PUMPING IRONY: The Hazards of Healing

For the past several years, I have greeted the random eruptions of mysterious lesions on my aging mug with little more than a shrug. Weeks and months would pass while these blemishes insinuated themselves on my helpless countenance before eventually fading away. I learned at some point that I was probably being visited by basal cell carcinoma, a relatively benign form of skin cancer that is especially common among older adults, so the fact that these minor annoyances tended to heal on their own persuaded me to simply wait them out.

But recent occurrences — and recurrences — have left me sufficiently vexed to overlook my general aversion to conventional treatment approaches and consult with a dermatologist. I figured, at the very least, I’d come away with a better idea of how to address the more stubborn of the two current eruptions, a wound that has populated my neck for longer than I care to remember.

When I described the relative success of my wait-and-see attitude to the dermatologist during my visit last week, noting how this particular lesion somehow refused to heal like the rest of them, she smiled sympathetically and gently suggested that I didn’t know what I was talking about. “They don’t heal,” she noted gravely. “They just go deeper, or they reappear.”

“They don’t heal,” she noted gravely. “They just go deeper, or they reappear.”

She grabbed a kind of lighted magnifying glass and carefully surveyed my facial terrain, spotting several other areas where she said cancerous cells were demonstrating their handiwork. Some could simply be frozen, she explained, but the others would require Mohs surgery. With a felt-tipped pen, she outlined four of the more seriously damaged zones while describing how she would take biopsies of each and send them off to the lab to be analyzed. My planned “consultation,” I suddenly realized, was devolving into something a bit more complicated.

Basal cell carcinoma is not as benign as I had thought, she explained. Leave it and other nonmelanoma skin cancers (NMSC) untreated long enough and they can cause serious tissue — and even bone — damage. Recent research, I later learned, suggests that these forms of cancer now cause more deaths worldwide than the more notorious melanoma.

In a paper presented at an October gathering of the European Academy of Dermatology and Venerology Congress, French researchers reported that these skin cancers accounted for more than 63,700 deaths worldwide in 2020, compared with an estimated 57,000 melanoma-related fatalities. And while those numbers can be deceiving — NMSCs accounted for more than three-quarter of all skin cancers, some 1.2 million reported cases that year — lead study author Thierry Passeron, MD, PhD, a dermatology professor at the University Hospital of Nice, argued that people like me need to take these cases more seriously.

“We have to get the message out that not only melanoma can be fatal, but NMSC also,” he said. “It’s crucial to note that individuals with melanin-rich skin are also at risk and are dying from skin cancer. There is a need to implement effective strategies to reduce the fatalities associated with all kinds of skin cancers.”

I was not yet privy to this information when my doctor coaxed me into the nearby operating chair. So it was with some consternation that I submitted to anesthetic jabs on the four affected areas. It would be a slight exaggeration to describe what then transpired as a bloodbath, but the process of extracting tiny samples from the cancerous tissue brought forth a generous stream of the red stuff — and not just from my face.

“There’s a cut on his ear,” the doctor called to her assistant after they’d collected the biopsies. She stanched the flow with a small towel while the two of them surveyed the damage.

The assistant, who had been cleaning me up, handed me a bandage. “Can you hold this on your nose?” she asked.

There are times when it’s completely reasonable to request an explanation for an apparent mishap, and there are times when it’s more helpful to hold your tongue — and, in this case, the bandage on the bleeding wound atop my nose. So, I lay still, flinching intermittently, as my doctor closed the mysterious cut on my ear with a series of stitches.

“Just one more,” she said. “You’re doing great.” I made a feeble attempt at a smile.

We live in a litigious society, so I doubt there are many doctors who would openly admit to their patients that they’d bungled some procedure. This was not one of them. She bandaged my wounds, told me where my Mohs surgery would be performed, and scheduled a springtime appointment to do a “head-to-toe” examination before exiting the room.

The assistant finished cleaning me up. “You’re not on a blood thinner, are you?” she ventured — a little late in the game, it seemed to me.

I told her I wasn’t and headed out the door, anxious for the healing to begin.

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