This is the time of year when dermatologists and cancer specialists ramp up their messages about the dangers of sun exposure. Without taking steps to protect the skin, the experts warn, we increase our chances of developing skin cancer and wrinkles.
I learned about these hazards the hard way, when my dermatologist confirmed that the tiny nodule that cropped up this year on the inner edge of my lower left eyelid was basal cell carcinoma (BCC). Unlike its cousin melanoma, basal cell carcinoma usually doesn’t spread to other parts of the body and is rarely lethal. But it can grow both above and below the surface of the skin. In addition to becoming unsightly, it can kill all healthy tissue in its path, including bone. About eight out of 10 skin cancers are BCC, according to the American Cancer Society.
My cancer showed none of the classic warning signs, such as bleeding or a scab that wouldn’t heal. In fact, it was flesh-colored and too small to stick out from behind my fringe of eyelashes. I noticed it only because it tickled slightly and I felt it when I rubbed my eyes.
My doctor said I was lucky to have caught the growth as early as I did. Still, the positive biopsy wasn’t entirely surprising, given my family history. Both my mother and older brother had developed the same kind of growth in exactly the same place. Mom was then in her early 80s and my brother Bob was in his early 50s, as I am now.
Heredity is one of the principal risk factors for skin cancer, according to Chevy Chase dermatologist Ali Hendi, a faculty member at Georgetown University Medical Center. According to research by the National Cancer Institute and others, skin cancer is particularly prevalent in fair-skinned people with light eyes — traits all my family members share.
“There are genes that predispose one to melanoma and even BCC,” Hendi said. “But the one for basal cell is rare. So the most common genetic component is the skin one inherits — the fair-skin gene.”
In families that are prone to skin cancer, it’s not unusual for close relatives to develop cancerous tumors in the same place, including the lower eyelid, Hendi said.
Cancers of the eyelid are not all that rare. One study found that they account for 5 to 10 percent of all skin cancers. One reason is that the eyelid gets the full force of direct sunlight. (Cancers on the upper eyelid, which is not nearly as exposed as the lower eyelid, are much less common.) In addition, it lacks a protective layer of skin. This allows it to stay moist and flexible but may increase its vulnerability to ultraviolet rays.
But it’s not just my genes that make me a poster child for skin cancer. My active lifestyle is another; a large body of research shows a close link between skin cancer and prolonged sun exposure. Since this risk is cumulative, chances of developing skin cancer increase with age. The thousands of hours I’ve spent riding my bike over the past three decades, often for five or six hours a day for days on end, have helped keep my blood pressure and heart rate low. But this prolonged exposure to sunlight added cancer risk.
Even when I try to be conscientious about applying sunscreen, much of the lotion I apply to my face gets washed away by sweat. (New FDA rules on sunscreen may help people like me figure out which ones will slither off the fastest. Labels on so-called water-resistant products will have to say how much exposure it takes for the product to become ineffective — 80 minutes is the max.)
I unwittingly enhanced my cancer risk a few years ago when I took up kayaking, another sport that lends itself to prolonged sun exposure. While it’s arguably less cumbersome to put down my paddle and apply sunscreen than to get off my bike to do so, spending lots of time in a kayak has its own risks. UV rays reflect off water, so I’m zapped by radiation from all directions, not just the sky, when I’m in a kayak.
Wearing a hat with a wide brim or a bike helmet with a visor can go a long way toward shielding the eyes. But don’t underestimate the importance of good-quality sunglasses, Hendi said.
“Look for sunglasses that block both UVA and UVB rays,” he said. Scientists believe the former can cause damage to connective tissue and increase a person’s risk of skin cancer. UVB rays also can be damaging, although they penetrate less deeply into the skin.
My growth was removed using Mohs micrographic surgery, the gold standard for treating nonmalignant skin cancers such as BCC. It’s also widely used for curing squamous cell carcinoma, another common cancer closely linked to sun exposure. Named after Frederic E. Mohs, the University of Wisconsin professor of surgery who developed the procedure in the 1930s, the technique involves removing the part of the cancer that is below the skin in stages, using a microscope to examine one thin layer of tissue at a time.
Mohs is especially well suited to small facial cancerous growths such as mine, since it minimizes the digging and scarring, my surgeon, David Lee, said.
Small tumors tend to have shallow roots and frequently can be removed with just one cut, Lee said. But treating larger or more advanced tumors is more complicated. In those cases, a surgeon may have to repeat the procedure of excising and examining tissue two or three times, enlarging and deepening the cut after each examination until the tissue sample shows no more cancer. The deeper the cut, the more chance for infection, scarring or a wound that doesn’t heal neatly.
“It’s a bit of a balancing act,” Lee said. “Obviously, you don’t want to take too much tissue. But you want to make sure you get the entire tumor.”
Because my lesion was so tiny, Lee was able to remove it in one swipe, leaving a hole so small — about an eighth of an inch — that there was little bleeding and I didn’t require stitches.
My cancer was cured in about the time it takes to get a tooth filled.
But that’s not the end of my story. Studies show that skin cancers have a high rate of recurrence. My family is a case in point. Although my mother died from an unrelated health condition before she had another flare-up, my brother has now had several nonmalignant tumors removed, as has my dad. They both now see a dermatologist who checks them for growths twice a year, which is what the experts recommend. My next appointment is scheduled for the fall.
For now, I have no intention of giving up the activities I love best. But I have stocked up on sunscreen. And I just purchased a great pair of wraparound shades.
Zeidner is a freelance health and fitness writer in Arlington.