Always wear sunscreen

OK, I know… this post is going to remind many of you of Baz Luhrmann’s Everybody’s Free to Wear Sunscreen. And, for me, ’99 was already probably too late (having been a beach lifeguard in the ’80s). But, I’d like to add a vote to that being very good advice.

This post is not going to be a technical one. It’s more of an experience one. And, one that I think everyone can benefit from. It’s true with everything in life – the sooner you find a problem, the easier it is to solve.

Back in 2010, I had a spot on my cheek that didn’t feel like much more than a little sliver of skin sticking up. It seemed to go away but then come back again. I saw a dermatologist who said that this is very common and is called Actinic Keratosis. It’s sometimes referred to as “pre-cancer” but the likelihood of it becoming cancerous is about 1 in 100 (this is just want I remember) and that we have an easy solution to freeze it off using cryotherapy. So, it was frozen off and gone. Well, for a few months. Then, it came back. And, then I had it frozen off again.

But, as life would have it, time went by. And, the spot got a bit bigger. But, somehow in my mind – the thought of it becoming cancerous was so low. I just became complacent. Last year, Paul started harassing me that I should go back and get it looked at. I argued that it was no big deal. It’s nothing. And, it wasn’t really doing anything interesting. Until this year. This year it actually scabbed and bled a couple of times. And, it seemed to be getting a tad larger. And, so I started doing some research, I read that there were a few signs that warranted having a skin lesion looked at:

  • Irregular in shape
  • Raised on the skin
  • Sore that never seems to completely heal or go away
  • Growing
  • Larger than the eraser of a pencil

And, all of a sudden I was a bit worried. So, I scheduled an appointment with a dermatologist (my prior dermatologist had left the practice). But, with my schedule and their schedule – this appointment got pushed out and pushed out and pushed out. Finally, I went to the dermatologist after we returned from our summer vacation. Where, as usual, we had been diving. And, yes, where I had been in the sun. So, as usual, I wasn’t really tan. I was more of a brownish shade of red. And, off I went to go see a dermatologist.

Now, I don’t know where things went wrong but this is how I remember that appointment (this is the short version):

(pleasantries, etc.)

Me: Actually, it looks about the best its looked in 6 months. The combination of salt water and sun seems to have done it some good.

Derm: Started to look at my cheek and ended up looking at the wrong spot… that’s how uninteresting it was…

Me: Well, I started to get nervous a few weeks back when I read the ABCs of skin cancer:

Derm: Oh, no. That only applies to BROWN spots.

OK, so this was a new dermatologist. And, we didn’t really know each other. And, she seemed pretty convincing that I was there for no reason. She proceeded to tell me that while the Actinic Keratosis that I was diagnosed with was sometimes called “pre-cancer” that the likelihood of it being cancer was really low (yes, I’d heard that before) AND that it usually takes decades for it to become cancerous.

So, while I wasn’t so impressed with the bedside manners of this dermatologist, they were [at least] making me feel like there was nothing to be worried about. In the back of my mind, I started thinking – maybe I don’t even need to get this biopsied. Maybe I should just get it frozen off again.

But, a bit more time with this dermatologist made me just want to “get it over with.” To be honest, I should have asked a lot more questions. However, I was already feeling like I was wasting their time. So, I just decided to move forward. We did the biopsy. I remember asking what would need to be done if it was something and their response was “not much more than what we’re doing today.” (but, again, it felt more like a brush-off than a real answer)

I left. I went home. I got more and more frustrated for the next few hours as I realized what an incredibly frustrating visit I had had. The doctor didn’t really interact. They didn’t seem to want to answer questions. I thought – at least I can research things and investigate this. I have people to chat with about this, etc. What would the experience be (with that doctor) for someone else who doesn’t use the internet, etc. I ended up writing a 2 page letter to the head of dermatology. Here’s a VERY small highlight:

Today, I had my first and last appointment with Dr. XYZ of Dermatology.

… They need to understand that just because my problem isn’t interesting to them, it’s still something that I want taken seriously. …

The good news is that they took away most of my fears of something nasty; I’m looking forward to hearing my incredibly lame results.

So, I waited. It was a Tuesday when I had the appointment. It was Tuesday night when I wrote the letter. Then, on Wednesday, I was even more frustrated with the biopsy. I was told not to remove the band-aid for 24 hours but when I did, I had a grand-canyon-like crevice on my face. [Note about my overreaction: it was about the size of a dime. But, it was on my face and it was awful looking. All I could think about was – sh*t, that’s gonna leave a mark. And, sh*t why didn’t they tell me that this biopsy was going to be so much bigger than the original spot and much deeper than I expected. Ugh. Again, I wish I had asked more questions.]

And, now I was even more frustrated. It looked like I was going to have a scar – for nothing. I ended up calling my regular doctor who put all of this to rest. Yes, shave biopsies tend to look really gnarly at first but they tend to heal pretty well. And, even a couple of days later, it was looking much better. OK, no biggie.

But, then I got the results (Friday afternoon at 4:30pm btw – have a nice weekend). It was Squamous Cell Carcinoma. Yes, it is cancer. On. my. face. And, Dr personality referred me to a specialist and my interactions with them were done.

So, that was it. I had a consult setup for the following week and I was going to have the procedure done at that time as well. It’s called Mohs Surgery.

OK, there goes my weekend; that was not what I expected.

So, I started reading and reading and reading and reading (er, the internet is both a good and a bad place to go for information). Probably what stood out in my mind the most was this: The average age for SCC is 66. People that get it at a young age are more likely to get other cancers. Great.

The good thing though is that Mohs Surgery didn’t sound too bad and I thought that it was probably the right direction. But, then I started to read about topical solutions (specifically Imiquimod). And, I started to wonder if Mohs was the best next step. And, then I decided I wanted a second opinion. So, I chatted with a few folks and got a referral for another dermatologist. She was out for a couple of days but her nurse talked to the head of their dermatology department and agreed that I should chat with someone else before I have the surgery. So, we cancelled that and I went in for my second opinion.

And, the long story short is that she was wonderful. She felt that Imiquimod wasn’t really the best for what I had. Instead, we should go with Fluorouracil. The Mohs Surgery has a 99% success rate but also was likely to leave a very large scar. My SCC wasn’t very deep but it extended beyond the area of the biopsy. So, we weren’t really sure how large the area actually was. The topical cream has an 85-90% success rate and would be a bit of a pain in the *ss for a few weeks (about 2 months) but would be a lot less likely to scar. And, of course, I can always go back and have the surgery.

So, we decided to go that route. And, that’s really the point of this post. I’m about to start teaching again next week, a couple of conferences are coming up, and my face isn’t all that attractive. In fact, tomorrow’s my birthday and Paul’s decided that the best present for me is a paper bag with two holes that just reads “wife” (yep, isn’t he nice :) ). And, it was going to be obvious that something is up.

But, even more than the lovely visual that is my cheek; I’ve learned a lot from this experience. And, if anything, maybe this will help some of you!

  1. If you don’t like a doctor, get another one. And, tell the clinic/hospital, etc. about your experience. In chatting with a few folks – they said that they had experienced something similar but they never wrote a letter. I realize that a doctor’s time is important. But, so is mine.
  2. Get a second opinion. Talk to people.
  3. Do research. The best post I’ve found about Fluorouracil is this one: My experience isn’t as bad as his but the cream definitely stings. The spot itches. It’s a bigger pain in the *ss than I had expected.
  4. Stay up on your health. The sooner you find a problem, the easier it is to solve. My SCC isn’t horrible. We did catch it very early. It’s very slow growing. But, I still [probably] should have taken care of this last year.
  5. Always wear sunscreen

So, I’ll leave you with a quick shot of what I looked like a few days ago. I’m not sure I’ll do the whole timeline thing as I really just don’t want to remember this nasty thing. But, it’s not contagious and I am fine. It just looks nasty!


Thanks for reading,

23 thoughts on “Always wear sunscreen

  1. Glad you persisted… Frankly, the Derm who said “brown spots” needs to be either retired of forced to go to school and actually learn there is such a thing as ATYPICAL PRESENTATION! Wife’s melanoma started out just like your small spot; had it burned off, but it kept coming back and it was always PINK and FLAT. Thankfully our Derm took a good hard look, biopsy sent to two other Derms who all said “atypical” and admitted to NEVER having seen one like it, but definitely melanoma – stage-3A.

    Like you said, and I’d like to shout it long and hard, “ALWAYS WEAR SUNSCREEN” and don’t skimp! An egg-cup FULL, applied at least four-hourly at SPF 30+ will give protection. Been in the water? Immediately dry-and-apply.

    Don’t mess with your skin – you get one life, why mess it up with skin cancer when you don’t need to?

    Sincerely hope the cream does what it needs to without surgery – that is another NASTY story…

    1. Yeah, I was pretty frustrated by derm1. And, I agree. If you have any spot that’s been there for a while and doesn’t go away – get it looked at. The worst that can happen is that you lose a bit of time and they tell you its nothing. But, if it is something – the earlier they find it, the more options you’ll have!!

    2. Hey there Stephen – I forgot to add…. First and foremost, I wish your wife all the best too! I hope they’re able to get all of that through surgery? And, thanks for your well wishes!! I think we should all buy stock in sunscreen. ;-)

      Have a great weekend,

  2. How many certified DBAs have you met, who really didn’t know what they were doing and who weren’t very knowledgeable about their job?
    Now…why would we assume that doctors (or lawyers, or whatever) were any different?
    That’s the lesson to be learned here. Take control of your own life/treatment/case.
    Thanks for sharing your story, Kimberly. Hope your recovery goes well.

    1. Well, yes and no. I would argue that along with their doctorate they have been REQUIRED to have years (quite literally) of training, plus residency. To officially be a SQL DBA there aren’t any “requirements.” Virtually anyone can just “call themselves a SQL DBA” but you can’t really call yourself a “doctor” without having gone through an official (and quite rigorous training process). But, I will agree that there are certainly levels of expertise – in EVERY field. And, one thing in which the derm seemed to lack is “bedside manners” so there’s some training to be [re]done. ;-)

      But, I totally agree that taking control. Talk to other folks. Surf the web (both good and bad – take that with a grain of salt and remember XKCD: Get a second opinion. BE INFORMED. And, to quote Paul’s favorite quote: there’s no fate but what you make. (I just couldn’t go without a terminator reference, eh?)

      And THANKS for your well wishes!!

  3. Skin cancer is nothing to blow off. Totally get the freezing of the pre-cancer spot – my mom gets those, but thank you for sharing about what can come next. Big hugs to you and sending vibes of speedy healing!

    – J.

    1. Thanks Jennifer! And, yes, if it starts to get larger or starts to become a sore (and bleed/itch), etc. then don’t wait. The freezing thing works for a while though. And, it’s super easy (which made it even more appealing). But, I think it also made me more complacent and so I waited a bit longer than I probably should have.


  4. Kimberly,

    You don’t know me, but I am an ardent student of yours and have quite enjoyed your blog and dnr episodes. So, as a “one side only” friend I want to wish you a speedy and complete recovery and all the best.

    1. Thanks Pilot Bob! (oh, and we have something in common too – I have my single-engine land private pilot’s license (got it in ’94)… but, I don’t really fly anymore (actually, since ’95). Amazing hobby though. I do miss it. But, it’s hard to stay current with all of the travel (for business) that we do. Enjoy! Really a great way to spend an afternoon/evening, etc.) Cheers! kt

  5. Kimberly — I too, can attest about how important it is to ask many questions to your doctor and get second (and third) opinion. It took me four visit to four different oncologist before I settled with mine. They need to value our time as much as we value theirs and most importantly, you need to feel heard.

    I hope all the best for you!!! Recover fast and stay well!!

    1. Hey there Yanni – Thanks! You’ve certainly been through a lot more than I. I was just amazed at how timid I was in my first appointment and how (later) I realized that (in that appointment) I didn’t “own” my time there. I allowed my time to be second to theirs and I event took their “advice” because they were the expert (even feeling like maybe I was overreacting because they were so convincing that I was wasting their time). Crazy in retrospect. Don’t get me wrong – we do need to listen. But, there has to be give/take and back/forth. I think a lot of doctors have forgotten that. I would suspect that you’ve been through a few… Hugs Yanni. And, thanks!! kt

  6. Glad you persisted and got it taken care of! I am horrible about wearing sunscreen because I rarely burn but this is a good reminder to do it anyway. And while I’m at it – ladies get your breast cancer screenings and get to know your own breasts! And not to leave out the men – there are a small percentage of breast cancers that occur in men so tell your doctor if you notice something unusual!

    1. Hey there Cindy – I’ve been reading about your journey too. Glad it’s looking good for you. While radiation requires a fairly intense schedule – it’s way easier (from what I’ve heard) over chemo. So, that’s really good. And, the fact that it looks like they got it all. AWESOME. CONGRAS!!

      And, for me – I’d also add regular prostate [PSA] checks. Just keeping the #SQLFamily healthy all around, eh? ;-)

  7. Dear Kimberly, thank you for sharing your experience – as someone who has a sensitive body and has had many drug reactions I totally support your view that you need to be valued and heard with a doctor, or find someone else to go to. I have not considered writing, but now that you have said that I will!! Wish you a speedy recovery and a long healthy life ahead!!


    1. Thanks Mala! And, yes. I think a lot of us allow our doctors to get away with too much. I just need to treat medical issues like any other – get as much information as possible and make an informed decision. Don’t just trust the “expert” but use it as yat-another input. In the end, it’s my life. It’s my decision. Thanks again Mala!!

  8. I wish you a fast recovery :) is one of my main learning resources. Thank you for sharing your experience.

    1. Thanks Diana – And, actually, it’s going really well! It was worse for about 1 week and then it’s RAPIDLY gotten much better. I definitely feel like I made the right decision!


  9. Hey Kim! Ouch! :( I wish you a fast recovery! Happy belated birthday! Wish you live a long and healthy life! The scar on your cheek will just make you look tougher :) Paul is funny, as usual! I don’t have to deal with the doctors but I have my own stories about the immigration lawyers that I’ve dealt with for the past 10 years :) It seems that if you get sick — you have to become a doctor; if you have a law question — you have to become a lawyer :) I’m glad that you’re stubborn and got to the bottom of this! Thank you for sharing! I hope to see you and Paul and the rest of your gang in 2014!


    1. Hey there Denis – Not sure how I missed this but THANKS! Yes, my stubbornness paid off here. ;-) And, it’s all better now. Barely noticeable. Kind of crazy actually.

      And, I’m sure we’ll see you somewhere in 2014!


  10. Paul’s decided that the best present for me is a paper bag with two holes that just reads “wife” – too much.

    At least it will be easy for me to pick you out in Charlotte!

    Praying it goes smoothly and that no long term bag will be required!

    1. LOL. Actually, it got worse for about a week (the week AFTER the paper bag… but, Paul handled it well). Then, it got better… much more quickly than I expected. So, good news – the paper bag has been recycled! ;-)

      See you at PASS Mike!

  11. Hey there Kimberly – very empathetic to your cause. Living in the melanoma capital of the world (Queensland – the Sunshine state), much of it comes down to miss spent youth – too much sun in the UV rays. We ran a very effective marketing campaign: Slip, Slop, Slap – in other words use sun screen. Cheers – Ian

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