin.) Use a sunscreen that’s broad spectrum and with an SPF of 30+. And wear a hat when you’re outside a while. Besides, hats are cool.
2. Visit a dermatologist.
Seek out a dermatologist and visit them annually or more often if you’re at higher risk. Even if you wear sunscreen regularly, it’s good to have an expert check in those hard-to-reach spots. As unpleasant as my experiences so far have been, it’s been nothing compared to what the treatment would be for skin cancer that has spread. Catching skin cancer early offers a much better prognosis than if it has advanced. Memorize the American Academy of Dermatology’s ABCDEs of skin cancer: Asymmetry, Border, Color, Diameter, and Evolving. Catchy, isn’t it? But helpful.
3. Pay attention to sunscreen ingredients
Use the Environmental Working Group’s Guide to Sunscreens® to find one with good ingredients that works well for you. Here’s my summary of sunscreen ingredients to look for and avoid. It might take you a couple of tries to find one you like but stick with it. Once you’ve picked one you like, put it on auto-ship so it gets sent to you regularly and you never run out. Even if you’re not sure which sunscreen to use, remember that any sunscreen is better than no sunscreen.
4. Wear enough sunscreen
Lastly, read instructions for amount of sunscreen. Most people who take the time to use sunscreen aren’t using enough. A full body application of sunscreen is 2-3 tablespoons. The amount for the face is 1 teaspoon. I suggest measuring it out a time or two to make sure you’re using enough. Even the best sunscreen won’t do its job well if you don’t apply enough of it.
My final word: wear sunscreen daily
I know I’m being repetitive, but this is the crux of it. I can’t imagine what I’ll look like at 80. At best, my skin will be more and more like Swiss cheese, or I may even end up with other letters of the alphabet to add to the S on my ankle. Maybe someday it’ll spell something nifty. In the meantime, I will be relying on the skill of doctors to carve me up and stitch me closed. I want you to avoid my situation by doing what you can to protect your skin.
While I have the greatest regard for the role our sun plays on our planet and how Earth is the perfect distance from it to foster life, I also have a proper respect for its destructive power. Please wear sunscreen and practice other protective measures.
