Until It Happened to Me

09:55AM May 24, 2012
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Sun exposure is not a laughing matter, cow-nose

So you don’t believe skin cancer will ever happen to you? You think your life will be over by then, anyhow?

Here’s what I want you to do: Look at the pictures on these pages. That’s me. Undergoing treatment for skin cancer. Becoming what some would probably consider quite unattractive.

Now ask yourself this: How would you like to look in the mirror and see this face staring back at you? Do you think that nice tan today is worth spending your final 30 golden years with such a face? Do you want to be called "cow-nose"?

Back in the day. I always had a tan when I was young. In my day, farmer daddies tied their sons—at least the more fractious of us—onto bald wheatland tractors around their ninth birthday and sent their mamas to get them when it was time to go to college.

There were no gimme caps in those days, and a decent straw hat cost you $5—10 hours of work, on a farm kid’s pay scale. Plus, it made the top of your head white and uncool. Nobody had ever strung the letters SPF together. If skin cancer had been invented, I never heard of it.

Now I’ve not only heard of it, I’ve got something like a layman’s Ph.D. Let me tell you about my recent Mohs treatment and how I was able to obtain these studio-quality pictures.

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What started out as a small, scaly spot on my nose was determined to be cancerous by my doctor. Basal cell carcinoma is a form of non-melanoma cancer, the least dangerous form of skin cancer.


I’ve been getting sundry forms of skin problems for 30 years or more. It started with something called actinic keratosis spots—scaly little spots that are considered "precancerous." My lay understanding is that most of them are harmless. But some of them can turn into cancer. So my wife sent me to a skin doctor. He started by using liquid nitrogen to "freeze" the spots off. I’d go in twice a year, and he’d freeze off 10 or 20 such spots on my arms and face and send me home looking like a smallpox survivor.

Then, one day, one spot looked "suspicious." He took me in the back room, gave me a shot of numbing medicine and biopsied it. A few days later, I got a call: I had cancer. It turned out this wasn’t "cancer!" with an exclamation point, just "cancer" with a period. Basal cell carcinoma. "Non-melanoma cancer," the doctor said.

I’m lucky. This is the most common, least dangerous form of skin cancer. Left untreated it can kill you, but it takes a long time. Squamous cell carcinoma, the other main non-melanoma cancer, is a little worse. Melanoma is the worst. It’s the one they blame on tanning beds, and if you don’t find it early and get it treated, it will cut your life short. Sadly, having even the basal cell stuff indicates a susceptibility to the more dangerous forms.

So I went back in and the doctor numbed the spot again and cut it out while we talked about the cattle market. No biggie.

He said I should always wear a 4"-brimmed hat, long-sleeve shirts and sunscreen. I was spending a lot of time in the office, and I told him so. He frowned the way doctors and wives do when you question their authority. "You’re getting more sun than you think," he said. "I can tell."

A period of maintenance. I followed through with regular, quarterly visits to the dermatologist. We went through lots of liquid nitrogen. Every now and then, we’d biopsy a spot and dig it out. Then came my first Mohs surgery.

Mohs—named after the guy who first did it—involves having a surgeon cut away a cancer spot one layer at a time. After each cutting, he takes a sample to the lab and looks to see if he’s got all the cancer. If not, he repeats the process. Mohs is mostly used in sites where scarring would be a problem, such as the face, or where you don’t want to sacrifice more tissue than necessary.

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After several Mohs treatments (and shots in the nose!) I was referred to a plastic surgeon for reconstructive surgery. A yellow bandage was sewn on until the Integra Flowable Wound Matrix, a cow tissue product, could be absorbed.

For the next few years, we did a lot of nitrogen, a bit of back-room surgery and the occasional Mohs procedure.

I thought I had it figured out: I go to the surgeon. She gives me some shots to numb the afflicted region. She scrapes the spot. She sends me to the waiting room. Her nurse comes in and says we didn’t get it all. I get another numbing session, another cut and go back to the waiting room.

After a repetition or two, the nurse comes and says it’s time to "close." I get back in the chair and get a bandage or, if it’s a bad one, a few stitches. Then I go home, whine a bit to my wife and, if I can convince her the painkillers aren’t working, maybe get some ice cream. That’s the way it always was.

Then it was different. This one got my attention. I had already planned on writing a piece about skin cancer for the magazine—just to show you youngsters the long-term effects of ignoring all that sun advice—so I held my camera out, pointed it at the offending spot and took a picture. I got the surgeon and her nurse to shoot more pictures as the day progressed.

This one started on the bridge of my nose—right below what is known in the family as "that awful Cornett bump"—and ran down the side. Around the fifth session, my surgeon observed it was a "good thing you have plenty of nose to work with." By the sixth session, she was talking about reconstructive surgery. By that time, more than five hours had elapsed and she had called me back seven times.

At four or five shots per session, I calculated she had given me about 30 shots in the nose. In the nose!

There would be no closing today. The Mohs specialist turned me over to a plastic surgeon, who booked me into a real surgery room. There, an anesthesiologist partially euthanized me and the surgeon stapled—did you get that? stapled!—some "Integra Flowable Wound Matrix" into the sore that once was the starboard side of my nose. Then he sewed onto that a bright yellow "bolster" pressure bandage and, with what looked to be 100-lb. test fishing line, pulled it up piggin’ string tight.

He said I couldn’t get in the sun or dust until the bolster comes off. So I’m confined to quarters.

Bless the cows. In a few days, we’ll take it off and see if the Integra took. It usually does, he said. It is made from bovine tissue—bless the cows—which the human nose absorbs like its own, putting blood vessels in there and everything. Then we’ll give it a while and see if it needs a skin graft. If it does—pay attention here, sun worshippers—he’ll cut a gash in my forehead, fold the skin down over my nose and sew it all together nice and neat.

So that’s the story. I bring it up for those of you who think suntans look so good. Look at those pictures of me. Do you want to look like that someday? If you don’t pay attention to SPF, hats and limiting your midday exposure, you just might be a cow-nose like me.

If, that is, you’re lucky. Otherwise, it might be melanoma. And that, friend, is no laughing matter.