I’m a Walking PSA for SPF—Don’t Make My Mistakes

I was diagnosed with basal cell skin cancer for the first time in my 20s, and have been dealing with dermatologists and excisions for decades since. Here’s what to watch for while having fun in the sun.

I vividly remember my first bad sunburn.

My mom had dropped me and a friend off at the pool for the afternoon with these parting words: “Remember to put on sunscreen.”

But we were only 11, and rather than slather ourselves in gloopy cream, we jumped straight into the pool and spent our time perfecting front flips from the diving board and drying off on lounge chairs. By the time dinner rolled around, our limbs, backs, chests and faces were glowing an angry scarlet.

Mom was horrified, of course, and tried to instil the value of sun protection that night as she rubbed aloe onto my tender skin, which was radiating with summer heat. In those days, though, few people practised what they preached (even my mom enjoyed some summer colour).

I grew up in the 1970s and ’80s, when everyone worshipped the sun and a “healthy glow” was a sign of affluence—it signalled that you had time to spend at leisure. Back then, no one wore SPF 15 sunscreen, which was the highest number you could get. My dad, blessed with Lebanese heritage, could spend a day lying out and be transformed into a bronze Adonis by sunset.

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Though I was prone to freckling and I lived at a high elevation, where the atmosphere is thinner and less able to filter out UV radiation, I believed that Dad’s half of my DNA should count for something. What I didn’t know then was that whether or not a person gets skin cancer comes down to a dance between genetics and behaviour. So I continued seeking the sun: I tanned on vacation and lifeguarded as a summer job in high school. Later, I headed to university in San Diego, where I arranged my classes to fall before 11 a.m. and after 2 p.m. so they wouldn’t interfere with prime sunbathing hours.

“You know, Lisa, your skin is probably going to pay for all of this tanning when you’re older,” a friend presciently warned me when I arrived home for Christmas break resembling the Coppertone girl.

Given my early relationship with ultraviolet radiation, it’s little wonder that at age 52 I have a two-inch curving scar on my face from my latest skin cancer excision. Other parts of my body are pincushioned with scars from biopsies and surgeries that go back three decades to when I was first diagnosed with a basal cell carcinoma (BCC) on my neck. As I often tell my teenage daughter, I’m a PSA for why everyone should shun the sun.

This message is more important than ever as the worldwide incidence of skin cancer continues its 20-year rise, says Lynne Robertson, a clinical associate professor and dermatology residency program director at the University of Calgary’s Cumming School of Medicine.

“We are seeing it in younger people as well,” says Robertson, who diagnosed six of my basal cell cancers over a 15-year period when I lived in Calgary.

Robertson says the rise in skin cancer is due to a combination of factors. People are living longer and doctors are better at detecting it. Additionally, it can take time for people to modify their behaviour, so even though we’ve been told to wear sunscreen, cover up and stay inside during the heat of the day, many of us are still slow on the uptake.

One in three cancers diagnosed worldwide is skin cancer, and up to 90 percent of them are caused by ultraviolet radiation. A staggering 80,000 cases of skin cancer are diagnosed annually in Canada, which is more than the number of breast, prostate, lung and colon cancers combined, according to the Canadian Skin Cancer Foundation.

If there’s a silver lining in this, it’s that you can actually see the cancer growing on your skin, which is the body’s largest organ. If it’s detected and removed early, it’s highly treatable. In fact, basal cell cancers like mine are completely curable, says Robertson. But the trick with any kind of skin cancer is to know what to look for. (Spoiler alert: In my experience, it hasn’t been a mole gone rogue.)

I noticed my first basal cell cancer at the ripe old age of 20, when I felt a new bump on my neck; it was a tan, pearlescent nodule that looked like a cross between a mole and a blister. This was unlike my other moles, which are dark, round and flat, so I felt compelled to have it looked at by a professional. A biopsy revealed it was a basal cell carcinoma.

These growths begin in the skin’s outer layer and account for 90 percent of all skin cancers. Basal cell cancers typically show up where the sun shines, like on your face and neck. All of my skin cancers have been BCCs, and they’ve all looked different from each other.

One appeared almost overnight as a round, flesh-hued patch on my temple, another as a freckle-like growth on my chest. There was the sore on my forehead that bled and would never quite heal, and the café-au-lait-stained bump on my back.

After that first diagnosis, I got in the habit of checking my body regularly for anything new or weird. Dermatologists recommend getting to know your skin and giving it the once-over every few months, or more often if you’re at a very high risk for skin cancer. (Risks include fair complexion, red hair, prone to freckling, a personal history of sunburns or skin cancer or a family history of skin cancer.)

My most recent skin cancer, an infiltrating BCC, started out like a sore or pimple and turned into a translucent nodule that stung when I washed my face, like a cut that hadn’t healed. Because of its location between my nose and upper lip, I was sent to the Vancouver General Hospital Skin Care Centre for Mohs surgery, a procedure that excises thin layers of cancerous tissue.

This day surgery removes small sections of affected tissue, which are examined with a microscope on the spot to make sure the surgeon has achieved clean borders around the cancer. This process is repeated until all of the skin cancer has been removed. Then, a plastic surgeon reconstructs the area the same day.

Before he sewed me up, the surgeon showed me the nickel-sized gouge on my face, reminiscent of a zombie bite. Basal cell cancer doesn’t metastasize, but it can infiltrate into deeper tissue, which mine had done. To close me up without making my mouth look like the Joker, he had to cut into the skin in my nasal fold, which is why the scar is so long. I still look like I was in a knife fight, but it’s getting better and will eventually fade to a white or pink line easily covered by makeup.

Because the basal cell carcinomas I’ve had don’t metastasize, I haven’t needed radiation or chemo. (Most patients with basal cell and squamous cell skin cancers won’t need it, either.) That’s why, when I fill out medical questionnaires that ask if I’ve had cancer, I always answer no—to me, my BCCs have seemed like “cancer lite.”

But my most recent surgery and the lingering scar have caused me to reframe my thinking: I used to say that these BCCs were merely a nuisance, but I don’t see it that way anymore. While basal cell cancers are almost 100 percent curable, the fact that they—and their squamous cell cousins—can cause serious disfigurement should give everyone pause.

Since I’ve already had 10 BCCs, there’s a high risk that I’ll get more as I age. My medical history also increases my risk of melanoma—a malignancy of the pigment-producing cells of the skin—by three-fold, says Alex Kuritzky, a practicing medical and cosmetic dermatologist with DERM Lab in Vancouver and a clinical instructor with the Department of Dermatology and Skin Science at UBC. Additionally, it increases my risk for other cancers, such as colon or blood cancer. (I do get routine colonoscopies, which helps with that particular anxiety.)

“Having six or more basal cell carcinomas may be a sign of having a genetic propensity for certain cancers,” Kuritzky says.

I’ve also had a few actinic keratoses (pre-cancers) removed. If left unchecked, some of these spots can turn into a squamous cell carcinoma, which is a generally more aggressive type of skin cancer.

I do find myself worrying more about getting melanoma as time goes on, but rather than fret over what ifs, I try to make up for the skin sins of my youth by protecting my mature epidermis. After that first skin cancer in 1992, I stopped lying out and became fastidious about using a broad-spectrum sunscreen (one that blocks both UVA and UVB rays).

As an adult, I’m the woman at the garden party or tropical resort wearing a giant floppy hat, plus sunscreen and a sun shirt, while sitting under a palapa or umbrella for full shade. On summer days in Kelowna, where I live, I stay inside between 10 a.m. and 3 p.m. when the sun is strongest. I’ve also started tracking the UV Index (take care when it’s three or higher). These are all sun-safe practices recommended by dermatologists.

I also try to be a role model for my kids. When they were little, I was religious about sunscreen and swim shirts, so they’ve avoided bad burns and freckling. My teen daughter now dabbles in tanning outside at the pool—which drives me bonkers (um, hello!)—but I believe she knows better and will turn into a sun-smart adult. She also recently discovered self-tanner lotion, which is a safe way to bronze the skin. (Though anyone who uses it should still be wearing SPF 30 or higher as well, as self-tanners do not provide any sun protection.)

Tanning beds, on the other hand, are not safe. Studies have shown that the risk of developing skin cancer from tanning beds is higher than the risk of developing lung cancer from smoking.

Mostly, I hope I’ve taught my kids to be self-advocates when it comes to their health. With each of my cases of basal cell carcinoma, I was the one who brought the lesion to a doctor’s attention. In a couple of instances, the dermatologist didn’t think it was anything to worry about, so I sought a second opinion.

“I often tell patients that a skin check is only a moment in time,” says Kuritzky. “If something continues to change, a second visit to the same dermatologist, or a second opinion, is warranted.”

We know our own skin best, so it’s important to trust that gut feeling if something seems amiss. Since I can’t turn back the clock on all of the sun damage my skin has sustained, I can at least remain vigilant.

Next: How to Spot a Problematic Spot: Use the ABCDE Method

Originally Published in Best Health Canada