Kim Smith didn’t have the warning signs of melanoma that some people get. Smith does have the fair skin that makes people susceptible to this most deadly form of skin cancer, but there were no moles on her skin that were growing or becoming discolored.
But Smith, a registered nurse who lives in Windham, isn’t the type to dawdle if she senses something wrong. She believes it is that tendency that saved her after doctors in 1999 discovered melanoma in one of her lymph nodes
As it turned out, Smith had the stage 3 form – stage 4 is the worst – of melanoma.
“My gynecologist found swelling in a lymph node near my clavicle, and sent me to my primary-care physician to have it checked out,” she said. “He told me to watch it, and come back in six months. I didn’t want to wait. I had something in me that was abnormal and just wanted it taken out.”
In August of that year, doctors removed the swollen lymph node. They thought at first it was not cancerous, Smith said, but further tests determined that she had melanoma.
“I was adamant that they do further tests,” she said. “They knew I was very worried. I had a personal care physician who was very willing to listen to my needs.”
Smith, who works as a nurse clinical consultant at Unum, said that doctors had no idea how long she had the disease or where it started. But she thinks she knows.
“I’m sure it was caused by sun damage,” she said.
At 52, Smith, the mother of two daughters, is at the youngest end of the baby-boom generation. In her younger years, she and her girlfriends spent much time tanning in the sun, and the idea of protecting one’s skin was practically non-existent. Quite the opposite, in fact.
“I don’t think we used anything,” she said. “We had a camp by a lake. I remember when I was a kid, we were putting on oil that smelled like coconut. We weren’t doing anything to protect ourselves. We were putting stuff on to make sure we tanned better. We got sun burns all the time, and laughed about peeling off the dead skin.”
Smith and her friends took it one step further. They would wrap aluminum foil around record album covers, and stick them under their necks while in the sun, to tan faster.
“I think there’s much more awareness now,” she said. “Primary care physicians do screenings for skin cancer now, and there are warnings about sun exposure.”
Smith also advises people to check their bodies for moles.
“For the most part,” she said, “people will have a mole that they have had for years and it starts changing colors. Mine had started from my lymph system before they diagnosed it. People at the time didn’t realize that a mole like that was a skin cancer that could be fatal.”
Following her surgery, Smith went to Boston to have more nodes removed from beneath her neck and arms. The nodes were clear of cancer, but she faced the rigors of a year that prevented her from working.
At first, she received intravenous injections to fight the cancer, then did self-injections for 11 months.
“It makes you feel like the worst flu you’ve ever had times 100,” she said. “I could function but I was always feeling tired and achy. You lose some of your hair. I lost some weight.”
After that first year, Smith received many scans.
“I was followed by an oncologist for 10 years,” she said.
Today, she is much more careful regarding exposure to the sun.
“I go outside but I make sure I’m covered,” she said. “If my arms get a little pink, I get out. I’m smarter about keeping my skin covered and wearing sun screen.”
And she is grateful.
“Amazingly so,” Smith said. “I was fortunate. But it’s always in the back of my mind. I’m always waiting for the other shoe to drop.”
Ron MacNeal, a dermatologist with Dermatology Associates of Portland, says that exposure to the sun is the leading cause of skin cancer. Exposure to arsenic and people who have had organ transplants also are risks, he said.
Baby boomers, MacNeal said, represent a “transition group.”
“They were kind of unaware,” MacNeal said. “As you get down to the younger ones, people are somewhat more aware.”
MacNeal acknowledged what most people seem naturally to find true: “People enjoy being outside,” he said. “It’s the sun. It’s natural.”
Fun or not, natural or not, MacNeal urges people to be careful in the sun. Go outside at times of the day when the sun is less intense, he advises. Make sure there’s a tree or some other source of shade nearby. Wear broad-brimmed hats. And wear sunglasses.
“A lot of people come in with cancer on or around their eyes and eyelids,” said MacNeal, who does skin cancer surgery daily. “That’s not a good place to get it. Surgery can be complicated.”
MacNeal advises getting the highest SPF (sun protection factor) you can afford in skin protection cream or spray. It’s a good idea to use these every day – not just while you’re in the sun, he said.
Start with an SPF of 60, he said.
“Thirty is not all you need,” MacNeal said. “In labs, they put it on thick. About nobody puts it on that thick. Higher SPF creams can be thick and oozy, and some people don’t tolerate that well. Sprays are an option.”
Once someone has experienced a bad sunburn, the risk for skin cancer is permanently elevated, MacNeal said. Those people should see a dermatologist, and also look for changes in the color of moles, or for moles that bleed, he said.
“As soon as the sun hits your skin, you’ve started the damage, especially if you have light skin,” he said. “Bring an umbrella to the beach. Be smart.”
But isn’t the sun good for you, and loaded with Vitamin D?
“Get your Vitamin D elsewhere,” he said.
MacNeal said that most baby boomers are not prone to visiting tanning booths, which also pounds the skin with harmful rays. But some who are on their way south for a vacation might, in order to get a “pre-tan,” he said. Spray tanning is a safer alternative, he said.
Larry Grard is a staff writer at Current Publishing.
A CLOSER LOOK
The three most common
types of skin cancer:
Basal Cell Carcinoma
It affects approximately 800,000 Americans each year, and is the most common form. Arising in the basal cells, on the outer skin layer, Basal Cell Carcinoma most frequently occurs on exposed parts of the body, usually as a shiny bump or nodule on the skin.
Squamous Cell Carcinoma
A tumor in the outer layer of the skin that can occur anywhere on the body. More than 250,000 new cases of squamous cell carcinomas are diagnosed every year in the United States. Middle-aged and elderly people, especially those with fair complexions and frequent sun exposure, are most likely to be affected. It often appears as a bump, or as a red, scaly patch on the rim of the ear, the face, the lips, and the mouth.
Has its beginnings in melanocytes, the skin cells that produce the dark, protective pigment called melanin, which makes the skin tan. Melanoma is the most deadly of all the skin cancers and affects over 44,000 Americans each year.
SOURCE: Reliant Medical Group