I avoid the sun, I’ve never been in a tanning booth, I try to keep my skin Casper-white (the ghost, not the mattress) and yet I ended up with skin cancer in my 30s. Here’s what it’s been like both procedurally and mentally. Spoiler alert for those who wanna wait until their 70s.
You wouldn’t have known it had you passed me on the street. It was just another Friday morning in November, rush hour, around 8am. I was walking toward downtown Montreal with a backpack containing a computer and a lunch, like tons of other 30-somethings heading to work.
I was not, however, heading to work. I was going to a clinic where two doctors and several nurses were about to cut a tumour from my person.
It was cut-out-the-skin-cancer day.
Nerves running high, knowing this day would be more unpleasant than any day at any normal office could be, I put one foot after the other until I arrived at the clinic. In my mind, I took comfort in the note that I had found that morning on the lunch I had pre-prepared. The note, put there by my girlfriend after I went to bed the night before, said simply: “You got this.”
Like many health stories, mine started with blood in a place it wasn’t supposed to be: my pillow. One morning, I noticed the smallest spot of red on it. I had known there was a red spot on the back of my head, but I wrote it off weeks prior as a slow-healing fly bite. Or some pimple-like-object. I have fair skin with plenty of freckles and blemishes so a red spot is not exactly a show-stopper.
But bleeding without prompting, while I slept, well, that was something new. So okay, I told myself I’d give it two weeks and if it didn’t heal then I’d call the doctor. And at first, it seemed to heal. No morning red spots. Until it got worse again. Soon there was a little spot of blood, on what was now a bandage, every morning.
With the doctor appointment set, the waiting game began.
Casually Dropping The C-Word
The first doctor I saw took a look and told me that, though she was not a dermatologist and could not confirm this, the differential diagnosis was skin cancer.
She used some medical terms for the type of skin cancer (which I later found out described exactly what it was) but it’s hard to hear the details after the C-word flies out of your doctor’s mouth.
Don’t worry, she said, it’s not a big deal, she said, it’s a slow-growing cancer, she said. It can be taken care of with an outpatient operation to cut it out and sew up the hole, and it doesn’t generally spread to other parts of the body. She told me this with the casualness of ordering lunch or talking about the weather. Just a little rain this afternoon, nothing to worry about. It’ll pass soon enough.
This was towards the end of summer. It would take another two months before I got the official laboratory-confirmed diagnosis, and another two weeks on top of that before I could get the procedure to remove it.
Getting The Results From A Computer
At a different appointment with a different doctor, they took a biopsy. This is a fun word for when they slice off a bit of your skin with some sort of
potato medical peeler. Two weeks later I went back for the results.
At the results appointment, the nurse got me settled and asked a few questions. She didn’t ask anything unusual and I was still optimistic and wasn’t even that nervous until, well… she tipped her hand. Or her computer monitor, more accurately.
She told me, as she looked at the doctor’s computer screen, “Well, your results are here, and the doctor will be in shortly.” Then she awkwardly tilted the computer screen away from me. I couldn’t see anything on it from where I was sitting before, but she moved it further from my field of vision anyway.
There was something bad on that screen.
The moment she left the room I went around to the computer and looked through my own file and test results, like I was a teenage detective in a YA novel.
(I’m really not the type to shuffle through someone’s computer when they leave the room — I’m very much a wait-for-the-doctor person — but everyone has that breaking point at which rules don’t mean anything, and for me that was that moment.)
On the screen was the lab report:
Received sample approx 10mm x 12mm…
Yeah yeah yeah. The report wasn’t reader-friendly. Every line looked the same. It took me a minute to find where they put the results.
Here we go:
…atypical [something something] found concentration of basaloid cells [something something]…
I was pretty sure I knew what that was, but a quick google search on my phone confirmed it — basal cell carcinoma. Skin cancer. Shit.
Time To Fight
After I read my own diagnosis, I went back to where I had been sitting in the doctor’s office and took out my phone. I started searching and reading and learning as much as I could until the doctor arrived.
Faced with difficulties, I over-arm myself with information. But really, in that kind of moment you feel you need to do something, anything, even though in reality had I sat there and stared at the wall then the outcomes would have been no different.
The doctor came in soon enough and broke the news. News which I already knew was coming, of course. I was already thinking about the next steps.
It was time to fight! (The cancer, not the doctor.) In my head I played army marching music as I listened politely while the doctor explained what a MOHS procedure was and how much it would cost. I asked some questions I was pretty sure I knew the answer to, but was curious to see if my doctor was gonna tell me the same thing as the internet, and we made the appointment for the procedure.
I marched out of the office ready for combat.
That was the pragmatic side of me, ready to get it done and move on. Underneath, however, there was a whole other layer of emotion swirling around ready to kick me in the ass. Apparently I was gearing up for the wrong fight.
Back To The Cut-Out-The-Cancer Day
The procedure works like this: They cut out a circle (in my case at least) of your skin based on what they think is the outline of the tumour. Then they look at it under a fancy microscope-type-thing and figure out if there are any cancerous cells on any of the edges. If they find any, they keep cutting pieces out in that direction until there is none left at the edges of the latest sample. It’s a standard skin cancer removal procedure and I was told it has a 99% success rate.
You start in the waiting room. Then you get called into the procedure room and they cut you up, bandage you up temporarily, and you head back into the waiting room for a few hours with a bandage over your open cut until they figure out where to cut next. You waste some time (in my case, it was hours) doing whatever on your phone, maybe having a snack, and they call you back in and cut out a little more. Repeat until you’re cancer negative.
Once it’s all out, you wait one more time for the closure surgery, in which they sew you up. Depending on how much skin was removed, and from where, it can take many forms. I was comparatively unlucky here and needed three cuts and a fair amount of skin moved around to close up the new hole in my head. I won’t go into the gory details, but this was the worst part. The cutting was easy. The reconstruction will haunt me. Avoiding a lengthly reconstruction is the reason you’ll wanna catch this kinda thing early, in the same way invasive dental procedures have convinced me to floss every damn day.
But like all things, eventually it came to an end. It was about 7 hours from entering the clinic to leaving stitched up. A quick stop at the pharmacy for a long list of meds and wound care supplies, and I was back home.
8-to-10 Weeks Of Please-Don’t-Be-Cancer
Though my family doctor thought I would be seen by a dermatologist much sooner, the healthcare system had other plans. It was a long wait to find out what this thing that could be cancer actually was. I kept hoping, each day as I covered up the spot with a small bandage, that maybe it was just a flesh-eating bacteria. Or a fungus, maybe. A “Here’s a [cream/pill], should be cleared up in a couple weeks.” sorta thing. I mean, that makes sense, right? That part of my head (on the back, towards the top) has touched plenty of hotel beds and airplane seats and dirty hats this year. I could’ve picked up anything!
I googled lots of pictures of skin cancers and mine didn't look like any of them. That's enough reasonable doubt for me. So in what turned out to be a fruitless effort, I kept it covered and didn't share pillows or hats just in case. You never know.
At a certain point though, I didn’t really care what it was anymore. All I wanted was an answer. I wanted to hear a doctor say, “It’s [this], take [this pill], now get outta my office so I can see the people who really need me.”
But even if I had hope for a simple solution, my interest in life outside of clinics took a nosedive.
I’m the type of person that, if I have anything to do on a given day, cannot relax until it’s done. For bigger things, it could be an entire week. Going out for dinner tonight? Allow me to pace the apartment all afternoon. Flying somewhere on Saturday? Whelp, there goes my week. I need a blank slate ahead of me to be relaxed, and I need to be relaxed to be at my best.
Waiting on a cancer diagnosis? That was not relaxing.
Unfortunately, there was not a damn thing I could do to speed up the process … except the one thing I could, and eventually did, do which was pay to go to a private clinic.
Thursday Nights Are For Crying
I received my diagnosis on a Tuesday. I walked out full of pragmatism and logic, ready to get it done. Tick it off the todo list and move on to the next. No problem, right? It was just a simple cut-it-out-and-stitch-me-up kinda thing. I’ll be dancing again in a day! No big deal. Do what you gotta do and it’ll be nice to have it in the rearview.
My emotions lagged behind my logic, as they always do, but they weren't too far behind.
“No!” I told myself, as I started to tear up about 10 mins after leaving the doctor’s office, still walking home. “You don’t get upset by this! Your appointment is set. It will be taken care of. It’s all good.”
Arguing back to myself, the way I often argue back to my irrational anxiety fears, seemed to work. It worked for a couple of days, at least.
By thursday night, the underlying emotions finally broke through. I sat in the living room, in the dark, quietly sobbing. Not on the couch, but sitting on the floor next to it. The floor is where I cry. I guess I like to physically replicate the act of hitting a low point.
Skin cancer at 35. Why the fuck is this happening?
I think it was the age and knowing what’s to come that hit me the hardest. I don’t know how I’ll ever feel relaxed in the sun again. I don’t know how many of these I’ll have to have removed over the years.
I don't know.
That was the hardest / lowest point. The second hardest was right after I got home from the removal procedure.
I arrived home in considerable pain -- more than I had expected. Some pain is difficult to describe, but this was not. It was like someone had plunged a chef's knife into my skull and left it here. Once the anesthetic wore off, so started 3 days of near-constant pain.
I took Tylenol and kept my prescribed opioids at the ready, not wanting to take them if I could tolerate it.
I did manage to tolerate the pain, and I never did take any of the prescription pain meds, but it wasn't the days of pain that got to me. It was a bag of sour cream and onion chips and some oatmeal cookies. My favourites. My girlfriend had them at the ready on my return from the clinic.
The day of the procedure was tough, but I made it through without a tear. Instead, it was the simple act of kindness that tipped me over the edge.
“Oh, I’m So Sorry”
The nurse who turned the screen away from me at my diagnosis appointment must have read similar results plenty of times. Mine, however, seemed to make her appear uneasy. Perhaps I just make people uneasy, but if I had to guess, I’d say it was my atypical age for such a diagnosis.
Same with the pharmacist who seemed somewhat skeptical about my prescription for, among other things, opioids. With my bandage well covered by winter clothing, and therefore no signs of an ailment, I must have looked like a normal guy on his way home from work casually asking for some drugs please. She asked why I needed them, and once I said it was for my skin-cancer-removal-surgery-recovery-party her demeanour completely changed. She became extra sympathetic and took as much time as she could to explain everything.
The age thing is certainly a big factor in all this. Sure, I’m 35, but thanks to all my skillful-but-not-skillful-enough sun avoidance, people often assume I’m younger. In any case, I'm a lot younger than you wanna be when you get skin cancer.
Here’s why: the recurrence rate. Because you can’t fully avoid the evil sun, it can very easily reoccur. From a Dutch study:
“An increase in the number of BCC patients, especially in younger age groups, may lead to an exponential rise in the overall occurrence of BCC over time, particularly because the population ages and most likely around 30% will develop subsequent BCCs within 5 years.”
(BCC = Basal Cell Carcinoma, the type I had.)
It follows that the 30% can only grow the longer the timeframe gets, and with a good 30-60 years left before the sun can no longer get at me, well, yikes.
One of the things I did while I was at home nursing my sewn-up head, was take a deep dive into my budgets and spending. Because even though we have tax-funded healthcare woohoo in Canada, I still paid good money to have this sucker taken care of.
See, when I was still “quite far down on the waiting list” (the public clinic’s words) to see a dermatologist, I called around and found a private clinic. If it was cancer, I wanted to know.
The initial consult was about $250, then $100 for the lab test, then $150 for each follow-up, then $1500 for the procedure. Some of the reconstruction costs were covered by the public system, even if it was a private clinic, so this isn’t the whole picture.
In total, I paid about $2500 while the government paid for what would have cost me an extra $1000.
I’m lucky that I can spend that. I did eventually get an appointment with the free public system, but it would have delayed removal by a least a month or two. Had I known that time difference upfront, it would have made for an interesting internal debate. The stress of waiting or pay the money? Perhaps fortunately, my choice was easier because the waiting period for free care was unknown.
And so, after gladly shelling out the money which amounted to about 10% of my annual spending, I started to look up reoccurance rates and adding it as a recurring cost to my early retirement plan.
How's that for responsible.
It actually works out kinda well, ‘cause for about $100/month, I can get a new computer or skin cancer every two years. I now have a skin cancer / computer budget. It makes sense to combine them because if I stay indoors, spending more time on computers, I’ll spend less time outside. And vice-versa. So the budget self-allocates pretty well! (I’m only half joking.)
Is The Rest Worth It?
A thought I keep coming back to: is the rest worth it? Is my life and are the people and the good times enough to make fighting cancer worth it? Because, while my fight may be small, bigger ones are coming. Cancer is looking at me like she’s starving and I’m a delicious hamburger. (Cancer is a she because she’s a total bitch.)
So if this is a small fight, and I’m gonna have much bigger ones, life better be worth it. I’m trying not to judge my life against that or anything — I don’t think that’s helpful — but I do need to pick out the good parts and appreciate them, understand why they’re good and create more good moments.
The world has felt muted for the past few months and over and over I had to remind myself that good times have happened, are possible, and will happen again if I want them to. I'm actually fairly good at keeping this perspective, having had lots of dark periods in my life — I even created an app to help me out — but it’s so damn easy to be comfortable and not fight to have those good times.
It’s so damn easy to sit idle under the sun and let the days pass by. But if I’ve learned anything, best to get the damn out of the sun and do something that makes it all worth it.
So, I dunno, maybe I’ll become a coal miner?
The Unearned Cancer Status
Perhaps the weirdest part of this whole thing is that I’m not sure how much I’m supposed to … care. Like, is it a big deal or is it no big deal? The first thought is that it’s cancer and cancer is really really bad and oh shit oh no no no no this can’t be happening. But the second thought is that it’s only skin cancer. It’s just a one-day procedure to remove, and a week or two of reconstruction recovery if you have big scars like I do, and then you move on with your life.
As my sister said when I told her, “If you’re gonna get cancer, this is the one to get!” She’s a doctor.
So I wouldn't call myself a survivor. I never had to go through any sort of chemo. My friends and family never had to rally around me and pull me back from the edge. I shouldn’t get to use the C-word. Maybe this blog post is even too much!
My norm is to downplay everything and so this certainly didn’t feel big enough to be something that should upset me, or my life's balance.
But emotions aren’t logical and the word cancer carries a lot of weight.
Not to mention the preventative lifestyle changes I will have to undertake from here on out. It's something I will live with from now on.
The more I read about this though, the clearer it becomes -- don't minimize it and don't listen to anyone who does because that's a one-way-road to a bad place.
In Conclusion, Wear A Damn Hat!
So look, you’re not going to listen to what I say but skin cancer is the most common form of cancer and the incidence rates are increasing. So wear a big hat and stay the hell out of the sun. And don’t tan for fun because that’s insane. And floss your teeth.
And if you can, find someone who likes to spend a lot of time staring at your naked body because skin cancer can appear in lots of places that you can’t see in the mirror and someone should be looking out for you. See also the part about this all being worth it.
For me, the biggest question mark will be how I handle the sun. I’m already an indoors kinda person who knows the evils of the sun. I could think, “just cover up, wear sunscreen, do your regular skin checks and live your life.” Which sounds great if I was a chill person, but if you haven't noticed from reading this blog by now, I am not that full of chill. A known health risk can tank my enjoyment of, well, anything.
I don't know how this will play out just yet. In the meantime, well, this is where I would have added an 'in the meantime' positive outlook or something, but, well, this story isn't quite over:
It'll Never Be Over
I wrote everything before this section while I was recovering from the surgery, but before my stitches were taken out. When I went back for my stitches removal and follow-up with the two doctors (dermatologist and surgeon) I didn't expect it to be a big deal. I didn't expect anything else added to the story.
Snip, snip, tug, tug, all done.
And while the actual stitch removal part was fine, that day hit me in an unexpected way. Before going, I was starting to feel a lot better mentally, thinking my brush with skin cancer was over. This day made me realize that it's never going to be over.
Because of my age, there are more preventative procedures they want to do. That'll be another day-long procedure in another six weeks from now, once my surgery scars have healed. The words "to kill any existing pre-cancerous cells" were not something I wanted to hear. I could have pre-cancerous cells?? Dammit.
I think it finally hit me that this is not a one-and-done thing. This a rest-of-my-life life-altering thing.
I want to be done with it. I don't think I ever will be done with it.
And as I hit 'publish' on this, that's where I am. Completely uncertain of even how to think about where this all might lead. Not exactly the clean ending I would want.
Life is a mess sometimes I guess.
I'm sure I'll write a lot more updates over the years as I learn and discover more about living in the shadows, both literally and figuratively. In the meantime, my focus is on doing my best to be doing okay. And that's enough for now.
Thanks to everyone who helped me in the last few weeks and months, especially the one who helped me more than I’ve ever felt I could ask or expect of anyone.