Adventures with Roberta

One night last week as Jon and I were changing clothes and getting ready for bed I noticed a small mole on his back that sent the arrow of my skin cancer radar so far into the red that it broke in half. My radar is perhaps more sensitive than most, and if you’re new to this website I should explain that I’ve had five suspicious moles and discolorations removed from my body in the last few years, two of which turned out to be skin cancer (you can read about my experience here, here, here, and here). So you could say I get a little jumpy when I see the tiniest skin abnormality, and for the next twenty minutes I grilled him as if he were a suspect in a gruesome homicide: how long has he known about this mole? Has it recently changed colors? Was he planning to have it checked out or was he just going to take his chances and SUDDENLY MY CHILDREN HAVE NO FATHER?

Problem is there was no one there to play good cop, so it looked less like an episode of “Law and Order” and more like a cartoon where a maniacal hen who’s been left in charge of an egg accidentally pecks it into a thousand tiny pieces.

Jon's suspicious mole

It could be absolutely nothing to worry about, but we’ve scheduled him an appointment with my dermatologist to be safe, and there’s a part of me that wants to thank Jon’s mole for reminding me that I’m due to self-treat another suspicious spot on my body, one I found on my forehead several months ago. It’s tiny, not even half the size of the fingernail on my pinky, but because of its rough texture and unwillingness to go away I brought it up with my doctor who diagnosed it as a “precancer” known as actinic keratosis:

An actinic keratosis, also known as a solar keratosis, is a scaly or crusty growth (lesion). It most often appears on the bald scalp, face, ears, lips, backs of the hands and forearms, shoulders, neck or any other areas of the body frequently exposed to the sun… In the beginning, actinic keratoses are frequently so small that they are recognized by touch rather than sight. It feels as if you were running a finger over sandpaper.

If you have actinic keratoses, it indicates that you have sustained sun damage and could develop any kind of skin cancer – not just squamous cell carcinoma.

In keeping with the tradition of naming these suspicious invaders I’ve decided to call her Roberta. When she isn’t busy disrupting the surface of my forehead she teaches salsa lessons at the local community center and routinely sleeps with her students.

Here’s a picture of what she currently looks like when I haven’t covered her up with make-up:

actinic keratosis

actinic keratosis

My doctor assures me that we’ve caught it early enough that I can successfully treat it at home with a medicine called Aldara, a topical ointment that I apply directly to the skin for a period of twelve weeks, and that I could even wait to start treatment if I was worried at all about its effects on the baby in utero. I’ve also put it off because of my vanity, because he said it would cause the spot in question to turn a reddish color that couldn’t be concealed with make-up, and I just wanted to get through my book tour without having to keep coming up with creative answers to WHY DO YOU HAVE A HICKEY ON YOUR FOREHEAD?

I figure no one is going to notice the hickey on my forehead when my boobs are the size of nuclear warheads and leaking milk with the force of a fire hose.

I wanted to bring this up here for a few reasons:

One, The American Cancer Society recently became one of the sponsors of this website, and they asked me if I’d be willing to write about one of the ways in which cancer has affected my life.

Two, some of you have written to ask if I’ve found any more suspicious spots on my body. I think you could ask me that question every year from now until I die and the answer will always be yes. This is just what happens when you’re as careless as I was in my teens and twenties about sun exposure, and as a result I will spend the rest of my life terrified that every skin irregularity could end up threatening my life.

And finally, maybe these details will be what finally urges someone to make an appointment with a dermatologist, maybe these images will turn up in some Google search and convince someone that they should take the discoloration on their forehead seriously. And so let me urge you, if you are at all unsettled about a strange place on your skin, please don’t ignore it. And in the meantime put on some sunscreen, hug your kids, and call your mom.

  • http://labradoris.weebly.com/blog-entries.html Labradoris

    Thanks for making this post, and also, being visible about your reasons for this post. :)

    I use Neutrogena’s Ultra Sheer Dry-Touch Sunblock SPF 85 every single day, rain or shine. I’m 25, but I have the family history and the skin tone/hair color to indicate, with big flashing neon signs, SKIN CANCER RISK in the future.

  • http://www.allegrasrose.blogspot.com Michele

    I have a two inch scar on the left cheek on my face. A scab that kept coming back that I believe would heal on its own and I continued to ignore came back to bite me. After almost a year I finally went to a dermatologist and was told it was basal cell carcinoma.

    After the diagnosis I was instructed to see a Mohs Surgeon (see http://en.wikipedia.org/wiki/Mohs_surgery) to have it removed. Usually if you catch these things early the surgeon will have to only go down “one level”, but in my case he had to go down “three levels” to clear all the margins. I’m in my 40′s and I also spent enormous amounts of time in the sun…sun bathing, swimming in the ocean, and going so far as to put butter and oil on my skin day after day as a teenager to get sun burn and tan. It was the thing to do in the 70′s ….get tan.

    I do believe though that my cancer came early. My Dad had basal cell carcinoma starting in his 50′s. I believe the use of a cell phone while it didn’t cause the basal cell, helped accelerate the process – every doctor I’ve ever told this laughed – said that the left side of the face is a normal place for cancer to grow because we’re all driving with that side of the face exposed. So tell me this..I lived in NYC for 20 years and did not drive for about 15 of those…I’m not sure I agree.

    Needless to say I, like you, am always looking at the moles on my skin, discolorations and any change that is abnormal. At the moment I have small tiny bumps on my chest (the bone in the middle) and I remember having sun poisoning there as a teenager. I am a bit panicked about it – although it is itchy and so perhaps it is not cancer. I have an appointment next week to find out what it is and hopefully it will just turn out to be a skin irritation of some sort.

    Anyway my thoughts about sun exposure are stay out of the sun in the middle of the day, WEAR A HAT if you must be out in the sun. I live in Arizona these days so being out during midday has no appeal for me….I go out in the morning and the evening and pay little or no attention to the idea of coloring my skin anymore.

    I’m sure the sun’s rays have strengthened..but that is another story all together. Love the sun..but know its boundaries!!

  • Karen

    Thanks for the information. I should take some steps my self just to check things out.
    And on the makeup issue with covering the red spots, have you tried Bare Escentuals? I am totally in love with it and have been for many years. Just thought I would pass that along to you.
    P.S. I purchased Diorshow after I saw it on your site and totally love it too. Thanks for the info.

  • MaL

    Yeah, educate yourself and be prepared for Aldara’s side effects, but don’t let google scare you off! Cryotherapy does take care of the one spot right away but doesn’t take care of developing keratoses beneath.

    I used to work with the dermatology residents at the U! I imagine the ones I knew are all graduated by now.

  • http://havingitall-maggie.blogspot.com maggie

    OK, you have officially freaked me out. I am calling the doc today!!

  • jen

    Thank you, thank you! I’m thrilled to see the ACS sponsoring your blog and to know that you’ll be writing about your experiences. I can only assume that you’ll lend the same hilarious yet thoughtful voice to this subject as you do all others, and that can only mean good things for the fight against cancer…a cause near and dear to me and mine.

  • http://maybeinutah.blogspot.com Mari

    Oh man, I know I am at risk: light colored eyes, fair skin, fried myself as a teen, etc. but I can’t afford to do anything about it yet. Damn Utah sun! (shakes fist)

  • http://blog.oliverifairy.com Katie

    Thank you so much for using your very popular wonderful blog for the Cancer Public Service Announcement. As someone who had to have half her nose cut off at the age of 20 (wonderfully recreated with the miracle of plastic surgery!) I’m all for getting the word out. Again, THANK YOU!

  • Jenna

    I was told yesterday that since I brown up like jambalaya sausage WITH sunblock on that I should go to the tanning booth twice a week just because I can… And I live in Colorado, a permanent tanning booth.

    I then started a skin cancer shpiel that my mother would have been proud of. Thank goodness for that mother and her obsessive need to lather me in sunscreen. I’m going to go call her now. Thanks for the reminder.

  • suenarita

    Some Dermatologists are Mole-happy, like mine. If they don’t remove anything they don’t make much money…

  • Rachel

    Calling my dermatologist today to find out when my last mole-check was. I too am a pale-faced one; one who spent the early 1980s lying outside slathered in baby oil and surrounded by a few aluminum foil reflectors to get as much UV out of that New Hampshire sun as possible. The stupidness of it is mind boggling. Thanks for the reminder and wishing you good news from the appointments.

  • http://stirrup-queens.blogspot.com Mel

    You know how sometimes the same thing keeps coming up in many places and you finally see it as a sign that the universe is telling you something? I am massively careless with sunscreen and it filters down to the kids. I just don’t think about it unless we’re at the beach and that’s a terrible way to treat your skin. First my friend had moles removed this week that turned out to be cancerous, then I was just at the food store behind a woman purchasing massive quantities of sunscreen, and now I come home to read this.

    Third time knocked it into my thick skull?

    Thank you for this. While Roberta sounds like a fun-loving girl, though a bit risky with her dalliances with students, I just don’t want her showing up on my skin. Or the twins. This post just made that sink in.

  • http://www.bornfit.com Jamie

    Hey! Thanks for the reminder, I ask my boyfriend weekly to get his 100 moles checked, please. I daily regret my hours lying in the sun and tanning beds.

    My grandma had skin cancer on her face and had to use a cream that left her looking like she had road rash for months. Thankfully it went away. SUNSCREEN is my new companion. Apply and re-apply!

  • Em

    After reading this, I made appointments for me(lifeguard 7 years) and my husband(southern california water polo player for like 15 years!!) to have a general check up at the derm this summer. Thanks. Seriously. You do good things with this site.

  • Fay

    I would like to add that it is important not only to go to the dermatologist to get any suspicious moles looked at, but to be very proactive about getting the mole biopsied. While there are several common features to skin cancers (the ABCDE rules), each one is different. I had a mole looked at by two dermatologists, both of whom said “Let’s just keep an eye on it”. If I hadn’t insisted on getting it removed on my second visit, I may be dead by now. Malignant melanoma can be easy to treat in the early stages, but is very serious in the later stages.

    Never let your kids get sunburned and make sure you use a physical blocking agent in your sunscreen (zinc), not chemical blockers.

  • tania

    i hope that folks read this far down into the comments. a lot of you are commenting on how paleness equates a risk of skin cancer and while that is certainly true, i’m reminding all the folks with darker skin to take care as well. i have an olive complexion, never burn and only tan, and still had a basal cell carcinoma removed from under my eye when i was 26. i went to a plastic surgeon because of the delicate location, and the ONLY REASON that the mass was biopsied was so that i could claim the surgery on my insurance. i had no idea it could even be cancer.

    because of my darker skin, i am considered “low risk” and might never have known it was cancer. we are all susceptible and need to wear sunscreen all the time!

  • http://your-life-is-now.blogspot.com SarahW

    And don’t forget to check the bottoms of your feet! Weird, I know, but I had a flat mole removed from there.

  • http://wordonthestreetis.blogspot.com Anonymous

    going to the dr tomorrow regarding mystery place on back. don’t want to. going anyway. thanks for the nudge.

  • Layne Marie

    Hmm. My boyfriend has a mole on his back that looks very much like Jon’s. I’ve been keeping an eye on it for a couple months and fear I’ve become the maniacal hen you describe. Apparently, he doesn’t like it when I “interrogate” him. And he runs away when I say “Hey let me check out that mole again!” as I come after him with a ruler and magnifying glass.

    But now, NOW that boy is going to the dermatologist ASAP. We do live in South Florida, after all, and he’s spent a large percentage of his life in the sun.

    It’s probably nothing. But if a dermatologist confirms that, I’ll have one less thing nagging at my paranoid mind.

  • http://dearmazzy.com Amy @ Dear Mazzy

    I need to show this to my parents. My mom actually owns a tanning bed. WTF?? And they think it’s ok for my daughter to play outside in Texas with no hat/sunscreen cuz she’s “in the shade” most of the time. In a 1-acre yard with 8 trees. Right.

  • http://greatdayinmaine.blogspot.com leesavee

    Thank you for reminding us to get ourselves checked. I need to make an appointment pronto, since I have my own Roberta (actually, I am planning to call her Bertha) on my cheek.

  • Pamela

    Is it true that when the dermo does an all over skin check they look at your female stuff and in between your butt cheeks too? Because I’ve heard that.

  • http://mypersonalminiseries.blogspot.com/ Queen of Chaos

    Thanks for the reminder. I have moles that were pre-cancerous removed. I returned to the Dermatologist 2 years ago, had a full check and more removed that were benign. Doc said to keep a watch out but not to worry on the ones I have left.

  • Lacey

    My father passed away after fighting squamous cell carcinoma and the complications from that last September, so no, I don’t believe you can ever be too cautious!

  • Alejandra

    thanks for the reminder… gotta go and call my dermatologist… got a “huge” (according to my vanity) on my back, and it had changed in it’s form… so…
    again, thanks for sharing this!

  • Negar

    I am covered with these, althought flat but dark. I heard that a person has an average of 600 on their bodies. I used to get worried now they are too many and I jsut stay away from the sun.

  • Katie

    After your last post about skin cancer, I went in and had my body checked. I was told that I am just one of those lucky girls that freckles alot and the one scary spot on me was actually a keloid scar that would just look worse if he tried to remove it. I then forced my hubby, who is more fair complected than I am (he has Irish, English, and Norse in his blood, I’m just German)to get checked out. Low and behold he has several “suspicious” spots that next year he’s to have checked out again. It might seem a little over-kill, but since both his mom and my grandpa both have had melanoma spots removed from their faces, I’m just planning on my boys having parents until they’re in their 60′s!

    Aside, why the heck to some of us get the dang “mask of pregnancy” that doesn’t leave after pregnancy!?!?!?! That’s my biggest issue, I have spots of dark freckles and then I have spots that don’t freckle or tan anymore either! I look like a frickin’ Michael Jackson wanna-be! Sucks!

  • http://lifeandtimesofstella.wordpress.com Amber

    CRAP. You are making me realize that I should really get to a dermatologist ASAP. Honestly, this has reminded me that I am practically an albino and was a *lifeguard* during college, and that during my pregnancy my skin threw a party and invited tons of new moles, red spots and rough patches. My skin looks like crap. But rather than throw my hands up and accept my new, less attractive reality, I should make sure I’m in the clear with all these new spots and rashes and whatnot. Thanks for the reminder, dooce!

  • Becky

    Thanks for this reminder. I just called my dermatologist about a red spot I’ve been trying to ignore. Also, this Friday is Don’t Fry Day – a bunch of orgs interested in skin cancer prevention have united to put it on – good info on sun safety there http://www.skincancerprevention.org/Events/DontFryDay/tabid/113/Default.aspx

  • KaraMac

    I went to the dermatologist for the first time this morning to check out a spot on my face. “That is a precancerous lesion. Do you have anywhere to be this weekend where you wouldn’t want a red scab on your face? No? Good, I’ll just burn that off right now.” The fun all happens before 9 a.m. in my life. :)

  • Anonymous

    John’s mole is SCARY looking! He is lucky to have a wife who is so observant as to notice a very weird looking mole. Good job and i hope everything turns out ok. Please keep us updated.

  • Darlene

    Thank you for this post, and especially the pictures. I had always thought, mistakenly, that the only moles to worry about were dark brown or black in color. That’s what you would always see in pictures of “suspicous moles.” A pinkish spot on my nose (that I orginally thought was a pimple) turned out to be a pre-cancerous growth.

  • http://anniefromasheville.wordpress.com/ Annie

    Thank You for posting a good reminder to all. My husband has stage 4 melanoma, which started out as a small mole on his scalp. Yes, he was a child of the 50′s with his little blond head buzzed down to a crew cut. We didn’t see it till it was very far gone due his full head of hair now. Watch closely and get everything checked. Early detection is the key.

  • domestikate

    Kudos for being so proactive on this subject, and thank you for sharing! I really appreciated your posts on basal cell a few years back, it made me think hard about my own skin.
    I’m a 35 year old woman and I just finished a 5 week run of Aldara for basal cell and AK on the skin along the edge of my top lip. My doctor told me very little about the drug, and prescribed it in a cavalier fashion. He even prescribed about 10 times the amount that I needed- and this is a very expensive medication.
    I hope that you’ll do some research on the drug and proceed slowly, it is a powerful medication, with many potential side effects. It’s even been linked to the trigger of serious autoimmune conditions like lupus.
    If you chose to use it- A little goes a LONG way, just the tiniest dab should cover that little spot.
    I chose to use it as freezing hadn’t worked and the other option (MOHS scraping) I would require some very tricky plastic surgery to my lip, and would still leave me with AK in the surrounding areas.
    So I used Aldara for 5 weeks, a few times a week it in a somewhat non-recommended area (close to the soft tissue of my lips). I was sick as a DOG for the duration. I had days where I would have thought I was dying if I hadn’t done the research into the side effects. And of course I was a horror show of scabs on top of scabs, which meant it was working. It’s healing up nicely now and I’m glad I muscled through.
    Hopefully dermatologists will come to a better understanding of the powerful nature of the drug, there’s so much that mine did not tell me.

  • Kari S

    Thanks for posting this and spreading the word. Im one of those lucky ones who have pale white skin and have to wear sunblock everyday. I had one mole removed and it came back negative but I am always checking my other moles that I have. Anyone runs a chance of skin cancer so its good that you are promoting self checks!

  • aliplus3

    Thanks for getting the message out that pale can be cool too!

    It’s particularly important to protect our kids – each sunburn under the age of 5 dramatically increases their lifetime risk of cancer. My derm (chief of dermatology at a renowned research and teaching hospital) said that babies can be protected with zinc oxide instead of regular suncream (most pediatricians tell parents not to apply sunscreen to babies under 6 months, but our neighbour’s 8-wk-old granddaughter got 2nd degree burns after 30 minutes in the shade. And we live in Quebec – hardly equatorial!).

    And don’t rely on sunscreen alone – cover up with SPF clothing, a hat and sunglasses with UV protection (you can get melanomas in your eye). Like they say in Australia: Slip (on protective clothing), Slop (on sunscreen with a high SPF) and Slap (on a hat).

    Also, darker-skinned people shouldn’t feel immune. Remember, Bob Marley died of melanoma.

  • http://geaux-dd.blogspot.com danielle

    I had two moles removed from my neck a little over a month ago. I agreed to see the dermatologist partly because of your previous posts about Fred and friends.

    They were moles I’d had all my life, and I felt sad when they were gone, mainly because of how long it took me to accept them. But I’m glad they were taken away and pronounced benign when I was 25 (I’ve since turned 26) rather than stay on my neck, continue to change size and color, and then become malignant in who knows how many years.

    I still have moles that I have to watch and get checked, because I spent every summer outdoors in Florida until I was 21 and rarely applied sunscreen. And even idiotically tried to use suntan oil last year instead of sunscreen.

    But here’s at least one person who listened to what you wrote.

  • Anonymous

    My poor future children… Every time I see an infant or toddler in the sun (even this morning at 8 am – in Chicago) I think to myself – oh gawd, I hope they’ve put sunblock on that baby.
    I’m very fair skinned and burned to blisters several times in my life. I haven’t had a full body scan in about 15 years but I started developing my first liver spots in my early 20s. so far all of my spots are non-worrisome, though there is melanoma in my family.
    It would be a good idea to find a doctor to get a good baseline to work from later.

  • http://www.ramblingsofasahm.com/ Vanessa Wilson

    It’s so nice to see that I am not the only one who gets crazy about moles and makrs on the body. I sent my husband last year to get 6 moles removed off his back. Thankfully they were not cancer. I also had two removed back in January. Thanks for sharing!

  • http://nancylovering.blogspot.com Nancy

    Two things: 1) thank you, and 2) stay well :)

  • Andrea

    As a 25 year old who was diagnosed with malignant melanoma on my lower abdomen (precisely where a bikini hits) at the age of 23 (which was surgically treated. My fiance and I now refer to my nether regions as “Franken-Crotch”) I applaud you for bringing up this topic. I was a relentless sun-bather. We’re talking hitting the pool after a trip to the tanning salon, because the sun just doesn’t rise early enough in the day.

    EVERYONE needs to be checked.

  • Angie

    I have been meaning to make an appointment for a routine skin check for a long time. After reading your post I actually called and made the appointment. Thank you for the reminder.

  • Anonymous

    Yep, and MY dermatologist told me if a spot bothers me, she’ll take it off. We don’t ignore anything.

    I drive my kids nuts with the sunscreen.

  • http://baerfeatcreations.com Stacy

    Not all cancerous moles follow the rules. My malignant melanoma moles were completely void of color; they were totally symetrical and they did not change.

    I am so very blessed that I am in remission; several people I went through treatment with were not so fortunate and mine was further advanced, stage iv.

    Don’t mess with this people. It is truly a horiffic disease. Dying from it is even worse.

  • http://www.momtrolfreak.com/momtrolfreak/2009/04/call-me-ishmael.html momtrolfreak

    Oh man, I get at least two things cut off every year, I feel your pain. I am SO white and SO Irish that really, I’m doomed to eventually have something come back cancerous. For now, though, I’ve got that effing keratosis pilaris BS, as well as something the derm calls Barnacles of Old Age. No shit.

  • Anonymous

    Maybe you should drop in at notesfromthetrenches.com, read today’s (May 21st) post and (gently) ask Chris (the blogger) to check out your cancer history before she pooh-poohs sunblock for her kids….

  • KTab

    Having never visited a dermatologist, can you go in, strip down, and have them go over your entire body with a fine toothed comb? And do you like your dr.? I’m in the SLC area and have been thinking of going in and your post today just reminded me. If you like him/her, and it doesn’t freak you out to give a referral, could you email the drs name? Thanks, Heather!! Oh, and I agree that your eyes look awesome in that shot!

  • P

    I’ve often joked that I’ve “bought” my dermatologist a condo on the beach. That would be the cruel reality, huh? :o )

    Living in Florida and being raised during a time when baby oil and iodine* were accepted sun(burn) oils has not been kind to my skin. Not to mention, I’m one step away from being a redhead. Anyway, I totally related when you said you would always be finding suspicious spots from here on out. My personal record was 23 during one visit. You know that little diagram they record them on in your patient records? Mine looked like I had chicken pox. Not pretty!

    Thanks for the gentle reminder that it’s time to go get spot checked (again)!

    * What genius thought that one up?

  • http://datingisweird.blogspot.com Serial

    OK, so I only have a year and a half left of my 20s, does that mean I get to continue tanning recklessly for the next 36 months? Please say yes! I look so much hotter with a tan!

    But gah. You’re right. I do have creepy suspicious moles all over the damn place ….

    Gah. Bah. Meh.

  • Ali

    I think I need to name mine too. I’ve had over 30 removed in the last two years – the worst being stage 1 melanoma. Paranoid doesn’t even begin to describe how I feel about my skin/moles now. And like someone else said, I am all for the scars if it means I get to live.