How basal cell cancer surgery turned a journalist into the “hat guy”

FAMILY PHOTO - Richard Harris began to wear hats after cancer surgery on his scalp.

For the past seven years, few people have seen the top of my head. I’ve been “the hat guy.” In fact, I’m typing these words wearing my Red Sox cap, probably my favorite from my burgeoning cap collection. The hat has become a virtual appendage, more a part of my identity than I had realized. When I updated my Facebook profile photo recently — the first without a hat — I was inundated with comments from friends and former colleagues who had never seen me without a hat or couldn’t remember the last time they had.

My affinity for hats was not a fashion statement; rather, it had its roots in the foolishness of youth, which came back to bite me decades later.

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As summer hits its peak, consider this a cautionary tale for sun worshipers.

In the spring of 1975, what seemed like a good idea turned out to be a colossal blunder. During a college-break camping trip, a group of us decided to abandon the Chicago chill and head south. What possessed me, a fair-skinned guy, to slather myself in baby oil and lie out in the Florida sun, I still can’t say. But I was 21 years old, and we know that a college student's judgment isn’t always spot on.

Rather than golden brown, I turned lobster red, sporting the mother of all sunburns, one so bad, in fact, that I spent the rest of the trip coating my back, chest and head with various ointments in a futile effort to lessen the sting and keep sheets of skin from peeling off — even from my scalp.

Thirty years later, I began noticing reddish, scaly blotches on my scalp, so I went to my dermatologist. He believed I was suffering from eczema and prescribed a topical cream. Even as the blotchy area grew, he remained convinced it was eczema. So my wife — smart woman — suggested getting a second opinion. It took all of five seconds for my daughters’ dermatologist to look at my scalp and determine I needed a biopsy.

Sure enough, the test came back positive for the slowest-growing form of skin cancer, basal cell. Although the doctor told me it rarely metastasizes and is seldom fatal, it needed to be removed. And because the cancer had covered a nearly two-inch square portion of my scalp, I would need Mohs surgery. That’s the technique that allows a surgeon to slice off one layer of tissue at a time (conserving as much tissue as possible) and then test whether there is any more cancer present. If there is, the next layer of tissue is shaved off and tested. The procedure keeps repeating until there is no more evidence of cancer.

As you’re scalped — you’re alert, but a local anesthetic numbs the top of your head — you must wait until the surgeon gets the all-clear that no more cancer remains.

But that was just the beginning. Once the cancer was removed and my scalp had healed, I underwent a cranioplasty to re-form the skull. This was to ensure that skin transplanted from my thigh could be grafted onto my scalp. Once the transplant was done, there was the matter of a bizarre-looking, one-inch-by-three-inch section of my scalp that didn’t grow hair. Think of it as the clearing in the forest. I didn’t care so much how I looked when I gazed into the mirror — okay, I did — but I really didn’t want to subject the outside world, let alone my family, to the medical-textbook exhibit that was my scalp.

Covering my bald spot

So began a rotating series of hats — baseball caps mostly, but occasionally a more somber, formal cap if I was attending a funeral or religious service. Sometimes, the timing was awkward, even at a ballgame when most of the fans in the stands were also wearing caps. When the public address announcer instructed men to remove their hats for the national anthem, I hoped those around me didn’t think I was unpatriotic when I kept mine on. I also recall switching jobs during this period and sending out an all-staff e-mail, introducing myself as “the hat guy” to preempt the inevitable question of why I’m always wearing a hat to work.

The cancer surgeon didn’t suggest I’d ever be able to grow hair on that newly transplanted scalp. So I was resigned to wearing a hat until my male-pattern baldness caught up with my blank patch. But a reconstructive surgeon later recommended harvesting hair from the back of the neck and transplanting it, follicle by follicle, to the new scalp that supposedly wouldn’t grow hair. Painstaking work. Worth a shot, I thought. The first attempt didn’t quite cover the spot, but a second round more or less did.

In the years since my diagnosis and surgery, I’ve remained healthy and cancer-free. I get my entire body checked regularly, and there’s no sign of recurrence. It has probably helped that my head has been covered virtually every day I’ve been in the sun for the past seven years. I have been through quite a few hats during that time, and something else occurred: Like many men in their 50s, my hairline kept receding. So now there are many days when I go hatless. It has actually been liberating to feel the wind on the top of my head. Who would have thought I’d miss that?

It’s impossible to connect the dots from that fateful Florida trip to my subsequent basal cell cancer, but among the risk factors for that disease are bad sunburns in youth. (My other risks, according to the American Cancer Society: having light-colored skin and being a man, which made me twice as likely as a woman to get basal cell cancer).

The episode did give me instant respect for the sun. It also made me smarter on all future excursions to the beach, where I maintain a ritual: Come armed with the highest SPF sunscreen I can find, stick the umbrella in the sand at an angle that provides maximum shade, and cover up any exposed skin. Once you’ve had basal cell cancer, your odds of getting it again rise by as much as 44 percent, according to a 2012 study.

During my carefree youth, the dangers of the sun weren’t part of the national conversation to the extent that they are today. And there’s now much more focus on prevention. Case in point: The policy adopted last month by the American Medical Association, which urges schools to allow a sunscreen exception to rules forbidding students from bringing over-the-counter medications to class.

The AMA now “encourages all students to possess sunscreen at school” without obtaining a note from a doctor. And the association warns that “even just a few sunburns can increase a child’s risk of skin cancer later in life.”

Hats off to the AMA.

Harris is a documentary producer and freelance writer.

 
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