By Dr. Jim Ferguson
The tiny spot on the top of my head looked no different than the other brown aging spots from sun damage. In fact, experts maintain that 90% of the appearance of aged skin is due to the sun and called photo-aging. If you don’t believe me go into the bathroom, take down your shorts or bloomers, and place your forearm next to your derriere. The only substantive difference between these two areas of skin is that one resides in the sun and, most of the time, the other does not.
Scaly reddened areas or areas with irregular pigmentation are very common on those of us north of fifty. I’ve never been a sunbather, although I worked on a tan once the summer I graduated from High School. As a youngster I remember being put in charge of my brother one afternoon while on vacation in Florida. We both suffered for not using the stylish zinc oxide my Mother gave us. Our punishment was stage one sunburns with reddened skin and even a few blisters of stage two burns. Through the rest of my life I wore a ball hat in the sun and liberally applied sunscreen.
Despite these preventive measures the lesion on my noggin enlarged and became crusty. Fortunately, my wife loves me and pays more attention to the vertex of my scalp than I am able to do. It was providential that the enlarging spot occurred over a balding area and was easily visible to an observant wife. A biopsy was promptly done and surgery saved my life. The take home point is that any area of the skin that changes is suspicious, especially if it is in a sun-exposed area.
The three principle skin cancers are basal cell cancers, squamous cancers, and melanomas. All are associated with sun exposure. There is undoubtedly some genetic predilection with these cancers because fair skinned people are at greater risk than others. Basal cell cancers are locally invasive. I once saw a patient who ignored this slowly growing type of cancer until the lesion on the side of her face was the size of a grapefruit. Her surgery was very problematic. My picture doesn’t show it, but I once had a basal cell cancer on my nose. It was small, but there’s not a lot of extra skin on the nose and a plastic surgeon was required to close the hole after the cancer was removed.
Squamous cancers are not only locally invasive, but they can spread into the blood stream and lymph system. Distant spread of a cancer is called metastasis and is a dreaded complication of this disease. Metastases can lead to death if cancer cells spread to vital organs like the liver and brain. The trickiest cancer is a melanoma because it quickly spreads into the lymph system even when small. Melanomas can occur anywhere: the trunk, the arms, between the toes, under finger nails, and even the retina of the eye.
Melanomas are often recognized as an unusual dark spot, a changing mole or a “new mole.” Here’s a clinical pearl of wisdom: you should not develop a new mole. The “ABCD” system of the Melanoma Foundation is helpful in evaluating moles, freckles, and dark spots. The A stands for asymmetry where one half the skin lesion is different than the other half. B stands for an irregular border of the lesion. C refers to an uneven color which can be shades of brown, tan or black. Finally, a skin lesion whose diameter is more than 6mm (about half the size of your pinky finger nail) should raise concern.
Several stories were on my mind recently as I awaited my surgery and then the pathology reports. I am part of a small group of pilgrims who are reading the Bible together this year. Last week’s assignment chronicled Hezekiah king of Judah from 700BC. This good king became deathly ill and he was told that he would die. His ordeal and prayer in 2 Kings 20:1-6 moved me as I considered my own fate. You should read this passage. Next, a book I’m reading focused repeatedly on Psalm 91. I had never considered this Psalm as I had others. Finally, as Becky and I were cleaning a rental house we own we started removing some note cards penned to a door frame. The first one I removed read, “I sought the Lord, and He answered me; He delivered me from all my fears.” (Psalm 34:4) Two hours later my oncologist called me with the good news that the cancer had not spread and that my life would go on.
As a scientist I have always lived within the realm of observable fact and reason. Perhaps these recent “signs” were serendipitous. Or perhaps I was looking for hope and then able to see them. I’ve had the experience of being shown a tree in the forest that was unknown to me. Later, I began to see these trees everywhere, as if my eyes were opened to a new reality. The patriarch, Jacob, once slept and dreamed of a ladder to Heaven. On awakening he said, “Surely the Lord is in this place, and I did not know it.” Perhaps the signs of Grace are everywhere for those who have the desire and eyes to see them.
As I’ve aged I’ve come to embrace a greater perspective of the Universe. I used to struggle more with life’s uncertainty; now I accept uncertainty as part of life and a greater vision. I accept the mysteries and embrace the majesty. History teaches that throughout the ages countless others have come to similar conclusions.
I quote Abraham Lincoln often because he was exceptional. As a child he was bruised by fundamentalist religious perspectives, and rebelled against spirituality as a young man. However, as he aged and in the crucible of the Civil War he came to accept the Master’s destiny for him and our country. I will close with a paraphrase of Mr. Lincoln’s pragmatic observations of the Bible and faith: Believe what you can on reason, have faith in the rest, and you will live and die a happier and better man. Well said, Mr. President.