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Fair skin

April 15, 2014

I have been going to a dermatologist for over 20 years, as I have fair skin with moles, the kind that can turn into melanoma. The first time I visited Dr. Mitch Kline, my first dermatologist (and if he took my insurance, my only dermatologist), he told me that when he studied, his class was told that if a person has a certain number of those flat, brown moles on their body, let’s say 15, that is a patient you should watch carefully. I have that number on one of my arms! So I have been going to a dermatologist for skin checks every 3 months since then. I did have a year when I didn’t have any basal or squamous or ‘on the way to melanoma’ moles at all. But that is very rare for me.

One time I had a mole on my left arm, just past where I could see it easily, that I thought was suspicious. I showed it to Mitch at my appointment, he biopsied it, and it was on the way to melanoma. He described it: ‘On a scale of 1 to 10, 1 being normal and 10 being melanoma, your moles are usually between 1 and 5. This one is a 7!’ He said he had nightmares where he woke up sure that he had missed a mole that was already a melanoma. I went for a skin check in two months that time.

I have been going to Dr. Ellen Marmur for a few years now, since Dr. Kline and his associate Dr. Quan stopped taking my insurance. It is a few years until I am eligible for Medicare, but Dr. Kline says he will accept Medicare. I had to find a different doctor in the meantime, and Dr. Kline recommended her, and she is terrific.

Now when I go in for skin checks, we look at every spot on my body, and if they look suspicious, she takes a biopsy. If it turns out to be benign, no problem. If it is a squamous or abnormal mole, I come back in and they do surgery and remove it, usually involving some stitches, no biggie. If it is a basal cell, they have to do a special surgery called Mohs (after the doctor who invented it), which involves removing the offending skin, freezing it and looking at it under a microscope, while you wait in the outer office with a bandage on your face or wherever. If all the edges are clear, they close the wound, put ointment on it, bandage it up and send you home. If not, they take more tissue and repeat the process until all the edges are clear. Basal cells spread in all directions, so until this process was invented they kept having recurrences at the same site.

The first time Mitch did a basal cell for me, it was on my nose and the hole created was the size of the tip of my pinky, so there had to be plastic surgery to close the wound. They took a piece of skin from behind my ear and used it to patch the spot, so now you hardly notice a difference at all. Now I pay close attention to little red spots that don’t go away right away – they look like a sucker bite that gets scaly. They tend to be basal. I had one under my eyelashes, so it was very hard to see. Dr. Marmur thought it might be a clogged pore, but biopsied it just in case. It was basal. Because it was the lower eyelid, when she had gotten the all clear, instead of doing the plastic surgery herself, she had to send me to a specialist on the eye, so it wouldn’t droop after healing.

My insurance is now saying they don’t cover that doctor, though I went to him because they said they would. Argh. I got that notice the day after I had my second basal right next to the first one on my lower eyelid, so I had just gone to the plastic surgeon once again. It was gotten in one swipe, but it was still on the lower eyelid, so they had to do plastic surgery again. They used the other ear for graft tissue, as I had just had the right ear graft a few months ago. Everyone says it is healing well, I just hope the insurance company can get their ideas together.

I have to thank all my friends for the prayer support, I couldn’t do it without you.


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