A nose full of trouble
Say this about Janet Williams. She knows herself.
And one thing she knows is that she is definitely not a sun person. Even when she and her husband went fishing with their children, she wore a large sun hat and watched them fish from the comfort of the shade.
“Even my house is dark,” she said.
Given her aversion to the sun, it’s surprising then that Williams, 70, learned two years ago that she had skin cancer.
“I thought the melanin in our skin protected us,” she said. “I have not known of any black person who has had skin cancer. Nor have I ever read about any black person getting skin cancer. Even my primary care physician was not aware of it.”
Williams, a retired pharmacist, was diagnosed with basal cell carcinoma in April 2006.
For most of her adult life she has had seborrheic keratosis, a common type of benign skin growths seen in older adults. She has multiple spots — on her torso as well as her face.
Seborrheic keratosis most often appears as multiple brown, black or even pale growths on the face, chest, back and shoulders. They seldom become cancerous, but can look like skin cancer. No treatment is required, but if they become irritated, inflamed or infected, or itch intensely, they can be removed.
Williams then got a growth on her nose. The doctors thought it was another seborrheic keratosis growth.
“It itched a lot, and sometimes I scratched it when sleeping,” she said. It became so annoying that she had it removed and tested, and according to her, she was told that the results were negative. It grew back even larger — it was as wide as a dime. The itching persisted.
She self-medicated, treating it with a topical skin steroid used to treat inflammation and itching.
A subsequent biopsy came back positive for basal cell carcinoma (BCC).
BCC is the most common form of skin cancer, accounting for roughly 80 percent of all skin cancers in both men and women. The exact number of cases is not known, as this type of cancer is not reported to cancer registries. It is estimated that almost 1 million cases are diagnosed each year.
Deaths from BCC are rare. This cancer tends to grow slowly, very rarely spreading to other parts of the body. It’s easily treated, but if left untreated, the cancer can grow into nearby areas and invade tissues and bone beneath the tumor.
BCC is usually caused by exposure to the sun and ultraviolet light. The cancer tends to develop on the head and neck — the areas that are most exposed.
Other causes include exposure to certain chemicals and radiation, a compromised immune system, a family history of skin cancer and, to a lesser extent, genetic susceptibility.
Although BCCs are easily treated, they can come back — in the same location on the skin or elsewhere. According to the American Cancer Society, within five years of being diagnosed with one BCC, up to 50 percent of people develop a new skin cancer.
Williams had Mohs surgery to remove it.
Mohs surgery is an effective treatment for recurring BCC, and is often used for large, deep or fast-growing tumors on the face. In Mohs surgery, the tumor is removed in layers, and each layer is examined immediately under a microscope until no abnormal cells are detected.
This procedure allows the complete removal of the tumor without taking an excessive amount of surrounding healthy tissue. Additionally, Mohs surgery minimizes the recurrence of BCC.
Because of the size and location of the tumor, Williams had immediate reconstructive surgery. The surgeon removed skin from in front of her left ear to help reconstruct her nose. The procedure took five hours.
Since the surgery, she has not had a recurrence, and the itching has stopped. And she has made even more lifestyle changes to battle the sun.
“I always take a sun visor with me,” she said. “And now I use sunscreen of at least [SPF] 30.”
Williams says her condition is not all bad.
“God allowed the lesion to be on my nose, so I could see it,” she said. “Otherwise, I would have ignored it.” |
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Janet Williams was unaware that black people got skin cancer until her diagnosis of basal cell carcinoma in 2006.
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