Illustration by Dahl Taylor

What You Need to Know About Skin Cancer

More than 2 million Americans will be diagnosed with the disease this year. Here is the burning and bleeding and healing that goes into removing it from the face.

I’m an old pro when it comes to skin cancer. Or, at least I thought I was. I had my first run-in with the disease when I was 31. It was on the top of my head. My hairdresser refused to cut my hair until I had a “mole” checked by a doctor. The next thing I knew I was having a nice crater carved into my skull. The surgeon also discovered another growth near my eye. It was a snap. The surgeon did all the heavy lifting. He admonished me that as a Coppertone baby boomer, I was destined to tangle with the problem again. Shame on me for those youthful days of lying in the sun smothered in baby oil. I swore that from that moment on, the sun would never directly hit my skin again. I slathered on SPF 30-moisturizer religiously.

Just to play it safe, I saw my dermatologist, Dr. Lucius Cook III, annually. A couple of years ago, he noticed something that bothered him. It was just a spot above my lip. He disappeared and returned with a canister. Taking aim, he blasted the spot with liquid nitrogen. When I returned months later, he still wasn’t happy. He took aim and shot it again. 

I went in for a checkup last August. He sat me down for a heart-to-heart. The “cryosurgery” wasn’t taking care of the job. I could either have a plastic surgeon take over, or I could undergo the Carac program. Like a miner prospecting for the mother lode, he took a long look at my face and said the latter might be the better alternative. He suspected more basal cell carcinomas were simmering on my adorable face. Unlike a chemical peel, the Carac would only attack the areas of concern. 

Basically, he said, it was a simple program: Use a thin layer of the topical cream once a day for two weeks, take two weeks off, and then use it for two final weeks. 

Every day, a new face stared back at me in the mirror, complete with additional sores and new shades of pink and purple.

I could do that. Then he said something that should have warned me that it was more than a simple cream treatment. He said we could start it around the holidays. Without asking for an explanation for the delay, I insisted that we start it now. I didn’t want to dilly-dally around. 

Evidently, he didn’t think I realized what I was getting into. He left the room and brought back pictures of people who had undergone the program. There was a man whose face looked like he had gone a few rounds in a boxing ring. Next was a woman whose eyes were barely visible from all the welts and swelling. Finally there was a person—I couldn’t tell if it was a man or a woman—whose face looked like the Elephant Man’s. 

I smiled—those people had obviously not used sunblock nor had they worn hats every day for decades. I would be fine; “Just give me the prescription,” I ordered. He then advised me that without insurance the tube would cost around $600. Luckily, my insurance would knock that down to $30. 

As I left his office, the office manager smiled at me and said, “Everyone who has done it is glad they did. Eventually.” It was that word—eventually—that hung in the air and occupied my mind in the weeks to come. 

The pharmacist had to order the prescription, so I had time to research this project on the internet. 

I found horror stories. There was a chat room where people consoled each other like they were in group therapy. Each story was basically the same. The first few days were a breeze. Then around the sixth day, the patient began a slow march into Dante’s Inferno. Victims described their experiences as if they were applying battery acid to their face. The cream itself didn’t hurt, but the aftermath was ugly and painful. 

By the time I picked up the prescription, my cockiness was starting to wane. I read the instructions 12 times in the hours before the first application: Wash face with a mild soap, Cetaphil. Pat face dry with a towel and then blot it with a paper towel. Wait 10 minutes and apply a thin layer of the cream to face avoiding the eyes, nostrils, and mouth. Immediately wash hands free of the cream. The no-no’s included sunlight and any dressings like makeup. 


Source: The Skin Cancer Foundation

For a timer, I used my iPhone. In the weeks ahead, I learned to hate my phone. As the seconds ticked down that very first day, I was shaking. Had I done everything right? Would my face break out, leaving me looking like a red cauliflower? 

I felt nothing after I applied it. Out of force of habit, I reached for my moisturizer but stopped and removed it from sight. In its place was now a roll of paper towels and a tiny 30-gram tube of Carac. It looked so harmless.

Carac is the trade name for the FDA-approved Fluorouracil, which belongs to the category of chemotherapy called antimetabolites. In addition to treating solar keratosis and basal cell carcinoma, it is also used to treat pancreatic tumors, rectal tumors, head and neck neoplasm, colonic neoplasm, and stomach tumors. It’s a tough little solution that “blocks the growth of abnormal cells that cause the condition.” 

With that in mind, I felt a surge of confidence the first week. No reaction. I looked a little flush by the seventh day, but it was probably the result of the August heat. The next morning, I noticed the flush was turning pink. 

The first “breakthrough” was on Day 10, when I arrived at the tony Sevy’s Grill for dinner with my husband and two friends. As I approached the table, I smiled and said, “I’ve got to go the restroom. My face is bleeding.” In the bathroom I saw a wee bit of blood dripping from what looked like a blister.

By Day 12 I was hurting. My swollen face had tightened and erupted with blisters. Every day, a new face stared back at me in the mirror, complete with additional sores and new shades of pink and purple. The pain was not a full-blown “Ouch!” but rather a constant discomfort. Even my eyes hurt. My daily routine changed dramatically. If I had errands, I would wait until the sun set. I looked scary. I tried my best to hide my face from others by wearing oversized sunglasses and hats with large brims.  Gradually, I found myself not making eye contact with people. I truly did feel like a leper. Vanity had been the first casualty in the battle taking place on my face.

Finally, Day 14 arrived. I happily celebrated lathering on the final treatment of the first round. Now, I was going to take two weeks off from ugliness and pain. But that didn’t happen. 

The following two days were the absolute worst. My skin had become a battlefield with Carac and “diseased skin” duking it out. I couldn’t sleep. I closed all the shades in the house. I couldn’t cry because tears only seemed to make it worse. I was depressed. The discomfort was never-ending. Finally, I broke down, filled a casserole dish with water and ice and dunked my face in it.  

Pride was the next casualty. I called Lucius for advice. He again admonished me: “You should have called sooner.” He told me to turn my refrigerator into a health center, filling it with Sarna lotion and cold compresses to use on my face. If we’d have FaceTimed, he probably would have suggested sticking my face in the freezer for a couple of days, too. 

Two friends, Claire Emanuelson and Angie Kadesky, heard of my project through the grapevine and sent a Tiff’s Treats surprise package of cookies, milk, and ice cream. Combined with the casserole dunking, things were looking up. 

Each day was better than the last. My face was truly in recovery mode. The pain diminished. For the first time in two weeks, I could breathe without hurting. But that little tube of Carac still sat on the counter, ready for round two. Instead of bleeding and swelling, I was now shedding like a snake. Didn’t matter. The pain was totally gone. It was so good to feel good.

The last two weeks would be a snap, or so I thought. Lucius had said that the areas that hadn’t been gobbled up by Carac would be the only ones hit this time. 

Like a termite feasting on wood beams, Carac attacked ferociously. The areas under my eyes exploded in dark red welts and the swelling had once again returned. I was so ugly and I hurt.

As I applied the final treatment, I knew what was coming. This wasn’t my first rodeo, but hopefully it would be my last. For the next two days I looked and felt like someone who’d undergone a facial with radioactive waste. Just as before, the third day was the turning point, with blisters turning into scabs and facial weeping being replaced by shedding.  

Ten days after the final application, everything was clear and there was no pain. People would come up and examine my face like it was the Shroud of Turin. 

Two months later when I saw Lucius for the post-treatment checkup, I told him about the pain and ugliness I had endured. He was delighted. I asked him if sadistic tendencies ran in his family. He laughed and said it was just proof that the Carac had worked. 

As the white-haired, fair-skinned doctor left the exam room, I asked him if he had gone through the program himself. He looked surprised and smiled. “No,” he replied. “I don’t want to scare my patients.” 


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