Sunday, November 4, 2012

The Facts About Skin Cancer - And My Story

The thing about blogging is that sometimes we need to be brutally honest with ourselves to be true to our writing. This blog is a warts and all account of my experience with sunspots and skin cancers. There will be photos of me looking God-awful like how I look without makeup and all my other paraphernalia. I am a little scared to put them up here, but know that the story isn't true without them.

The message is to be sun safe. Love yourself, protect your skin and be careful with how you look after yourself.

My skin isn't great at the best of times. Genetically speaking, I am destined to be the not-so-proud owner of multiple skin cancers towards this end of my life (actually, I am still really young - I think - but as my skin has already been so damaged, I am already experiencing what others might not experience until much later in their lives, if at all). I am fair and freckly. I have already had 1 sunspot burned off, and another cut out, so when I spotted a new lesion on my face, I was saddened, but not surprised. I have my father's skin. I know what can happen. I hope I have been kinder to my own body, and that it won't be as bad for me.

The facts about cancer in Australia are (and I have taken this information directly from The Cancer Council Australia):

Every year, in Australia:
  • skin cancers account for around 80% of all newly diagnosed cancers
  • between 95 and 99% of skin cancers are caused by exposure to the sun
  • GPs have over 1 million patient consultations per year for skin cancer
  • the incidence of skin cancer is one of the highest in the world, two to three times the rates in Canada, the US and the UK.
There are three main types of skin cancer:
*Both basal cell carcinoma and squamous cell carcinoma are known as non-melanoma skin cancer.

Incidence and mortality:
  • Two in three Australians will be diagnosed with skin cancer by the time they are 70.
  • Over the past decades, the incidence of skin cancer has risen in Australia. From 1982 to 2007 melanoma diagnoses increased by around 50%. From 1998 to 2007, GP consultations to treat non-melanoma skin cancer increased by 14%, to reach 950,000 visits each year.
  • Non-melanoma skin cancer is the most common type of skin cancer. This type of skin cancer is more common in men, with almost double the incidence compared to women. Over 434,000 people are treated for one or more non-melanoma skin cancers in Australia each year. In 2007, 448 Australians died of the disease.
  • Excluding non-melanoma skin cancer, melanoma is the third most common cancer in both Australian women and men, and the most common cancer in Australians aged 15-44 years. More than 10,000 people are treated for melanoma in Australia each year. The five-year relative survival rate for melanoma is 90% for Australian men and 94% for Australian women. In 2007, melanoma caused 1279 deaths in Australia.

About two years ago I noticed a small lesion forming on my inner cheek (next to my nose). I consulted three separate doctors who ALL told me that it was nothing to be worried about, however my gut instinct told me to persevere. The 'lesion' was developing a crusty exterior, which is typical of a skin cancer. So two years later I finally made an appointment to see a Dermatologist, who told me that it was a concern and that it would have to go. It was still an epidermis level carcinoma, which meant that it had not yet grown 'legs'. The good news was that it wasn't a bad one at this stage, and should be fairly easy to remove.

We discussed removal options. I could have it cut out. This is by far the most effective way of removing a skin cancer, with an almost certain guarantee that the entire area of 'bad cell area' will be removed. It also has the greatest chance of leaving a scar. I wasn't keen on leaving a scar - call me vain - but given its prominent location on my face, I was interested in my other options. Most interesting to me was the use of a technique called PDT, or 'Photodynamic Therapy'. Using this technique, permanent scarring is rare, and results are excellent.

The full process (and I should stress that this is only MY experience using PDT, and is not indicative of all patients) went as follows.

Day 1

1. I was taken into a small room where a cream called 'Metvix' is applied to an area covering and slightly larger than the lesion. Before they apply the cream, the specialist will slightly scratch the 'affected area' with an instrument that resembles the thing dentists use to clean plaque off your teeth.

Metvix cream used in PDT

2. Then they put a covering on it (so that you resemble a mini-mummy) and send you on your way for three hours so that the cream does it's job before the next stage. I pay for the entire procedure at this stage so that when I return for the second (and worse/painful) part of the procedure I can fly out of the surgery like a bat out of hell, rather than endure the stares from everyone in the waiting room later.

Covering Stage 2
3. At least three hours later you return to the surgery for Stage 2. I had been told that this was going to be painful, and I won't lie, it was REALLY PAINFUL. I have had three babies without pain killers, and this was still worse. To be fair,  I was given a local anaesthetic below the area that was going to be treated. And yes, a needle in your face isn't fun. Maybe it wouldn't be so painful anywhere else on your body? I'll still take that over doing this without pain killers. Hopefully the next time I have a needle shoved into my face it will be full of Botox, and not anaesthetic... If you ever have to endure this whole process, I'd just about beg for the anaesthetic if they didn't offer it to you first!

Putting my light proof goggles on in anticipation of 'the light'
4. Once the local anaesthetic has worked its magic, the 'light' is switched on. That light is so bright that it even shines through the goggles and through your lids when they are closed. The reaction with the cream is immediate. Over the area where cream has been, you feel an instant needle-like pain. I can only describe it as like a thousand needles being jabbed repeatedly over the area, or as someone holding a flame-thrower over your face and blasting you at close proximity! The first treatment is always the worst because you don't know what to expect. The nurse will ask you to tell her if you want the light switched off at all for a break, and it only took me 30 seconds before I asked her to stop. In my defence, it was really burning on the finer skin of my nose, but once the anaesthetic spread, it seemed to help a little. Whilst it blows a cool breeze onto the area being treated, it also feels like it's blowing a thousand sharp needles. I managed the next 6 minutes and 30 seconds with no interruptions! It is 7 minutes of hell (at least it was for me).

Under the 'light'
Apparently the light doesn't affect skin that hasn't had cream on it. in fact, if anything, it stimulates the collagen in your skin, giving you a healthier glow. (Might have to remember this down the track).

I look all relaxed here - but trust me when I say that I was trying not to bite off my tongue.
5. They then cover the treated area with a cover to protect it from light/exposure, which you need to keep in place for at least 24 hours. Underneath, you feel like your skin is falling off your face. You want to crawl out from underneath your skin. Panadol helps. In fact, it helps so much I'd recommend taking a few before the whole process. The trip home was awful. You have to keep the treated area out of the sun until it heals. Thankfully I had my mum with me the first time to drive me back to her house. I did laugh a lot, if only to stop myself from crying.

The reason I look like such a sad and cranky mole here, is because a) I am a sad and cranky mole. b) I am taking my photo without makeup on, and with a bandage on my face, with all intents on putting it on the Internet. This is a scary thing.
And then the 'healing' takes place. I am going to show every warts and all photo, so that you can see the process. Before I had this done, I found loads of before/after photos, but not a lot about the process. This will hopefully fill that gap!

I slept really poorly the first night. I was constantly changing the ice packs for my face, hoping for any relief at all. I was also trying to stop any swelling from occurring, but this also proved futile, as you can see below!

Day 2

I look like I have just done 3 rounds with Mike Tyson - which is also how I felt!
I removed the bandage 24 hours later and this was what I saw. I was horrified. This officially meant that I was on 'inside only' duties until the swelling went down. Having never been in a real fight before, I wasn't sure how long the swelling would take to go down. Incidentally, it takes about 3 days... just in case you ever need to know! The swollen eyelid was the worst! I could even feel it in my sleep. The good news is that by this stage, the stinging has stopped. So you can just focus on the visible side effects.

Day 3

One of the possible side effects listed on the take home pamphlet is 'the development of small pustules that look like pimples filled with pus'. Nice huh?

Small pustules developing around my nose - so gross I can't even begin to explain
The pamphlet says that if these develop you need to contact your Doctor. So I did. And he said "Oh, so how many would you say have developed?" And I answered, "I have no idea! A few..." And he asked, "Would you say 6? 12? 24?" And I said "It's hard to tell, as they're kind of joining together.(I know, gross hey?) But maybe like, 12? But they don't look too bad, really..." So his advice was, "See if you can bust them carefully, and put an antiseptic cream like Betadine on them, and see what happens. Call me if it gets worse." So off I went, and did as the doctor ordered. And things looked better!

See?! I don't look like a complete freak of nature! Just a little red...

And a close up... you can see it's still a bit weepy. The Betadine helped dry it out, but what I didn't know is that the Betadine also sticks to the peeling skin, giving you a Frankenstein look about you on Day 4...
Day 4

On Day 4 I had to take my eldest daughter to the hospital to have her tonsils out. I was afraid that I would arrive at the hospital looking like my husband bashes me (which, incidentally, he doesn't!), but thankfully the swelling had gone, and I tried (mostly in vain) to cover the redness with some makeup. Over sized glasses also helped hide my face, and if anyone stared, I quickly jumped in to tell them that I had just had skin treatment for a cancer thing done on my face! (FYI - when you are in a hospital, no one really bothers to ask what's wrong with you anyway. They already figure that if you're there, it must be something...). At this stage I started applying Cetaphil moisturising lotion (it's a really gentle moisturiser). It helps with the drying out of your skin. I continued this every day from this point onward.

IT'S ALIVE!!!! Bits of skin actually do continue to peel and fall from your face. So when it all dries out, you are left without as much redness, but loads of skin that starts flaking off.

Day 5-10

Over the next 5 days, the peeling continues. Several layers will come off, but it is a slow and gradual process. I was fine to go out and about (making sure I didn't go into direct sunlight) without feeling uncomfortable. There is some redness that remains at the treatment site, but the skin continues to heal nicely. Towards day 10 I started to feel some very slight tenderness around the actual lesion site, but nothing that caused me any discomfort.

Almost nothing left. Some slight redness at treatment site. But otherwise fine
Day 10

We decided to go to Dreamworld for the day. I lathered myself in sunscreen, moisturiser, and slip, slop, slapped! As we were readying ourselves to head out, I couldn't help but marvel at how nice my skin was looking. As a regular wearer of makeup (concealer, foundation, etc.. etc. to cover bags under eyes and whatever other crazies I have lurking on my face), even I was surprised at how healthy my skin was looking and feeling. So maybe there really is something to the whole 'stimulated collagen' thing. I'm going to do more investigating! Here is my evidence anyway... I was wearing only sunscreen on my face on this day - and mascara... but I would never dream of leaving home without mascara.

Looking all glowing and happy not to have skin peeling on my face!
Day 11 (up to 3 weeks later)

I had my return appointment booked for 11 days later. Most people return within 2 weeks for a follow up treatment (if required), but no later than 3 weeks later. I was feeling physically ill at the thought of having to go through it all again. I returned to the clinic with much trepidation. This time nothing hurt as much. The needle, the scratching of the lesion surface, the PDT. It all seemed milder. The nurse explained that as the cells in the area had already been damaged, there would naturally be less pain this time around. I was instantly relieved!

And so the process begins all over again; the cream, the light (PDT), the bandage, the burning feeling, the flaking skin. The good news is that second time around isn't anywhere near as bad - or as painful. And the healing seems to be much faster. I didn't swell up as much either.

Ten days after my second treatment, my face is back to 'normal'.

Now I have to wait three months to go back and make sure it's all gone. Fingers crossed! x


  1. Whoa!!!!!
    what an experience!
    I am a big user of sunscreen and makeup with sunscreen in it! have been for over 25 years. I have olive skin and I am absolutely determined not to get a tan! I have also just bought a great selection of hats! I haven't worn them much in the past, but I have gone au naturale with my hair and am terrified of burning my scalp especially where it is a bit thin (part of the reason I have stopped colouring!) and white!

  2. I too have fair and freckly skin and remember those times as a child when it was OK (but painful) to get burned. All good advice, thanks for sharing your experience and I'm glad you're now OK.

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