Basal, squamous or melanoma?

I was a grumpy old shitbag at work today. To those of my workmates who read my blog, can I just apologise for being so bad-tempered and snappy? I'm truly sorry. None of you remotely deserved it and I feel rotten for bringing down the happy vibe in the studio today.

I think I'm slightly freaking out without letting myself actually realise that deep down, I'm freaking out. A couple of weeks ago the innocent little age spot which has been quietly sitting on my right cheek for a couple of years, turned a dark and angry red overnight, and has become slightly raised and a wee bit itchy. At first I thought it was maybe a flea bite, so I left it for a week to see if it went away, but it hasn't.

I went to see my doctor yesterday and she thinks it may be either a basal or squamous cell carcinoma (but probably not a melanoma. Phew!). She's concerned enough about it to refer me to a plastic surgeon who will do a "punch biopsy" where they punch out a bit of the -whatever-it-is- and have it analysed - and from there they will decide what treatment it needs.

At first when I called the plastic surgeon, they told me I would have to wait three weeks to see him, so I freaked out a bit and told them that my whatever-it-is had appeared from nothing overnight and that I really really didn't want to have to wait such a long time before getting it checked out. I'm now seeing him on Monday in his lunch hour. Heh. Thanks, Mr PS!

I've done my research on the internets with "The Google" and I now know that basal cell carcinoma is the most common form of skin cancer, with over 800,000 new cases in the US alone each year. It's also fairly easily treated, as long as you deal with it quickly and don't mess around pretending it's not really there (or that it's a flea bite!).

A small percentage of BCCs are more aggressive and don't respond so well to treatment, but again, if dealt with early, they can generally be sorted. BCC has a very low rate of metastasis, which is when a cancer spreads from one part of the body to another.

Squamous cell carcinoma is the second most common form of skin cancer with over 200,000 new cases per year estimated in the United States. Most are not serious, and again can be treated very successfully if you catch them early enough. A very small percentage (2-3%) are more aggressive and can spread to other parts of the body, often with fatal results. Gulp. Hope I'm in the 97% if it is an SCC!

New Zealand has one of the highest rates of skin cancer incidence and mortality in the world, and it's the most common form of cancer here. We have nearly 50,000 new cases a year (out of a population of only 4 million people!) and over 300 deaths per year.

Skin cancer is caused by over-exposure to ultra-violet (UV) radiation from the sun, especially UVB.

CFCs (mainly from spraycans and refigerators) have damaged the ozone layer, and it's the ozone layer that protects us from UVB rays, so we're all more at risk now than we were 50 years ago. Here in NZ we've also got very clear skies (not much pollution) and because we are situated so far south, in the summer as our part of the planet turns to face the sun we are closer to it than those countries nearer the equator (and further away during the winter). [Click on this or any of the other pics to see more detail.]

I remember as a kid going on holidays to France and literally cooking myself on the beach, slathered in suntan oil (not sunblock!) and, well, frying. I've had one really bad sunburn experience in my life, in my early 20s when I got so badly burned my friends had to stay up all night laying wet towels across my back and legs to stop the skin blistering off. I could hardly sit down for a week, my skin was so tight and damaged. Ow! I've never done it since.

When I first came here to live, I was amazed at the contrast between the New Zealand sky and the hazy, polluted skies of Europe. Here the sky is so blue it almost hurts to look at it (in a good way!), but the sun is also fierce compared with most other places. You can literally feel it burning you after only about 10 minutes in the sun. Being a bit of an English Rose, skin-wise, I've always been really careful here. I'm the one with the wide-brimmed hat on, a decent pair of sunglasses, long sleeves, factor 30 sunblock at the ready, and probably sitting in the shade.

On a New Zealand beach it's quite rare to see people lying in the sun getting a suntan for hours on end. Most people wear hats, t-shirts, sit under umbrellas or in the shade, and almost all Kiwi kids wear those little full-body swimsuits that make them look like something out of the 1920s. The weather forecast always includes a UVI reading and an indication of burn time in the summer. Burn time is how long you could stay out in the sun without sunblock before you would start to burn. It's often well under 10 minutes.

Still, because we're such an active outdoorsy nation, it's hard to always stay out of the sun. I'm a bit of a gardener, so I do get my share of sun on my face, arms and shoulders in the summer, and I confess I don't always wear the hat, shades and sunblock when I'm just pottering around in the garden. Maybe I should have done.

On the face of it (haha bad pun!) my online research has shown me that I should be feeling pretty optimistic, and even if it does turn out to be a carcinoma, the prognosis is very good. We're certainly a million miles away from the drama of oh-my-god-I'm-going-to-die territory - we don't even know what it is yet - but I have to admit that this is bothering me quite a bit more than I would have expected it to. I think there are a couple of reasons why part of me is a bit freaked out, even though the rest of me is doing pretty well.

I suppose the first reason is that I feel guilty because I smoke and because I don't do nearly enough exercise and my diet is awful. It's easy to take your continuing good health (against all odds!) for granted until suddenly it isn't there any more. I know I'm not remotely at that stage yet (if ever), but I suppose even the suggestion of something like this can make you stop and think about what you're doing and what you'd like to be doing in 5 or 10 years time (or 20 or 30 or 50!). Still being alive would be an excellent start I think :) as would being a darned sight healthier and fitter than I am now.

So there's guilt and there's also motivation to change my lifestyle a bit. Don't know if I can give up the fags, but we shall see.

I think the other thing - and it's the one that is making me the most grumpy - is that it's at moments like this when you get a bit of a reminder of your own mortality, that it would be really nice to be able to share it with someone. I think this is a moment where I could really do with a great big hug (or 20), and someone who'd let me curl up next to them on the sofa for the evening and who would put their arm around me and stroke my hair or something and let me blather on about whatever I wanted to blather on about.

I know that any and all of my friends would do that for me in an instant if I asked - because they are all totally awesome people, but just this once it would be really really nice if there was someone in my life who knew without being told, or did without being asked - if for no other reason than I feel a bit of a twit calling up any of my grownup friends to ask them for an evening on the sofa having my hair stroked and my hopes and fears listened to. :)

*Sigh* it really really sucks being single sometimes.

Useful Links

• Basal Cell Carcinoma
• Squamous Cell Carcinoma
• Skin Cancer Prevention and Early Detection
• Sun Exposure and Skin Cancer
• SunSmart New Zealand

Part 2 - Out, damned spot!
Part 3 - Stitches come out, results are back, is it cancer?

Technorati tags: skin cancer, basal cell carcinoma, squamous cell carcinoma, ultraviolet radiation, ozone layer, ozone hole, sun, SunSmart, New Zealand, health.