I visited a dermatologist last week for a routine yearly examination. This is a ritual debasement in which I have to strip down and a doctor scans every inch of my pasty flesh, looking for anomalies. Like she usually does, she scanned me and said I was boring, nothing exciting at all (this is the comment I always get from women.) Then she noticed something…
“What’s this circular brown spot on your abdomen?”
“Oh, it’s nothing — I got spattered by some hot liquid in the kitchen…”
“OK, nothing to worry about then,” as she turned to fill in some forms.
“…a couple of years ago.”
She perked right up at that. Something interesting at last! It hasn’t healed up at all well over the last few years, so something is going on there.
She quickly whipped out a hypodermic and numbed the skin, and then did a shave biopsy, which was not fun. It wasn’t particularly painful, but now I’ve got this small wound I have to wash and bandage every day, and it hurts. Nothing at all debilitating, more annoying than anything.
I got the results from the lab yesterday. It’s a benign squamous cell carcinoma in situ.
Gross Exam:
Received in 10% NBF is a shave biopsy that measures 6 x 5 mm. The specimen is divided into 2
sections. All of the tissue is submitted for processing.Microscopic Exam:
There is hyperkeratosis and acanthosis, but no significant dysplastic changes within the
epidermis. The dermis contains a mild, nonspecific inflammatory cell infiltrate.
Fortunately, I have taught cancer biology for years, so I know all the lingo. There’s nothing to panic over.
To be on the safe side, though, I have been scheduled for in-patient surgery for mid-August, after the biopsy damage has healed. They’re going to scrape off a big patch of skin, about a centimeter across, to scour out all the nasty little cancerous cells. That’s the part I dread: if this little biopsy slice is hurting right now, that bigger extirpation is going to hurt even more.
Boy, this summer sucks.
This is called Bowen’s disease, and it is not benign just because it technically can’t metastasize.
I’m just using the term the doctor used. I think generations of soap opera watchers have learned there are only two kinds of cancer, benign (good) and malignant (bad!) so she was phrasing it in the most non-threatening way she could.
Yeah fair enough. I should have said, it can’t metastasize yet. Have it cut out.
I was a soccer referee in SoCal for 25 years. My dermatologist frequently finds work the the itinerant MHOS surgeon that comes to the office every month. For a while it seemed I was keeping him in business. No biopsies need last week for a change. I think there was one each of the last three visits. Very annoying, but at least everything has been caught early before it had a chance to turn nasty.
I’ve had one melanoma and one BCC, still waiting for a SCC to get my skin cancer trifecta. I have my next dermatology appointment July 8. What would I tell my younger self?
“Wear sunscreen, jackass.”
Four years ago, I had a tumor on my right kidney. Fortunately, it was one of the cancers that came with a 97% survival rate. They just had to remove the organ. No chemo or radiation.
I got off lucky.
I’m sorry to hear about this, PZ, actually glad it’s easily dealt with. Except for having a large piece of skin scraped off, that does not sound appealing and I hope it hurts as little as possible.
This is the second time in mere weeks that I have read the word extirpation.
The first time was about the cow eating maggots in Texas and what government can do to alleviate that problem.
From my experience earlier is indeed better!
Had a basal cell carcinoma (the one that’s even less scary than squamous) about 20 years ago. Treated with a topical cream, end of problem. It was in an odd place: the center of my back — presumably the result of all the sunburns I got as a kid, when no one thought that was more than a temporary inconvenience. More recently, I had a series of visits in which my GP froze a dozen or so hyperkeratoses on my head and torso, out of an abundance of caution.
Now: broad-brim hat and SPF-50 sunscreen are standard attire all summer. I will celebrate this sunny, hot Canada Day, I’ll be putting up a partition wall in my son’s basement.
Right there with ya PZ. I’m on for a MOHS next Tuesday. 4th one so far.
Cancer sucks, but at least you’re getting the care you need (and at least it was caught before it could spread, because SCC CAN metastasize, eventually). It’s also lucky that the dermatologist had the wisdom to do a biopsy in the first place.
My mother was at the derm for some kind of minor dermatitis back in 2018, and the doctor noticed a weird patch of skin on her arm (completely unrelated to her actual complaint). Her spidey senses got tingling, so she took a quick biopsy. Mom then got a call, on a Friday night at 8 PM, that went to voice mail, telling her to anticipate a call from CancerCare the next week, but not actually explaining anything (for privacy reasons, I’m assuming she couldn’t communicate the actual diagnosis on a voice message, in case someone else heard it). Obviously that freaked everyone out (as the name implies, CancerCare deals with…cancer mostly), and we were all catastrophizing for the whole weekend, until Monday when Mom called the derm and was told she had MERKEL CELL CARCINOMA (or MCC, probably the deadliest skin cancer…melanoma kills more people because it’s far more common, but MCC is a FAR worse diagnosis for an individual). But Mom was also lucky. It was a localized/in situ tumour, and for MCC these have a 5-year survival rate of 78% (which is still shockingly low…localized melanoma has a 5-year survival rate of >99%). But if she hadn’t had that appointment, odds are she would be dead by now, because once MCC spreads to a lymph node, 5-year survival rate plummets to about 50% (76% for melanoma, for the equivalent lymph node/regional stage), and spreading further, we’re looking at ~20%. And unfortunately, a lot of people get diagnosed too late. Even if she noticed the spot eventually and got her GP to refer her to a derm again, that can take a year here (hopefully it wouldn’t take that long, but the issue is, her doctor at the time had NEVER ACTUALLY HEARD OF MCC, so he may not even have recognized the spot as requiring emergent intervention, thus a longer wait time would have been likely).
She got the cancer removed, as well as the sentinel lymph node (thankfully clear of cancer cells), and the pathology confirmed the biopsy diagnosis. But she’s fine today, so…bad luck to get a pretty rare cancer, good luck that it was caught so unbelievably early. I mentioned her story to a derm I know, and he said he’s seen just 5 people with MCC in his career (which was around 25 years at that point, including residency), and 4 of them died from the disease within a year of diagnosis (the 5th is still alive). None of them were diagnosed at the localized stage though. Cancer scares the crap out of me.
Yeah, Merkels are nasty. Here is a description with some pics: https://acadderm.com/merkel-cell-carcinoma-murky-cell-carcinoma/