Serene Karplus, Nederland.  It began with a little red mark. It didn’t stick up, it didn’t itch or hurt, I didn’t feel it, and don’t even know when it appeared. One day, raising my arms in front of the mirror to place a barrette in my hair, I saw it on the back of my arm just above the elbow. It was an uneven mix of red and brown, maybe the size of a nickel. I didn’t think much of it. At some point, I showed it to my sweetheart and made a mental note that I should check it out someday.

Another pink, crusty spot the size of a pencil eraser near my wrist has itched and annoyed me for years. Several years ago, my primary care physician had referred me to the dermatologist in her building to get it biopsied. He said, “I can see just by looking at it that it is nothing. I can freeze it off for you if you want”. No biopsy. The freeze didn’t work, it never healed, and just annoyed me more. I didn’t return to him, but also never pursued it elsewhere, figuring it was just an irritation I’d have to live with.

During the April 9 Health Fair series, I visited one in Boulder, as our local mountain fair shifted to being offered in November. They said their skin check appointments were filled up for the day. I persisted, driving down to another one the following week. The dermatologist volunteering there examined my skin and declared a few spots benign, asked questions, and insisted I visit her office within one day regarding the red mark. She biopsied three spots. Five days later, results indicated the one the other dermatologist ignored was a squamous cell carcinoma requiring immediate removal and the red mark that did not resemble a mole was a melanoma.

Squamous cell carcinoma (SCC) is a fairly slow-growing skin cancer that occurs on areas of the body exposed to UV rays. It can spread to the tissues, bones, and nearby lymph nodes. It is easily treated when caught early. Although I’d had it for years, I was lucky in that it appeared to be contained and easily removed. Factors that make a person more likely to develop SCC include: older age; male; fair-skinned; blue, green, or gray eyes; blonde or red hair; spend time outside; tanning beds or bulbs; long-term exposure to chemicals such as arsenic in the water; Bowen’s disease, HPV, HIV, AIDS; exposed to radiation; inherited DNA condition. I had all the first six factors except gender.

The melanoma was a bigger deal, requiring an urgent surgery resulting in a nearly four inch scar across my arm with two layers of stitches. I am fortunate that it was only 0.4mm deep, well short of the 0.75mm that triggers lymph node biopsies (indicating metastasis). This early removal sets me up for 95% success for complete recovery, with the rest of my life including close vigilance and extreme UVA and UVB protection.

Early signs of melanoma are changes to the shape or color of existing moles, or in the case of nodular melanoma, the appearance of a new lump anywhere on the skin. At later stages, the mole may itch, ulcerate, or bleed. Early signs of melanoma are summarized by the mnemonic "ABCDE":

Asymmetry

Borders (irregular with edges and corners)

Color (variegated)

Diameter (greater than 6 mm or 0.24 inches, about the size of a pencil eraser)

Evolving over time

These classifications do not apply to the most dangerous form of melanoma, nodular melanoma, which has its own classifications:

Elevated above the skin surface

Firm to the touch

Growing

Metastasis of early melanoma is possible, but relatively rare: less than a fifth of melanomas diagnosed early become metastatic. Metastatic melanoma can show in symptoms of loss of appetite, nausea, vomiting and fatigue. Brain metastases are common in patients with metastatic melanoma. It can also spread to the liver, bones, abdomen or distant lymph nodes.

Many of us tend to disregard skin cancers as a common malady lots of folks have, believing we can someday get them cut off and everything will be fine. Understanding that a delay in diagnosis and removal can allow possible metastasis makes urgent action on this cancer a matter of life and death. It is critical to survival that we catch it in the early stages when it may be easily treated. A friend of mine, a brilliant cancer researcher, died in her early sixties from a small melanoma on her little toe that quickly metastasized in the months while she patiently waited for her next oncology appointment.

We all live at high altitude with higher exposure risks than wherever we moved here from or wherever other family members live who show no signs of melanoma. Wear updated technology high SPF protection creams and/or fabrics and a broad-brimmed hat. If you have any unusual marks, bumps, or oddly behaving moles, please don’t wait as long as I did for the next 9 Health Fair to offer skin checks. Visit a dermatologist now.

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All adults are welcome at all Mountain MidLife and Nederland Area Seniors events, attended mostly by folks over age 50. Everyone is invited to all meals at the Nederland Community Center. Please call two days ahead for lunch reservations (a week ahead for dinners and breakfasts if possible) to 303-258-0799. Missed the deadline? Call anyway. Costs listed show first the over-age-60 requested anonymous contribution, then the under-age-60. Please note that all over age 60 are welcome regardless of ability to contribute financially.