1. a small patch of light brown color on the skin, often becoming more pronounced through exposure to the sun.
synonyms: speckle, fleck, dot, spot, mole, blotch, macula
When I was a child, my grandmother used to tell me the freckles that appeared all over my face and body were the result of a “million angel kisses.” She assured me every opportunity she had that I was special and the angels had smothered me with kisses before I was even born. As time went on and more freckles began to surface, I was convinced it was simply a sign of their undying affections.
I know now that my grandmother wasn’t exactly telling the truth about my freckles. Her diatribes about making her way to California from Cleveland, Ohio on a wagon train were also untrue. But that’s what Irish grandmothers do. They spin magical tales that captivate the wee ones who sit wide-eyed at their feet. When I think back on all her tall tales spoken in her dramatic half-cocked Irish brogue, I realize these are the best memories of my childhood.
In reality, freckles are pigmented spots that arise from sun exposure. Anyone can get a freckle, however some individuals (like myself) were born with the presence of the melanocortin-1 receptor MC1R gene variant. This genetic variant is why some of us end up with a ton of freckles as we grow and are exposed to the sun. When we are exposed to UV-B radiation it activates melanocytes which increases melanin production. This can cause freckles to become darker and more visible. So in essence, I am still special, just not angel kissing special…
Not only am I blessed with the melanocortin-1 receptor MC1R gene variant, I am very fair-skinned and have hazel/green eyes. In other words I burn easily. I grew up at a higher elevation (4,500 feet) in a small community surrounded by mountains. Playing outdoors was all I knew as a kid. We climbed, we hiked, we skied, we swam, we did anything that had to do with outdoor activities. And we did it all without sunscreen and more often than not without a hat. I can’t even count the number of times I received sunburns so bad I blistered and eventually peeled. Those were the days when moms brought out the aerosol can of Solarcaine to soothe the screaming pain of sunburn. Oh if they only knew then what we know now…
Sun exposure, especially to the point of sunburn, can have a dramatic effect on the skin over time. It can actually change the DNA and result in skin cancer. You do not have to have fair skin to end up with skin cancer. Even dark-skinned individuals have been known to experience skin cancer. People who have sunburned at least once increase their chances of getting skin cancer by a whopping 50%. Imagine the odds if you have had multiple burns over time.
Nowadays more young people are being diagnosed with advanced Melanoma, many of them in their 20’s. Pediatric Melanoma is also on the rise with some cases occurring as young as the age of 2. There is no cure for advanced Melanoma (Stage IV). There are a lot of experimental drugs, but no known cure at this time. The prognosis for Stage IV is usually 6-9 months. Grim indeed.
I have heard people exclaim “well at least it’s only skin cancer.” To me that is a pretty foolish statement. I suppose we like to remain in denial when it comes to the sun and like to think we can just run down to the Dermatologist office and have them scrape these little annoyances off so we can get back to tanning. Cancer is cancer and it can be unpredictable and ugly. Once you get skin cancer, whether it be Basal Cell, Squamous Cell, or Melanoma, the odds become higher that you will have more skin cancer at some point in your life. And if you are one of the unlucky, it will spread to your internal organs and you might die.
Yesterday I had a follow-up appointment with my Dermatologist so he could check several other spots of concern on my body. This appointment followed my initial visit and biopsy of the first Basal Cell Carcinoma near my eye. I had eighteen Seborrheic Keratoses (pre cancerous growths) frozen with liquid nitrogen (Cryosurgery). Seven of the spots were on my hands, eight on my face, one on my leg, and two on my chest and upper abdomen. I also had one lesion on my back biopsied to check for cancer.
My Dermatologist is very concerned about my face to the point he is putting me on Efudex (topical Chemotherapy) for 3-4 weeks in the fall/winter to fight off any pre-cancers or cancers lurking underneath the surface of the skin. Efudex is not a very pleasant experience. In his words: “Efudex is a topical chemotherapy, and, like many other types of chemotherapy, it is aimed at selectively destroying abnormal cells (in this case precancerous and cancerous cells). Over the course of the treatment we expect the affected areas to get red, inflamed, swollen, and sore. These areas may ooze straw-colored fluid, may bleed, and may become quite scabby. Some undergoing treatment will experience severe pain in treated areas. The reaction caused by Efudex in the skin can be quite dramatic and even alarming. For some people, 3 weeks of treatment is an impossible goal; for others it can be done relatively easily.” Let’s hope I am one of those “relatively easily” peeps.
Of course I was all over researching Efudex the minute I got home from the doctor last eve. I came across the typical horror stories as well as patients who had very minimal difficulty going through the regimen. Here is a video of one man who went through Efudex treatment. He is a fellow videographer and his production made me laugh and understand better what it is you go through with the treatment.
Today all the spots he froze have lovely raised blisters. They still sting a little bit but the one on my chest which was the largest pretty much burns constantly (see photo below). The biopsy spot on my back is also continuing to protest a bit. The last thing I wanted at this juncture in my life was to look in the mirror and see blisters staring back at me. But I realize the importance of attacking these cells before they have an opportunity to morph into something far worse like Melanoma. Indeed a small percentage of people who have Basal Cell Carcinoma have had their cancer spread to internal organs and die. But it is a very small percentage when compared to the rapid and difficult to control spread of Melanoma.
Now I await the biopsy results for the lesion on my back. I am also waiting for the Mohs surgeon and Plastic surgeon to coordinate a date and time for my surgery. Plastic surgeon you say? Yes, I will most likely need some reconstruction surgery when they remove the Basal Cell on the bridge of my nose because it is so close to my eye. It will all depend on how much skin they need to remove on the surgery day. They won’t know until they start cutting and looking under the microscope. The thing about Basal Cell is its affinity for rooting out under the surface of the skin. It is not simply removing the exposed tumor on the surface, but more often removing tissue beneath or around the tumor until the margins are clear. They can be sneaky little bastards. The result can be quite disfiguring. Thus the Plastics surgeon…
[Up on my soapbox now] – Please remember to use sunscreen; one that protects against both UVA and UVB rays. Limit the amount of time you and your loved ones (especially your children) spend in direct sunlight between the hours of 10 and 4. When you go outside, wear a great big sexy hat to protect your beautiful face and scalp. And please, oh please don’t be misled into thinking tanning booths are safe. They are not. They are responsible for a large percentage of the cases of Melanoma today. I don’t want you to have to go through what myself and millions of other Americans are going through on a daily basis. One person dies of Melanoma every hour…
Pale is definitely the new sexy.