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Skin cancer can sneak up on the most savvy

/ Source: Self

Maybe you were sunburned as a kid, or haven't been diligent about wearing sunscreen, but you probably thought that, should a suspicious spot appear, your doctor would catch it and keep you healthy. Well, that isn't always the case.

More than 90 percent of dermatologic surgeons have seen at least one patient in the past year with skin cancer that was overlooked or misdiagnosed by a nondermatologist, finds a survey of 271 docs by the American Society for Dermatologic Surgery in Rolling Meadows, Ill.

Horrifying, especially as melanoma is the most common cancer among women ages 25 to 29, and skin cancer is the cancer most frequently diagnosed in women. Don't be the case that's missed. Read these stories, and take away a new sense of self-vigilance.

Iris Glass

"I was told the bump was simply a benign cyst."

— Diagnosed with basal cell carcinoma; South Salem, New York

For years, Iris Glass, 45, lived with a bump on the inside corner of her left eye. Even after a friend advised her to have a dermatologist check it, she brushed off the suggestion. "I was too busy to take time away from the office, so it wasn't until three years after my friend spoke up that I finally booked a checkup," Glass says. On the day of the appointment, though, the dermatologist didn't do the exam himself; he had a physician's assistant do it. When the PA never mentioned the bump, Glass inquired.

"She looked at it, poked it and said, 'It's nothing more than a cyst. An ophthalmologist can remove it for aesthetic purposes,'" Glass recalls. So she booked the procedure. But a few weeks after removing part of the bump (the odd location prevented a complete removal), the ophthalmologist phoned Glass with bad news. The removed tissue, sent to a lab for testing, was diagnosed as basal cell carcinoma. Although it is the least serious type of skin cancer, it can erode the skin if left untreated.

After the carcinoma was thoroughly removed, the plastic surgeon performed a skin graft, replacing the thin skin near Glass's eye with tissue from behind her ear. The new tissue was lighter-skinned. Plus, it thickened during the healing process, creating a flap of skin, an irregularity Glass found embarrassing.

It took two more cosmetic surgeries for Glass to feel comfortable with her appearance. But the Mohs, which has a 99 percent success rate with basal cell carcinoma, has kept her cancer-free. And although she's still haunted by her missed diagnosis, she feels oddly grateful for her brush with cancer; it taught her the importance of finding the best doctor and paying attention to her body. "I'm so afraid of being misdiagnosed again," she says. "I'm now one of those people who goes to every doctor in town until I find the best one. Well, actually, the best two."

What you can learn from her

Make time for your health: Get an annual skin check, regardless of your skin tone. "The key to securing the near 100 percent cure rate is early detection and appropriate treatment," says Andrew J. Kaufman, M.D., a dermatological surgeon in Thousand Oaks, California. And choose your doctor wisely. "Anyone, even a doctor, can potentially miss a skin cancer. But studies show dermatologists are best at identifying them," Dr. Kaufman explains.

Jaime Regen Rea

"I'm telling Jaime's story so that one less mother has to bury her daughter due to skin cancer."

— Donna Regen, mother of Jaime Regen Rea, who died at age 29 after battling melanoma; Dallas

As a teen, Jaime Regen Rea was self-conscious about the large, dark mole she had had on her left shoulder blade since birth. At 14, she and her mother went to a dermatologist, who shaved it off, and that, they thought, was the end of that.

But six years after the procedure, the scar tissue left by the mole's removal started to itch and bleed. A new dermatologist diagnosed the condition as an infection and treated it with antibiotics. Then a few weeks later, during a routine physical, Rea's physician discovered a swollen lymph node in her neck and sent her to a surgeon. There, Rea inquired about the still-irritated skin on her back. Alarmed, the surgeon biopsied the tissue.

Despite Rea's fair skin, blue eyes and obsession with tanning (all things that increased her odds for skin cancer), neither she nor her mother was prepared for the test results: It was melanoma. The lesion had penetrated multiple layers of skin. (Soon determined to be stage II, the tumor had not yet spread to her lymph nodes; ironically, the swollen neck node was a harmless inflammation.) Rea required surgery to remove several layers of skin and tissue, leaving a 9-inch scar across her back.

"I had never heard of melanoma," remembers Donna Regen, Rea's mother, who immediately threw herself into researching her daughter's condition. Countless questions surfaced; among them: Was the mole cancerous when it was removed when Rea was 14? (There was no way to know, unfortunately; the doctor never did a biopsy.) Where did the original shaved-off tissue go? (She learned that the doctor had thrown it out, despite lab testing being standard procedure.) And why was the spot initially diagnosed as a simple infection — and not cancer?

For three years, doctors closely monitored Rea, doing blood tests every three months and yearly scans to watch for the cancer's recurrence. Rea graduated from college and began a fashion career. Then in March 2002, a month after getting married, she had her annual scan. Her oncologist soon discovered the melanoma had returned. This time it was stage IV cancer that had spread through her lymph nodes, causing a large tumor in her abdomen. It was removed, and Rea began immunotherapy.

But despite almost two years of treatment, another tumor appeared in her chest. After it was removed, Rea began a clinical trial for an experimental drug that required exhausting weekly travel from Texas to New Jersey. But nothing could stop the tumors that, over the next year, grew in several places, including her liver and brain. Rea died on March 16, 2007. "I'm telling her story to convince other women to be vigilant. Jaime wouldn't want this to happen to anyone else," Regen says.

What you can learn from her

Choose a doctor who is board-certified in dermatology; that assures the M.D. is receiving continual cutting-edge training. (Find one through the American Academy of Dermatology.) Ask how many skin checks and procedures she has done. "It should be in the thousands," says Michael Albom, M.D., clinical professor of dermatology at NYU Medical Center in New York City. And never be afraid to get a second opinion — it's your health and life.

Kimberly O'Brien Sanga

"I regularly check my skin for suspicious spots to stay healthy."

— Diagnosed with basal cell carcinoma and squamous cell carcinoma; Salem, New Hampshire

As a child, Kimberly O'Brien Sanga, 31, spent an intense amount of time in the sun. Her family had a pool, and Sanga played outside almost every day. "At the time, we applied sunscreen only once a day — if that," Sanga recalls. As a result, she suffered two severe, blistering burns at the ages of 8 and 11. On top of burning, Sanga frequented tanning beds as a teenager. "Each month, I'd buy an unlimited membership to my local tanning salon, and I'd go three or four times a week year-round — winter, prom season, just before spring break, sometimes even in the summer."

Then, at 18, while showering, Sanga noticed a brown spot with a strange-looking red line running through it on the top of her left breast. She hadn't remembered seeing it before, so she made an appointment to visit a dermatologist the following day.

As soon as her doctor saw her mole during the exam, Sanga recalls, a look of concern crossed his face. He called in her father from the waiting room and explained that the unusual look of the mole suggested skin cancer. Considering her history of sun exposure, the doctor recommended that the spot be excised and biopsied immediately. Two weeks later, the results revealed Sanga had basal cell carcinoma.

The dermatologist instructed Sanga to begin monitoring her body for new moles or changes in the size, shape or color of any current moles. Soon, she discovered a change in a second mole, located a half inch from the first one; it had gotten darker and changed its shape. "Three months after the first mole was taken off, I was lying on the same table, once again, having another removed," she recalls.

For reasons not understood, Sanga had a reprieve from new or changing moles between the ages of 20 and 25. But the battle resumed in the years that followed. In the past 13 years, Sanga has had a total of 42 moles cut from her body (27 of them in the last two years alone). Most were dysplastic nevi (the technical term for atypical moles that can morph into actual cancer) and were removed as a precaution. Seven, however, were actually diagnosed as basal or squamous cell carcinomas.

"I am covered with scars from head to toe," she says. "They are on my head, my neck, my armpit, my back. I even have a huge, 2-inch-long scar on the bottom of my left foot and another on the top of my right toe. Every time I go to the doctor for a checkup, I fear what the diagnosis is going to be."

Sanga continually checks her skin for suspicious spots, and her husband takes part, too, checking hard-to-see areas such as her back. During the process, she pencils in the location of her moles as well as their descriptions and any changes on a body map, so she can keep track of their status and update her doctor, whom she sees every three months. Her doctor is currently monitoring an additional 30 spots.

Sanga shudders at the thought of her sun-worshipping and habitual indoor-tanning days, which have sentenced her to a lifetime of problems and health scares. So what gets her through the reality of more scalpels, stitches and scars? "My strong desire to be around 50 years from now," she says.

What you can learn from her

Sanga's vigilance is key to staying healthy. Follow her lead and get to know your skin every month. (Do it when you do your breast exam.) "Self checks are crucial to preventing skin cancer and detecting it at a treatable stage," Dr. Kaufman says. In fact, patients find one third of melanomas. And don't even think about basking in the sun sans sunscreen or using a tanning bed.