This is where they took the not-cancer out...

About a month ago, I went in for a routine mole check with my dermatologist--I'd made it a habit to go in for the screenings every 6 months about 10 years ago. The first time I saw him, he found something suspicious, and scalpel biopsied it. It came back as moderately atypical, and had to be further removed with what I'll call a punch removal system--they have this device that carves out around the mole. Then, they lift it up and slice it from underneath, leaving something that looks like a paper punch in your skin. They stitch this up and send you on your way. That time, the removal came back as clear in the margins, and I was done.

Since that time 10 years ago, he's decided to take off one other mole that wound up being suspicious, but he got that all completely off with the first scalpel biopsy. Aside from that, it's been a couple of false starts initiated by me--things like a mole on my neck that started bleeding, which turned out to be nothing. A spot on my face, which was (embarrassingly) nothing more than a scar from acne.

A month ago, the thing he took off looked completely innocuous, and he said it would be unlikely to be anything serious. I took this to mean that, if anything, the atypical part was small, and he probably got it all out with margin with that single cut. The location on my back, being just underneath the shoulder blade and close to the spine made it too painful to swim for a couple of days following the excision, but after that, I was back to normal...until I got a call that I needed to come back in for more work.

The nurse on the phone explained to me that I needed to come back in, and after some questioning from me, I was told that my biopsy was moderate atypia and was not clear in the margins. So, on Tuesday of this week, I went in for surgery, foolishly believing that I'd be able to go straight to work and resume a normal life immediately afterwards. It turned out he had to cut a lot more off of my back than I realized and the mole had grown inward enough that he had to cut into the second layer of skin--as we chatted during the surgery, he explained that since he had to cut into that second layer, he had to go all the way through it so that it would close properly. He put 6 internal stitches in the second layer of skin, and 13 in the first. I'll find out if he got all of the atypical cells out in a couple of weeks.

So, that's what it took to take the not-cancer out of me. Some people have asked what this means, and some have assumed that because of the size of the cut that I have had skin cancer removed--I haven't. Moderate atypia is a precursor to skin cancer that doesn't always evolve into skin cancer. The only hard statistic I've been able to find is that about half of diagnosed malignant melanomas arise from moderately atypical moles--the other half, I assume, look like melanoma right from the very beginning--I will call those the douchiest melanomas.

I've thought a lot about why I'm in this position--some of it is genetics, just because I'm pale enough to make some off-white wedding dresses look tan. Some of it is bad luck, and some of it is sun exposure. Though I have to say there's not a whole lot that's different about my sun exposure history than most. I remember a single blistering sunburn as a child, and that was on my shoulders--I have never had anything removed from my shoulders. I spent my high school and college years as a swimmer--but only two of those years had a significant amount of time in an outdoor pool. At Pine Crest, I swam from 4pm to 7pm every weekday in the south Florida sun, and 7am to 11am on Saturdays. The morning weekday workouts were before the sun came up, so I can't blame those. Perhaps those two years were enough to do the lasting damage to my skin that exists now. I'm a triathlete, so I get some continuing sun exposure throughout my life, though anyone I train with knows I sunscreen to the point of being a nuisance. I'm not perfect and occasionally screw up. I've had a mild sunburn once in the past 4 years. And sunscreen washes off in a pool regardless of how much it says that it's waterproof, so for an hour and half workout, I'm getting some sun exposure. Thankfully, my dermatologist is a realist, and tells me to live my life but do what I can to protect my skin from the sun--continue sunscreening--continue training, and don't sweat the small mistakes.

My opinion? We're all living on borrowed time past the age of somewhere in our mid-30s. From an evolutionary standpoint, the human body doesn't need to survive past the point of the significant reproductive phase of its lifespan, which starts with adolescence, and ends with the reduction of fertility on the female side of the species (mid 30's--ticking biological clock, etc...) Even though I'm male and that part doesn't explicitly hit me, the human race doesn't need older males to reproduce. So we're all degrading as time goes by, and modern medicine has made many significant advances in keeping us alive longer. Anyone who's an adult approaching their 40s can likely point to things that would have killed them without medical intervention--it may be simple for some, and more complex for others. In my case, I've got some early detection of potentially pre-cancerous skin growths in addition to some rounds of antibiotics and the removal of my appendix. They're keeping me alive and hopefully helping me to avoid some more significant issues later on with what these moles might have become.

So let's hear it for modern medicine keeping us going!  Even if that does mean some nasty looking stitches along the way.