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.

  • Pamela

    Why thank you Heather for the timely reminder! My doc just told me last week to make an appointment with a dermo for a mole check. For me it wasn’t very urgent so I needed a little nudge I guess! Also people don’t forget sunscreen on our part in your hair, and your scalp if you are balding! Very very easy to burn there!

  • Terri Sinclair

    THAT EXACT CANCER is why my mother had half her face taken off last year. She went to several Dr.s who brushed it off as an “age” spot.

    It wouldn’t go away with treatment so,biopsy. CANCER.

    Yes she is now cancer free but the word to get out is CANCER DOES NOT ALWAYS START WITH A WEIRD SHAPPED OR DISCOLORED MOLE.

    It can be something as simple as the photo you posted! This is a great message to get out. With several people with melenoma in our family this looked NOTHING like anything we’d previously been shown This just looked like a little “brown” age or “liver” spot.

    GREAT MESSAGE

  • LCRado

    I read your blog every day but have never commented. Thank you for bringing up such an important topic. I work for the American Cancer Society and am due to give a talk about melanoma in just a couple of minutes. We can do all the research in the world to find cures for cancer, but the best way to treat cancer is to catch it early. Knowing your body and checking out any abnormalities is the most vital step in decreasing your risk of dying from cancer. Thank you for the reminders!

  • Anonymous

    Just to lighten the mood:

    RE: naming invasive substances: When I was nursing, my breasts were gigantic and I felt they had lives of their own. So I named them, Rita and Lenore for right and left.

  • Let me warn you as half of a couple where both parties have had to use Aldara for other issues, you can get a nasty immune-like reaction to the cream which feels like flu and is fairly miserable. You may want to consider this in the timing of your use.

  • Thank you for sharing this, Heather. I lost a dear friend to melanoma a year and half ago. She was only 35 and left behind three young children. (Her story can be found here: http://www.lyonsfamily.org/ ) I am now the Sun Nazi. I go a little crazy when I hear my friends talking about getting burnt, or even worse, hearing them talk about their children getting sun burnt.

  • Thanks for sharing this about skin cancer. My cousin went through a similar experience and I do try to be aware of any unusual moles on my skin as well. I had a cyst removed a few years ago that came back fine, and now have my own personal dermatologist but this reminded I haven’t been for an annual exam in over 3 years!

    Great insight for those of us who loved to “bake” in the sun in our younger years!

  • SANDRA

    CANCER–RUN now GET A PAP SMEAR. I’m 46–I’ve had PAP smears yearly since age 16..no ABNORMAL paps EVER. Last year (April 08)–my gyno calls and says pap is abnormal.WHO? Me–a colposcopy was done. ZERo health problems.

    I HAD STAGE 1B CERVICAL CANCER.I had a radical hysterectomy, ovary & lymph node removal within 2 weeks.

    RUN GET A PAP SMEAR. now–I mean NOW.

  • Amanda

    My husband has has a weird little dry patch of skin on his cheek for a couple of months. I think your post may actually get him to go to the doctor.

    Thank you!

  • Dana

    Hey Heather! Thanks for bringing this up. I have been having icky stuff cut off since I was about 23 (40 now) by the dermie and I’m a nut about mole checks and sunscreen. I’m a fair skinned readhead so I go about every six months. My most recent visit involved a 2 inch incision, internal stitches and skin glue. Better that than the alternative.

    I had a weird thing happen the other day: another mom I barely know at my son’s preschool had on a shirt that showed her back and she had a mole that would have made me blaze a trail to see the doc. I didn’t say anything to her about it then, but I wish I had. I may go find her number and totally impose on her. It’s a weird situation to be in. “Hey, we barely know each other and I’m not a doctor, but I don’t like the look of that mole.”

    Listen, people who THINK they maybe, might need to go see the dermatologist: suck it up and GO! Seriously. Melanoma is only curable in the early stages. Do not wait the three months.

  • Thanks for the reminder

  • Dana

    And another thing, I love your honesty. I always appreciate anyone who has the guts the lay it on the line and not tap dance around what is really on her mind. Congrats on the baby!

  • Running a Plastic Surgery Center, I see skin cancer all the time. It is much more prevalent in youg women than most people realize, so get that thing taken care of and get John’s too! I am only 26, but I have sworn off the sun. I want to be old and pretty not old and look like an old leather boot! Tell Roberta to pack her bags! Oh, and get a good plastic surgeon to remove the one on your forehead, you don’t want an ugly scar right there for everyone to see!

  • Anonymous

    Thanks for posting this! I have one such spot on my forehead and have wondered for about a year what it is. I live out of the country, which makes going to the dermatologist a fairly difficult thing. But I’m going to make an appointment and hopefully get some of that cream!

  • Damn, cancer is such a rancid bitch.

    I’ve been SUPER lucky that, instead of cancer running in my family, it’s only obesity, depression and coronary arty disease (this is not sarcasm- I make it a point to eat right and exercise regularly to thwart my genetic ancestry).

    I fit in with the group of people labeled “White as you can be without having a pigmentation deficiency”. I do not tan, I burn. And when I put forth all of the effort and tanning lotion to BE tan, it just looks fake and uneven. I also have massive amounts of freckles on my face, arms and various other sun-exposed parts of my body (luckily they have started to fade with age). All of my face moisturizers and lotions have some degree of SPF in them, and I try to be foundation and concealer that contain some, too.

    What’s Jon’s mole’s name? I vote for Dick Cheney. You could call it “Tricky” as a nickname.

  • MedStudent 201

    Jon’s Lesion looks like a Seborrheic Keratosis, but should be diagnosed by your dermatologist. Here’s a bit of info:
    Noncancerous growths that may develop with age, seborrheic keratoses can appear on the chest or back, alone, or in groups. They may be dark or multicolored, and usually have a grainy surface that easily crumbles, though they can be smooth and waxy. No treatment is necessary unless irritation develops or their appearance is a concern. Because seborrheic keratoses may be mistaken for moles or skin cancer, see a dermatologist for proper diagnosis.

    By far the easiest treatment (and cheapest and safest during pregnancy) is cryotherapy (freezing or burning it off). Mayo clinic is a reliable resource for many medical topics: http://www.mayoclinic.com/health/actinic-keratosis/DS00568/DSECTION=treatments-and-drugs
    Best of luck

  • Anonymous

    My cousin died of melanoma at the age of 32…he had found a mole on his back, and a few years later, we buried him. There is no such thing as being too paranoid about this. Thanks for informing the public about the risks and signs that can lead to cancer.

  • Abigail Joy

    Wow. I am a believer. Dooce, you’ve got a way with words that sends chills down my spine. No. Really. I now feel the need to inspect my body for skin abnormalities. Oh God, the hypochondriacs are going to love this post.

    But seriously. Thanks for the prompts and prods and words of advise.

  • I would love to be able to call my mother, but she died two years ago from-you guessed it-skin cancer. Please, always wear sunscreen and a hat, and don’t forget your children.

  • I recently wrote a story about the dangers of overexposure to the sun for a local magazine, and it’s no joking matter. One woman found the worst sort of cancerous lesion on her back, but it was too late. It spread to the rest of her body and she died within months.

    We all need to get back to the turn of the last century, when pale skin was considered beautiful and only common peasants and laborers had tans. Fashion maven Coco Chanel sparked the suntan craze in the 30s when she stepped off a yacht with an accidental sunburn that had turned into a tan. Photographers were wowed by her new look, and they shot photos of Coco’s new cocoa look around the world, prompting future generations of admiring women and men to bake themselves into a pre-cancerous state under the sun or at tanning salons.

    That said, I think I could live without the disgusting photos of the offending mole, Heather! I was eating lunch when I saw those, and I assure you I’m not hungry anymore….(just kidding, you’re doing everybody a service by dragging us into reality).

  • Sally

    I’m so happy you share this sort of information to make people more aware. I have lots of skin issues, partly because I’m 41 and there was NO SUCH THING as SUNSCREEN when I was a child. I had dark hair but fair skin with freckles. I get my skin checked yearly! Thanks for sharing Heather!

  • Tam

    My grandpa is 91 and currently dying from skin cancer. I’ve named all my spots after the Duggar children with the assurance that there will be more of both.

  • Tam

    Also, Aldera is most commonly used to treat genital warts so guests might judge you when they go through your medicine cabinet.

  • I used Aldara for my warts back in the day and it cleared all of them up (except for this one on my hand. But IDK if its actually a wart). I should probably go back to the dermatologist.

  • Abi

    At least you aren’t a bald man. My father-in-law had to use that topical medication (a similar one, at least) on his entire head. ONE HALF AT A TIME. So, he was teaching classes while half of his bald head was peeling off.

    Woo for having hair!

  • “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.”

    I don’t ever comment because really? What needs to be said that hasn’t been said 6,482 times before…but I just have to tell you, Heather, that that line up there? Made my day. I love the way your mind works.

    Thanks, too, for the public-service announcement. I’m off to make an appointment to have a spot on my face checked that’s been a concern for a few months now…

  • mj

    sometimes, they may not even look like a mole, but be aware of anything that changes. I had a doo-hicky on my hand (looked like a very, very tiny wart) that started to grow, just a little. I really thought it was nothing, but my inner voice said otherwise. The dr. didn’t even think it was anything, but removed it anyway. It turned out to be something with spitz cells, which carry the same dna as cancer. I’d never heard of it, and neither had the hand surgeon who needed to take a small chunk out of my hand.

  • OH HEATHER!!!! i just went to the mole doc yesterday. two moles were removed and sent for a biopsy. one week they tell me. the ones i went in for were healthy, and the two they took off and sent in i mentioned as a last minute thought. SHEESH! so now i wait. and wait. and wait. and am glad to read about your moles. it’s right up my alley today;-)

  • I recently had a giant basal cell carcinoma removed from my decolletage. It’s still healing, bruised, and ugly. I have sutures under the skin that won’t dissolve for another 2 months. It makes for a very sexy neckline. I also have two large chunks of skin missing from my left back and right hip from moles closer to melanoma then they are to suspicious moles.

    Blech. Where do I sign up for American Cancer Society ads? 😉

  • If anyone is still reading this far down into the comments…
    May is Melanoma/Skin Cancer Detection Month and many doctors do free screenings. Yes, it’s late in the month, but I’ve found several in my state that are yet to happen (some in early June). Check out the link in my name for the American Academy of Dermatology to find a FREE screening in your state. I’m attending one June 6.

  • It’s a bit cosmic that you posted this today. I just went to the dermo this morning to check on a suspicious mole. Turns out I am going to have to have it biopsied. Am I worried? Um, yeah! Actually, FREAKED out is a little more like it. But I am trying to put it out of my mind until I get the results.

  • Natalie

    I turned 30 a few months ago and suddenly changed directions completely regarding my skin care. I recently went to the dermatologist (for the first time)to have some rough sun spots on my nose looked at. He took two seconds and said I had a Roberta. He then proceeded to “freeze” it off. It worked, I think. It turned dark brown for about 6 days then peeled off. It’s still red though (after 2 weeks).

    Good luck with Roberta.

  • I am freckly and careless and love the sun. Thanks for the reminder to stop being a dope and take better care of my skin! I have all these dark moles on my arms and shoulders that I have deemed harmless, but what do I know! Going to get them checked out… I’m so spotted though I’m afraid I’m going to come back looking like swiss cheese.

  • geegee

    Thanks for keeping skin cancer in the public eye, Heather. I’d just like to add that as a very light-skinned, light-eyed woman who leads a very active life, I’ve always been quite cautious about my sun exposure, have long worn hats and sunscreen (for 30 years!), never used a tanning bed, and I’m *still* having pre-cancerous moles removed. I started having suspicious-looking moles removed in my 20s, and while all those biopsies came back benign, these days they don’t. So don’t think that if you’ve been careful of your exposure to the sun, you are immune. Everyone needs to be vigilant about changes to their skin.

  • Gretchen

    My husband just had a keratosis removed from his head. He shaves his head anyway, and now he’s sporting a little round bandaid in the spot the tore out the nasty business. This is his second or third round with this stuff. He’ll deal with it the rest of his life.

    The same week that my husband’s dermatologist found this, my father told me that his urologist detected an infinitesimally small amount of cancer in his prostate. They caught it *miraculously* early, so he’ll be okay after some radiation treatment.

    I hope.

    Good luck, Heather. Skin checks every 6 months are a part of your life from now on. 🙂 It will save your life.

  • Thanks for the reminder! My daughter was born with a fairly sizable mole on her shin, and people regularly ask what it is. (I usually want to answer that it’s a tick I’ve neglected to remove for the last 14 months!) I’ve asked the pediatrician about it in the past, and he’s said it looks okay, but she’s due for her next check-up soon, and I need to remember to have it looked at it again. It’s a small thing to do to stay safe!

  • bonzai

    Thank you, Heather, for revisiting this on a regular basis. I’ve had 6 precancerous spots removed for the same reason – loved that Hawaiian Tropic SPF2 Tanning Oil. Bright for someone who is so pale they absorb light rays like a sponge.

    I’m sure there are smug trolls out there thinking “What’s the big deal? What a hypochondriac!” Well, the older sister of my equally pale friend from HS died last year when her skin cancer came back after 2 years and metastasized to her lungs. She was gone in two weeks.

    Keep naming the invaders and keep reminding people – you make us laugh, you make us cry and maybe you’ll save a life. Not a bad day’s work.

  • Curl

    I had a 1.5 cm brown bump show up on my back several years ago that my MD cut out. The biopsy then said it was a WART! Ewww! Then I went to the dermatologist a year ago for a small flat rough area on my cheek and they scraped it and it came back as: A WART. Ewww! They looked NOTHING alike.
    I am 49 and I have so many yucky spots I wouldn’t even know I had something new (well, EVENTUALLY I would). My dermatologist is like “oh, that’s just a LENTIGO,” no big deal. Except my arms look like a 70 year old’s. I religiously wear SPF 50+, but when I was younger I ran and cycled all the time with minimal sunscreen.
    I’m an RN, and I see lots of 70+ year old skin, so I know of which I speak. People get lots of benign lesions: brown bumps, seborrheic keratoses (totally benign waxy bumps), lentigos, etc. It can make it hard to see anything new that is a bad guy.
    So full body mapping and yearly dermatologist checks are imperative for us old(!) folks who might not even notice lesion number 11,286.

  • As a dermatologist I remove lots of skin cancers. I always amazed at how young my patients are becoming, and its not only because I’m getting older. The youngest patient I’ve had with a basal cell carcinoma is 16 – no underlying genetic disorders, just lots of sun. I for one never mind seeing patients with spots that turn out to be nothing, so don’t put off the check. As far as sunscreen: SPF 30 EVERY day, spf 45 for the beach. Zinc oxide or titanium dioxide of 9% or more will give you better protection than anything chemical and put on lots. Most SPF ratings are based on a full body application of more than an ounce, so a bottle of sunscreen should last one person about 3 days at the beach – less if you reapply like you should.

    PS – Jon’s spot is a seborrheic keratosis, so don’t worry too much. This does not mean he shouldn’t see your dermatologist. Families that play together get similar amounts of sun together. Many times I’ll see a patient who has found a new SK but not noticed the actual skin cancer elsewhere.

  • Natalie

    Thank you for your enlightening post, Heather. This is a lot of comments to pick through, so I am sorry if anyone has already asked (or answered) this question…. I have always been careless with getting sunburned and in the past routinely went to tanning beds. I have very pale skin, blonde hair, and light eyes. I have always had moles on my back, but my question is: what should I be looking for? How do whether or not to get these moles checked? Thanks!

  • Thanks for writing this. I just went for a check-up yesterday and I have to have 4 spots removed. I asked if I could wait until fall and she practically took my head off w/ her NO. So I’m starting to really work myself up and this calmed me down a bit.

  • Like you, I have Casper-white skin and know I had pretty bad sun exposure in my youth. I’ve been meaning to make an appointment with a dermatologist for YEARS, and now I finally just made one. Thanks for lighting a fire under my @$$!

  • I hate to say it… I hardly ever use sunscreen. In fact, the few times that i have used it (and reapplied liberally every couple of hours), I have ended up with the most awful sunburns. When I go without, my skin tans and is fine. I am convinced that at least in my case, sunscreen is a conspiracy.

  • Natalie – If you have more than 100 moles of any type, especially if you are fair skinned (easy sunburn, little tan) you should probably have a yearly exam after your twenties. For any mole think ABCD:

    Asymetry
    Border irregularity
    Color changes
    Diameter changes

    That said, I don’t take off every asymetric or smudgy mole. It also important to remember that removing moles does not change cancer risk. Most melanomas (70% +/-) start on previously normal skin.

  • Tricia

    Thank you for the reminder… and I’d like to add, Ladies, please don’t wait longer for an appointment with a female dermatologist if you have any concerning spots! I just called U of U, and there’s a 2-month wait for a female doc, but I made an appointment elsewhere with a male doctor for next Wednesday. One week vs. two months? Don’t put it off!

  • I am SO with you on getting the moles checked out. We are big mole-checker-outers at my house. My son is one of those people who get a full-on end of summer tan on the first day of spring and he was born with tons of moles. So, even though most people don’t get their kid’s checked for skin cancer – we get the moles checked out once a year just to be safe. Hopefully it will become enough of a routine for him that he’ll always do that. I personally am an albino and can somehow get a sunburn while sitting at my desk at work – so I’m also a big sun screen advocate. I think it’s cool that you share your skin cancer stories (and all your other stories, for that matter) with us – if you can help ONE PERSON avoid skin cancer then you’ve accomplished so much. Congrats on the baby, by the way!

  • It doesn’t even matter if you were irresponsible as a teen. I am 26, have never had a burn, have always worn at least SPF 30 every day(more when I’m beaching) and I had 2 pre-cancerous moles removed. I am very fair w/ dark hair so even as a child, I was covered in SPF.

    Ladies, you do monthly breast exams..why not a full body scan? Ask your sig other to look(it could turn into fun)

    And of course, a yearly check by a doc is important.

  • Thanks for reminding me that I need to nag my husband about getting his mole checked out!

  • Aren’t the keratosis just ‘lovely’! I have a few on my forehead that are currently being treated by a dermatologist. I’ve had a malignant melanoma removed from my leg (at 36 years of age) and have a few BCCs that will be dealt with once I cease breastfeeding.

    My GP failed to identify my melanoma. I asked him for a referral to a dermatologist to treat the solar keratosis on my forehead and for the cosmetic removal of the weird mole on my leg. The Dermatologist was shocked at the size, discolouration, change in texture etc of the mole and whipped it out straight away fearing that it was a significantly bad melanoma. Fortunately for me, although it was malignant, it was confined within the epidermis and could be removed ‘in situ’ and didn’t require further exploration of lymph nodes and Chemo/Radiation therapy. Try digesting that concept when you’re 5 months pregnant.

    Moral to story, get a referral to a dermatologist for a proper skin cancer screen at least once in your early adult life. GPs and ‘skin cancer clinics’ are not trained professionals.

  • Anonymous

    Mole-checking is one of my wifely duties (love, honor, obey, mole inspect). You’ve already got lots of positive reinforcement for sharing your adventures in dermatology, but just to pile on, thank you for putting this out there. and thanks for helping the ACS.