So all this begins with cancer. Not the big "C" cancer, but rather the rather diminutive "c" cancer. Skin cancer. Squamous cell carcinoma. Non-melanoma.
The skin cancer call came three days after I’d sat through a Big "C" meeting with some oncologists at Memorial Sloan Kettering (MSK). That meeting had not been for me. That meeting had been for my 31-year-old cousin Jonathon from Calgary, who was married one year ago and then shortly after, learned that a clear cell sarcoma, which had been in remission for seven years, had metastasized to his lung area. The Big "C." I’m not going to give any statistics on this particular "C" because, frankly, they are not comforting statistics, and because, far more importantly, Jon would not want me to.
The week also happened to be the week before my daughter’s fourth birthday. And so, the days were consumed not only by discussions of medical records, biopsies, insurance and treatment plans, but by Tinker Bell invitations and a princess cake.
My dermatologist is an old-school dermatologist. We do not talk about taking 10 years off, or plumping or firming or smoothing. We talk about moles and whether they’ve changed shape. We talk about spots and whether they have thickened or darkened or are irregularly shaped. I have had all types of dermatologists. The dermatologists who have their own retinol skin line for purchase on the way out after the collagen injection. And I have no judgment about the utility of these services. Except that my old-school dermatologist spent his appointed 20 minutes with me, studying my dark and rough spot,s and my other dermatologists spent their 20 minutes with me working on expensive treatment plans to smooth out my laugh lines. So it came as no surprise that my old-school dermatologist, who spends all his time talking about what nobody wants to hear, found the squamous cell cancer on my chest and the other dermatologists did not.
When I took the call from my always careful dermatologist, the news felt somewhat inevitable. Growing up in Colorado in the '70s and '80s, I could count on one hand the number of times we applied sunblock. Fair and living at high altitude, we’d still apply baby oil and sit out and sizzle all summer. During ski season, we’d absorb the reflected glare of high mountain spring skiing. The extent of our sun protection was zinc oxide if we blistered. Thirty years later some of that behavior is probably prosecutable, but in 1978 we all just wanted a tan.
According to the American Cancer Society, 3.5 million cases of basal and squamous skin cancers will be diagnosed each year on more than 2 million individuals. There were 76,600 cases of melanoma, the more aggressive skin cancer, diagnosed in 2013. Melanoma accounts for 9,000 of the 12,000 skin cancer deaths each year.
Although small numbers, it still means that 25 percent of skin-cancer deaths come from a non-melanoma skin cancer, with 2,500 deaths from squamous cell carcinoma. In most of those cases, the skin cancer was not treated early or involved a suppressed immune system. As an adult, I knew that the UV skin damage as a child and teenager had been dangerous, but the call from my dermatologist was the first time I’d also considered my own overall immune system health.
Jon is devoted to keeping his immunity strong daily. He grew up as an extreme snow boarder and outdoor enthusiast in northern Alberta. He exercises regularly and follows a careful diet that limits sugars and processed foods. He attempts to follow the best that both Western and Eastern medicine have to offer on immunity. He is all about managing his sense of dread and anxiety by refusing to spend time on questions that cannot yet be answered. He is smart. He is funny. And he is vigilantly upbeat.
I asked him before the meeting at MSK if there was anything he wanted to make sure he covered with the oncologists. Jon said he did have one thing he did not want discussed under any circumstance. “I don’t want to talk about how long I’ve got,” he said, “who the hell wants to talk about that in the time you have.”