My Skin Cancer Shock

Caught by Surprise

One week after surgery (in
the office, top, and at a
shoot). (Bottom photo:
Michael Waring)

"What's that on the tip of your nose? We need to do a biopsy." My mind was elsewhere, distracted by the neon surgical goggles of my dermatologist, Fredric Brandt, MD, who peered at my face, Botox syringe in hand. Here's irony for you: I'd been so busy examining my wrinkles that I ignored the shiny dot on the tip of my nose. It had been swimming in and out of view beneath my makeup for months, and I figured it was just a subtle textural change. In no way did it resemble any of the photos I'd seen showing the warning signs of skin cancer. No sores, crusting, or discoloration. No itching, oozing, or irregular borders, just a persistent shine.

Botox, Restylane, Perlane, and Sculptra don't scare me, but I'm a wimp when it comes to scalpels and stitches. When my doctor said, "I'm sure it's nothing; let's just check," the biopsy actually sounded pretty routine. Brandt numbed me up and swiped off a tiny bit of skin. Frankly, I was more concerned about getting through afternoon meetings with the Botox positioned just right. I'd sworn off Botox a year before and, like any junkie, craved its smoothing effect the minute my expression lines turned up, or rather, down. There was no way I could have skin cancer, and I put it out of my mind with Zen-like concentration. The bad-news call followed four days later -- "a basal cell carcinoma. I checked twice to be sure. You need Mohs [micrographic] surgery ASAP."

Smart-ass beauty editor that I am, I made the mistake of going online to do a little research. Never do this. The Mohs technique removes thin layers of tissue until all diseased skin is gone. The "after" pictures were horrifying, even for a pro like me who's seen plenty of graphic procedures at dermatological seminars and cosmetic surgery conventions. But I had no choice, so I assembled three top New York doctors as my A-list team -- Brandt; Mohs specialist Leonard Bernstein, MD; and plastic surgeon Daniel Baker, MD -- to re-create my nose afterward. Each is a guru to the stars, so I should have been feeling pretty cocky. But I wasn't.

On some level I had known this was coming. My teens were spent at the beach marinating in orange Bain de Soleil; my 20s, basted in a baby oil-iodine blend. A tan back then was considered healthy looking, glamorous, sexy -- the darker the better. Midwinter, I'd sunbathe with a foil reflector around my neck. Coppertone QT and Ultima II bronzer were my backups; I'd cheat with them between roastings. I wised up fast as a young beauty editor, scrambling first to prevent further sun damage and later to correct my past misdeeds. The anti-aging skincare market and my face seemed to grow up together.

I don't care what anyone says. Vanity is a familiar and healthy emotion for mature women. I find that a little egotism and self-appreciation go a long way when you're dealing with hormonal changes, brown spots, crinkles, and thinning hair. Our generation's narcissism has been great for our looks. We're the ones who put stretch in jeans; made shaggy, layered haircuts hip; and stocked up on Spanx to keep ourselves svelte in our wrap dresses. And now, with perfect timing, we're the generation that's making tans uncool.

Practically every 40-plus woman I know anticipates skin cancer. Basal cell carcinoma is the most common form and sneaks up on about a million faces every year, with noses, ears, and lower lips the prime targets. Mohs surgery has the highest cure rate of any skin cancer treatment (about 96 percent). It also leaves intact the highest proportion of healthy surrounding tissue.

Bernstein had already done 700 Mohs surgeries in 2007 before he got to me. I hoped the damage to my nose would be minimal and that the cancer hadn't invaded bone or cartilage. Unfortunately, there was no way of knowing until he started slicing. "The visible marking and growth above the surface are no indication of what lies beneath," he said. "Some basal cell carcinomas on the nose form roots of diseased tissue that extend deep, way beyond the boundaries of the visible lesion." If Brandt hadn't caught the spot just in time, I'd have had a significantly bigger problem. "In one year, the cancer would have doubled in size and depth," Bernstein said; I'd probably have needed a flap reconstruction from my forehead (and a lifetime of bangs).

Let's face it, your nose is the center of your face -- your entire profile -- so was I going to have a Michael Jackson situation? My Mohs was scheduled a month from the diagnosis to accommodate the schedules of all three doctors. I drove my husband, Robert, and friends crazy the week before the surgery, endlessly examining my profile in a magnifying mirror and the slightly pearly lesion Brandt had zoomed in on. As with cosmetic surgery, the results of Mohs depend heavily on the skill of the doctor. Brandt and Bernstein were both reassuring about getting the tumor completely out, but what would I look like? I'm kind of fond of my profile; after they sawed away at it, what would be left?

At my pre-op consultation, my plastic surgeon, Baker, who'd do the reconstruction, listened patiently to me whine and wail, then reassured me I'd be as good as new when he was done -- maybe even better. Some Mohs patients do not choose reconstructive surgery if the removal of tissue is minimal. But there was no way I'd be okay with a big dent, asymmetry, and lots of scarring. We decided that my ear would provide the donor skin: the closer to the cancer site, the better the match in skin tone and texture, he said.

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