Growing up a freckly Floridian with none of the Cuban melanin my tawny sister so blissfully enjoyed, I endured my mom slathering me in zinc oxide before our afternoons at the pool earning me the way cool nickname of “Panda Face.” When reviewing press emails, I gravitate towards suncare pitches, always searching for that sunscreen that will allow me to elude the residue of my youth. But skin cancer? Like a true beauty nerd, I read the Mayo Clinic report filed a few years ago that laid out the dire statistics. I knew that basal cell and squamous cell cases have skyrocketed especially among women aged 30-49, but I always considered skin cancer the concern of the much older tanning bed set, not a skincare obsessive like me.
During a facial with OG aesthetician Sonya Dakar she urged me to have a spot on my nose tip checked out. And low and behold it was a precancerous lesion. Two years later it morphed into basal cell carcinoma and I had to undergo surgery to remove a nickel sized tumor right smack in the middle of my face.
Several years after surgery, I’m doing well but I’ll be honest it was a way bigger deal than I expected and I’ve learned some invaluable lessons along the way. From how to monitor precancerous lesions to beauty treatments that double as cancer-fighters to the items that will get you through MOHS surgery. Here is all you need to know about skin cancer from someone whose been there and done it.
Know the risk factors
After my skin cancer diagnosis I was outraged. I was even a bit ashamed given my status as a beauty professional, but there are just some factors that were out of my control. Dr. Julie Karen, a board certified dermatologist who specializes in MOHS micrographic surgery at Complete Skin MD in NYC counsels,“Major risk factors for the development of skin cancer are intrinsic – light eyes, light hair, fair skin, freckles, increased number of moles, tendency to burn, family history, as well as extrinsic – frequent sun exposure, history of sun burns.”
The Skin Cancer Foundation attributes 90 percent of nonmelanoma skin cancer and 86 percent of melanoma skin cancer to UV radiation. While I was extremely careful since childhood, my history of growing up in South Florida exposed me to a higher than average amount of UV radiation on a daily basis. I was not wearing SPF 30 everyday during my elementary and high school days. While skin cancer is most common among the over 60 set, if you live in areas of high altitude or lots of sun, you could find yourself facing a skin cancer diagnosis on the earlier side simply from your daily dose of unprotected sun.
Don’t shy away from skin biopsies
My basal cell looked like a tiny sore on the tip of my nose much like a flat pimple others look like pink pearly bumps or tan spots. The tricky thing is they can look like any myriad of imperfections we see on our skin every day. Board certified dermatologist, MOHS surgeon and skin cancer awareness advocate Dr. Ellen Marmur says, “The alarming thing about BCCs is that they can mimic many other benign conditions like freckles, scars, acne, rosacea, or nevi. A board certified dermatologist will look carefully and is trained to know when you need a skin biopsy—a small sample is enough so don’t hesitate!”
Take precancers seriously
My first biopsy left just a little dent and came back as precancer. This gave me a false sense of security. The spot was frozen with liquid nitrogen and I thought that we had stopped it in its tracks! I proceeded with my busy Manhattan life as a writer and mom of three, and skipped a skin check.
What I didn’t know is that even treated precancers require close monitoring every three months and if they do not completely resolve after treatment you should get another biopsy. Two years after the liquid nitrogen treatment, mine deepened in color which prompted me to book my overdue screening. While I was lucky because my type of cancer grows slowly and takes a very long time to invade surrounding areas, I still should have been religious about my skin checks. Self-care is such a buzzy topic at the moment and in retrospect, I really let myself down on this point.
If your biopsy comes back as precancer or actinic keratosis, a common skin condition that can lead to squamous cell carcinoma, take it seriously and discuss the various options for treatment. Methods include liquid nitrogen, topical chemotherapy creams and eletrodissection. One favored by both Dr. Karen and Dr. Marmur is photodynamic therapy. Says Marmur,“We love BLU-U Photodynamic Therapy which uses a blue LED light in conjunction with a targeted medicine called aminolevulanic acid to explode precancers.”
Prepare for Mohs surgery
Once you get a cancer diagnosis, especially if it’s on your face and neck, Mohs surgery is the answer. With a 99 percent cure rate, it’s considered the gold standard. It can last anywhere from about an hour to six hours but the average case lasts around two. You can find qualified MOHS surgeons at www.mohs.com. It’s impossible to know how long you’ll be at the dermatologist’s office so wear comfortable clothes and bring someone for moral support.
“Since our goal as MOHS surgeons is to maximize cure rates while sparing the least amount of normal or uninvolved skin, the surgery can sometimes go on several stages beyond what is anticipated.”
Netflix and (try) to chill
What makes MOHS surgery unsettling aside from not knowing how big your scar will be, is that you are awake while the surgeon meticulously cuts out tiny sections of the offending spot. First the area is numbed with a series of injections. It definitely stings but no more than Botox along your crows feet. Each layer is inspected under a microscope to see if the edges still contain cancer cells. Each “stage” takes about 30-45 minutes. So there is a lot of waiting around with your open wound bandaged hoping to hear that your edges are clear. While my cancer appeared small, it had “substantial subclinical roots” so I had six passes performed. I definitely shed a few tears at stage five, and could have used some Jon Snow knee bends or an Amy Schumer stand up to get me through, so I advise bringing an iPad or reading material.
It’s ok to go plastic
Both Karen and Marmur perform the vast majority of their closures, MOHS surgeons have been extensively trained on how to repair cancer-specific defects but they do work with plastic surgeon’s on difficult cases. Says Marmur,
“Any defect that requires movement of bone, cartilage, blood vessels and nerves are often repaired by plastic surgeons.”
If your defect is on your nose, I would suggest having a plastics person on hand. I rushed this step and wish I would have gone with someone that specialized in noses. Take time to research several options and be sure they focus on facial not just general plastic surgery. If they don’t take the time to go over the various ways they could close a Mohs defect using skin grafts or various skin flaps don’t use them. Dr. Marc Zimbler, a NYC facial plastic surgeon advises,
“You want the procedure you’ll be needing to be in the top three of the most popular procedures of your prospective plastic surgeon’s practice.”
Be patient with scars
Laser treatment is great for Mohs scars and many dermatologists include these modalities free of charge for their Mohs patients. Dr. Karen’s usual protocol is a pulse dye or vascular laser like a VBeam to reduce redness that is often present in early wound healing and later a Fraxel or a Scion laser to blend the scar.
Dr. Karen introduced me to the Silagen brand silicon sheets, placing these over my scar 24 hours a day during the first three months really helped.
Aesthetic treatments can do double duty
While it does take time, eventually your scar will fade, but you’ll want to imbue your lifestyle with as many cancer-preventing tactics as possible. While I was always very into anti-aging treatments like thermage and botox, I eschewed lasers like Fraxels due to my sensitive skin unwittingly depriving me of some cancer-fighting benefits. One 2012 study found that fractional lasers are not only excellent for photo rejuvenation but also tangentially target actinic keratosis. Dr. Marmur agrees, conditionally,
“A laser like a Fraxel Dual Restore certainly helps eliminate sundamaged skin including precancers. However, it is not specific or selectively targeting precancers—it is random.”
Antioxidants are your friend.
Nearly every dermatologist recommends various antioxidants as part of an effective anti-aging routine, but they are particularly vital to a skin cancer prevention plan. They protect from free radicals which produce inflammation that causes poor cell function and DNA damage. DNA damage leaves skin more vulnerable to mutations that lead to cancer. UV exposure is awesome at depleting antioxidants so be sure to provide your body with lots of these protective substances both topically and internally.
One study out of Australia found that taking 500mg of nicotinamide, a form of Vitamin B3 twice a day cut the rate of new squamous -cell and basal-cell cancers by 23% in high-risk individuals. Heliocare is another potent antioxidant supplement that has been proven to offer an SPF protection of four.
Don’t forget the basics
Year-round daily sunscreen of SPF 30 and above is a must as is reapplying every two hours. For the skin-cancer prone, Isdin is a favorite. It’s a zinc-based sunscreen with DNA repairsomes. For reapplication I love the colorless mineral powders by Sweat Cosmetics. During the summer months wear hats, UV protective clothing and stay out of the sun from 10-4pm. Dr. Karen recommends the super stylish anti-aging fashion brand Mott 50 and taking cover until 5 just to be safe!
Unfortunately, where there is one cancer, there are more likely to be others. Marmur compares the effect to weeds in a garden so make sure to weed your garden with skin checks every 3 months and an occasional Fraxel while you’re at it. Finally, spread the word. It’s never too soon to instill daily protective habits. I send my melanin-challenged eight-year old with a mineral powder brush each day to school. She thinks its makeup and applies it to the “girl team” before recess. You’re welcome, fellow moms.