This here bringer of the pooper to the fun party

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.

  • 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!

  • 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.

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

  • 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.

  • 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.

  • 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.

  • 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!

  • 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!

  • 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

  • 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.

  • 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.

  • 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!

  • 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.

  • 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!

  • 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.

  • 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.

  • 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.

  • 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!

  • 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.

  • 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.

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

  • 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 …!

  • 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.

  • 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.

  • 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.

  • 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.

  • 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

  • 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.

  • 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!

  • 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.

  • 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!

  • 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.

  • 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.

  • 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.!

  • 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!

  • 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.

  • 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.