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://www.cluckandtweet.com Alison @ Cluck and Tweet

    Although I applaud the PSA (really…my husband’s dad died of melanoma after spending a lot of time in the South Seas during WWII), I tend to be a bit of a hypochondriac. A bit meaning that I google all symptoms (mine, my children’s, my friend’s children’s…which is how I found out that salty sweat is a symptom of Cystic Fybrosis and you should lick your child to rule that out). Last time I was sick I thought I had hip cancer. Turned out it was strep throat.

  • Megan

    I read this post before going for a jog. As a result, I remembered to put on sunscreen before I went out. Thanks, Heather!

  • Leslie

    Thank you Heather. I’ve had a spot on my face for over a year now that is unsettling and haven’t had it looked at because I don’t want to go through the hassle of finding a dermatologist. I will make an appointment now. I know it’s something I needed to do but I was really procrastinating. I promise I’ll go now.

  • PamD

    My husband was treated for AK last summer. He had many more spots than you, and it was something that got worse over time. He used Carac (which, I believe, is similar to Aldara). I would be extremely careful with any of these drugs while pregnant or breastfeeding – think you mentioned that you were going to wait until after having the baby. These creams are basically “chemo in a tube”. The drug will bring to the surface all the AK’s that you can’t see right now, as well as, treat what you can see. My DH’s face got very raw and red, and he was very uncomfortable for a while. He took a few days out of work because of the discomfort, and he didn’t want to scare anyone! He stuck with the treatment though because he didn’t want to mess around with skin cancer, or have stuff burned/cut off his face when he’s older (like his mother currently goes through). I can’t remember the website right now, but before he started treatment he followed someone else’s experience on some blog – including pictures. It wasn’t pretty, but almost everyone that I read about was glad that they had done it – side effects and all. If I can find the link I’ll submit another comment. Best to you and your DH.

  • http://angryredhead.wordpress.com Candice

    I don’t think I’ll ever look at my friend Roberta the same way again.

  • http://www.TwentyFourAtHeart.com Twenty Four At Heart

    thank you for writing this. I’m a melanoma survivor (5years). I’ve lost my aunt and uncle to melanoma. (Most people don’t know melanoma is not only caused by sun exposure, but also can appear in gentic “clusters”) I’ve talked about it on my site before but I don’t have nearly the reach you do. thank you.

    A very important message …!

  • http://www.bellystory.blogspot.com/ Belly Girl

    I’m going to categorize back-mole-checking under “killing bugs” and “getting stuff from high shelves” with the reason to have a husband. How in the world would he ever have known about a back mole if you didn’t see it? I don’t blame you for making him go in to get it checked, that does look suspect. Scary!

    Have you ever gotten those pregnancy skin tags? I did a search for them after I read this post and they are SO WEIRD LOOKING, it makes your teensy tiny forehead mark look like nothing.

  • Anonymous

    By sharing this information on your blog, I am certain you saved at least one person out there who has some sun damage. Love your blog! Best wishes to you and your family.

  • http://radkitch.com Erika

    I come from a long line of practically transparent people for whom sunscreen was invented. Thanks for bringing more attention and a pre-summer reminder about such an important and easily prevented disease.

    erika

  • dooce

    #68. KTab, yes you can just go in and have them look over your entire body for anything suspicious. I would actually recommend everyone do this. I visit the University of Utah hospital (just Google the dermatology department), but since it is a teaching hospital you have to be comfortable with students looking at your naked bum. And know that they will giggle about it later.

  • http://mvmedstudent.wordpress.com Michelle vs the Med Student

    Aldara? Heck, all the docs I’ve know just freeze AK’s off, like with the freeze spray they use on warts. B/c thats what Aldara is, a wart treatment with other applications. But family practice docs tend to lean towards saving the patient some money. One spray? free vs. cream? $150 … But I suppose you get $150 worth of peace of mind.

  • http://www.grumblesandgrunts.com Jamie

    Cool new sponsor. I’ve been trying to talk my husband into getting a funky mole on his shoulder checked out for years, maybe he’ll listen to YOU.

  • Vee

    Thank you so much for this, I am Hispanic, and for some reason my people think skin cancer will never touch their lives which is beyond stupid. Made even more stupid by the fact that we’re light skinned. I wear sunscreen all the time, but my boyfriend and sister brush off my suggestions for them to put it on. I’m forwarding this to both of those jack*sses right now.

    BTW-Good luck with your delivery! You’re glowing and beautiful.

  • http://www.humanbeingblog.wordpress.com Lynn @ human, being

    Heather, as an 8-year survivor of malignant melanoma, thanks for bringing this topic up to your readers attention.

    I’m also the PR director for an NCI Comprehensive Cancer Center, and we recently had a free public skin screening. We had 148 people come through for cursory (read “not-naked”) skin checks, and of those people 4 had basal cell carcinomas and 2 had melanomas.

    Most people think that skin cancer is no big deal. The truth is skin cancer is no big deal IF it’s caught early. A melanoma that’s just 1.5 milimeters thick can kill you. My melanoma was 3 mm thick. I am alive today (as is my daughter, because I was 22 wks pregnant when I was diagnosed) by the grace of god.

    Melanoma is one of the few cancer types that not only has NO CURE once it has metastasized, but has no effective treatment other than surgery. If you get melanoma and it is in your lymph nodes, that’s bad news. Your only hope is highly experimental treatments(read not-FDA-approved because it only works in about 15% of people and it almost kills you in the process). I’m 8 years out and I still have a 50% chance of dying from melanoma in my lifetime. And I’m 39 years old.

    The only way to protect against skin cancer is to keep your skin out of the sun. The jury is still out about whether sunscreen use protects very much at all. Because even though sunscreen use is going up, so is the incidence of melanoma in the US among young women.

    From the NCI Cancer Bulletin, July 22, 2008:

    “The annual incidence of invasive cutaneous melanoma, the deadliest form of skin cancer, increased among Caucasian women in the United States aged 15 to 39 by 50 percent between 1980 and 2004.”

    Your risk for any type of skin cancer, but specifically melanoma goes up exponentially if you:

    * have light colored eyes
    * have red hair
    * have pale skin
    * have a first or second-degree relative who has had a melanoma

    Our motto around here is if you have skin and it’s been in the sun, get it checked by a dermatologist. Even my 8-year-old daughter gets skin checks every year.

    The most important thing to watch for is moles that change in any way: get crusty, get bigger, get darker, lose their border.

    You can also take digital photos of your moles every quarter or so to note changes, because they may happen slowly. Or quickly, as mine did. Bring the photos with you to your annual skin check if your dermatologist doesn’t take photos like mine does.

    So if you feel something weird is going on on your skin, don’t delay. It’s better to have a microscopic scar on your calf, or your face, or your forearm and have had the lesion be benign then to be dead.

    This is my soapbox. At least I’m no longer putting notes in tanning beds around the city that say “Stop Committing Suicide! Get out of this tanning bed!”

    Lynn

  • http://www.diapermonologues.com/ mrs.notouching

    I have my appointment next Thursday. Thank you.

  • stefanie

    i didn’t bother to read all 70 something comments before mine so if this has already been said, sorry. aldara. my doctor seems to be in love with it because he tries to prescribe it everytime he finds something new on my skin so it must be useful stuff. but two times i’ve tried to use it and never made it past a week. it left me feeling like i had the flu- muscle and joint aches so severe that i couldn’t get out of bed the day after it was applied. i hurt so bad i literally couldn’t move my fingers without feeling like i might vomit from the pain. i’ve known other people who have had the same problem with it and i’ve known people who have used it and had no problem at all. i’m not trying to scare you i just think that if i had known about the possible side effects in advance i would have stuck with it long enough for it to do some good.

  • http://abroadallmylife.livejournal.com/ Kim

    After reading your initial cancer posts, I checked a mole I’ve had all of my life. Went to the dermatologist, who said it was probably nothing but should be removed within the next year. So, I scheduled the appointment for the next week and now am down one mole and up two stitches. Thank you for being so frank about this; I hope it helps more people realize how important sunscreen and regular monitoring of moles/spots/etc. are!

  • Sarah

    My husband has a mole on his chest.
    He calls it ‘BOB’ as does our almost 2 year old son…

  • JennyM

    You actually *are* the reason I scheduled a dermatologist appointment a few weeks ago when a strange place showed up on my arm. Turns out the strange thing on my arm is a dermatofibroma and so far, nothing to worry about. But now I know and now I have a dermatologist and we’re keeping track of all of it.

  • Cris

    Thank you, and I hope everything turns out fine.

  • http://abridesbrain.blogspot.com Jenn K.

    Thank you for being so diligent about this. I don’t usually post comments but this post is deserving. I recently (summer of 2008) lost someone very close to me to Melanoma. So many people think that little moles are no harm. It was shocking how fast the disease will pass through your body (total 9 months). Catching things like this early is the only way to prevent further spread of cancer. Thank you for at least reminding people that going to the dermatologist once a year is just as critical as any other yearly physical!

  • http://jocelina.livejournal.com Jocey

    I totally credit you for the visit I made to the dermatologist last summer, and going forward I will credit you for reminding me that I need to go in again pretty soon here. I mean, I was going to go anyway, really, I swear I was. Honest.

    My first visit was pretty awesome, as check-ups go. The dermatologist had the most caterpillar-like eyebrows I’ve ever seen, and they held me transfixed for the duration of my exam, which was great because it totally distracted me from the fact that a sixtysomething dude was minutely examining my nearly naked body and asking me if I had any moles on my vulva. (I don’t.)

    I hope Jon’s visit goes equally well, and that Roberta departs from your forehead in a timely fashion.

  • http://www.curlyred.com Kendall

    Dooce, you are very, very wise.

    Sunscreen is one of my best friends. And why aren’t tanning beds looked at with the same criticism as cigarettes? Makes no sense to me.

  • Erin

    Thank you so much for this post, this is exactly what I needed to hear. I’ve had a mole growing on my leg for the past year and it started as only a small obnoxious little pink “zit” but has now grown into a larger and more obnoxious and painful pink mole right in that spot that no matter how much sunscreen I put on always gets burnt next to my knee. And I’ve been putting off going to the dermatologist because like your previous skin cancer posts I have to make sure there is funding for such a venture. But hearing your story really makes the possibility of cancer real and I need to get this damn thing checked out. So thanks again.

  • http://elizabethlovesbacon.blogspot.com Elizabeth

    OH MY GOSH I totally have one of those actinic keratoses thingamabobs! I noticed it a year or two ago and couldn’t figure out why I had a scar-like thing growing in a spot where I know I didn’t have a zit (my forehead, right near my hairline). I was going to use it as an excuse to see a dermatologist but then got sidetracked and never got around to it. As a blue-eyed blonde who has had more than her fair share of blistering sunburns, I know I’m retarded.

    Thanks for the 411 — DERMATOLOGY: STAT!

  • Leslie

    Thanks. Saw something weird the other day and as soon as I stop writing this, I’m making an appointment with my dermatologist. Really appreciate your honesty and the reminder.!

  • http://jackandjillputupablog.com/ Jack & Jill Put Up A Blog

    Thanks for the reminder to go get checked out. Glad to hear everything is alright with you. Peace & Love.

  • lynn

    My sister and her husband both battled melanoma 5 years ago. Their 20 something daughter has started the White for Life club, meaning she will never get a tan from the sun or a tanning bed. My 20 something daughter lives in Hawaii – tempting to sit out and get that beautiful glow but she has also joined “the club” and has been able to enjoy herself for 2 years at the beach by lathering up and having an umbrella handy. Having a member of the family get cancer really increases your risks – good luck with the doctor appointment!

  • http://www.tbonelee.blogspot.com Jess

    This post scares me considering that I just suffered an incredibly bad sunburn and am freaking out that I’ve now doomed myself to die of skin cancer after leading an otherwise ambitiously healthy life.

  • Lindsay

    I had a conversation with my friend earlier today about how she should go see a dermatologist to check out her moles. But now after reading your post, I think I’ll make an appointment as well. I have a sunspot that is growing. Thanks!

  • Emily

    I first had a mole removed from my skin when I was 10 or 11, and in the past few years my arms have exploded with freckles I never knew were there. I like the freckles, and I like the idea of soaking up enough vitamin D to last me through a long northern winter (or trying), but I have never felt so motivated to put on sunscreen as I do right now.

    Thanks Heather. I hope Roberta is teaching salsa lessons in the afterlife soon.

  • http://www.happinessontap.com Elizabeth_K

    Congrats on the new sponsor, and on finding Roberta before she got a little TOO familiar with you, like she does with those salsa students.

  • Roxie in Birmingham

    You win! I have an appointment at 1:40 today to have the spots on my face checked. Thanks Heather.

  • http://figcookies.blogharbor.com Caren

    Had a visit with the derm on Monday after husband said: You’ve a funny looking zit by your ear. NOT a zit but mole that had changed. Derm said it looked OK but lopped it off & biopsied it to play it safe.

    Thanks for reminding us all about the importance of getting routine mole checks!!

  • Anonymous

    Dooce,
    You probably will never know how many people’s lives you may have saved by taking up this noble cause. Keep pushing people to protect themselves from the sun and get checked by their dermatologist. I am one to talk as I have never been checked, have umpteen “Robertas”, have a family history of skin cancer. So, I am going to make me an appointment today and I thank you for giving me a much needed kick in the hiney!

  • http://bilateralhaze.wordpress.com/ Lara

    I have one of those sandpapery spots on my face near my nose- skin cancer central thanks to my teenage years spent in the California sun. I’ll now be sure to have it checked out.

    Thanks, Heather.

  • Jill

    Hi guys,
    Just a quick reminder….as well as sunscreen, don’t forget to wear sunglasses!! I have had numerous basil cell carcinomas cutt off my body (mainly forehead) and of course now I use sunblock liberally. I never even thought to protect my eyes as well until yesterday I went to the eye doc and have a suspicous freckle on the back of my eyeball…YES! My eyeball!! Please wear sunglasses and put them on your kids as well!

  • http://affichedunefille.blogspot.com/ Kism3t

    Thanks for the kick in the butt. I’ve made an appointment with my Dr. and will get a few Roberta’s checked out myself. :)

  • Laura

    THANK YOU HEATHER for writing this! I have witnessed the excruciating pain, heartache, and devastating effects of Melanoma and its toxic treatments including bio-chemo and IL-2 therapy, and drastic surgeries on my grandmother, husband and father- the latter two are my beloved Melanoma warriors and survivors. Be proactive people! Melanoma can be deadly when not caught early because it is one of the more difficult cancers to treat. Prevention is the key, wear sunscreen, stay in the shade, “pale” is the new tan ;)

  • http://www.anapires.wordpress.com Ana

    May I ask a little question? If it’s a sort of a mole, like a little lump, what exactly would the dermatologist do to check it out? …Would it involve needles, like, right there and then?

    Because I have this thing on my leg. And I’m a pretty anxious person. I need to know what to expect before I can get myself to set up anything.

    Thanks.

  • Rebecca from Memphis

    if only one person takes this to heart then your job is well done. I had a “spot” cut off of my back about 10 yrs ago and I was lucky it was not a cancerous spot however the cutting off hurt like hades!! Maybe the spot on your forehead will turn out to be nothing of importance at all.

    On another note….
    Look forward to reading your blog each day! Love you humor, wisdom and insight! Some days makes me laugh out loud!!

  • Dee

    I put sunscreen on after reading this post… thank you!

  • http://www.itsjennytime.blogspot.com Jennifer

    I am right on board with you Heather. I have had several suspicious spots removed and now am a skin nazi for me and my family. They hate me. But I don’t care.

  • Lindsey

    Thank you. I have just made an appointment with my dermo to examine a patch near my hair line that is always darker in the winter and spotty in the summer. I know exactly what it is from- I missed it in an early morning sunscreen application 2 years ago in Key West. Only that spot burned and has been discolored ever since. I should have known better. I found 2 cancerous moles on my fiancee’s back last year and saved his life. I always forget about myself though.

  • Elizabeth

    Without stopping to read all the posts along the way to see if this question has been asked already, had John ever noticed the spot before you brought it to his attention? I just got a bit of a laugh out of “has it changed color?” ‘Cause how could he possibly know? :-) Good for you, making your children’s father take care of himself — men are terrible at it!

  • http://ceramicfish.org Heidi

    Thanks for bringing this up, Heather. i have needed to have my moles checked out for way too long – and i noticed one last week looks very weird now. i’ve been putting it off because i have other health issues AND my mom just had a stroke so all of our time has been spent taking care of her.

    i’ll be making an appointment shortly.

  • http://sunshinecupcakes.blogspot.com kara

    Oh my god, googling “skin cancer” yielded the most horrifying images known to man.

  • Amy K

    I just had a Roberta cut out of me with Mohs surgery. Get my stitches out tomorrow. It was basal cell carcinoma and I hope no one ever gets one! Looks like a red blob that never goes away and sometimes even throbs and hurts. Mine was on my cleavage or where my cleavage SHOULD be :) I had noticed it and went in for a check and a full-body check too. Wear sunscreen please! it helps prevents wrinkles too :)

  • Aspen

    Thanks for sharing your story Heather. I actually got my diagnosis YESTERDAY. I go in for surgery the first of June to have a spot removed from my leg. I too had to get my vanity in check. Because of my addiction to tanning, I am now going to have a hole in my leg. So thanks for sharing, like you…I will now constantly be checking every spot on my body for the rest of my life. Vanity is a bitch!

  • http://zeghsy.blogspot.com zeghsy

    i got all excited about roberta teaching salsa, but she really kind of a slut. i’m afraid i can’t hang out with her.