Carpe Diem A Little Harder After a Skin Cancer Scare

I recently went to Mayo for my annual Lynch syndrome screening, and I suffered from scanxiety more than usual this time. Last summer, my brother was diagnosed with a rare, aggressive form of biliary tract cancer. Sadly, this has been his third bout with a Lynch syndrome-related cancer, and he is only 60. Fortunately, he has received the immunotherapy Keytruda and is in remission. He has always been a pillar of health, so I find his frequent bouts with cancer somewhat disconcerting.

Thankfully, my endoscopy and colonoscopy were both clear — not one polyp was to be found in my colon. I attribute this to my daily aspirin intake.

The most distressing part of my Mayo visit was to the dermatologist. I thought this appointment would be the most benign of all — I'm used to having a mole removed here or there, but the dermatologist was alarmed when she examined the moles on my right arm and came across what she referred to as "an ugly duckling."

I am of Greek descent and get dark quickly during the summer months. There is no family medical history of skin cancer; honestly, I am not a huge fan of most sunscreens because of the toxic chemicals some may contain. There is also a strong correlation between low vitamin D levels and the development of colon cancer. Even though I live in the Midwest, I have a high level of vitamin D in my body due to being outside with my dog every day and from eating eggs, spinach, kale, loads of mushrooms and drinking plant-based milk fortified with it.

The dermatologist used a dermatoscope to examine my skin for abnormalities. The doctor came across a black spot the size of an eraser head on my right shoulder and asked if I knew how long it had been there, and I honestly thought it was just another mole. She pointed out that this lesion was positive for “the ugly duckling” sign as it was significantly darker than my other moles. The nurse numbed my shoulder and used a circular tool for a punch biopsy and removed the dark tissue from my shoulder. The doctor asked about my sunscreen habits and informed me that the pathology result could take up to ten days.

As soon as I left the office, I turned to Google: "What is the ugly duckling rule in dermatology?”

"The ugly duckling sign refers to one mole among many that stick out and look different ('the ugly duck') and should raise suspicion for melanoma."

"Ten days? I have to wait 10 days?" I thought to myself. I was horrified, and all I could think about was how I had spent the past decade fretting over the development of colorectal cancer — I may now possibly have melanoma, the worst skin cancer. Yes, melanoma is one of the cancers we with Lynch syndrome may be susceptible to.

For five days, I was beside myself and in disbelief, and I could not help but catastrophize the situation. All I could think about were my son, best friend, and dog Meli — what would become of my baby Meli?

I tried to rationalize the situation as best as I could. My thoughts included: "We are simply animals having a human experience, and cancer is the price we pay for being complex, multicellular beings. You are lucky beyond measure; you've had lots of opportunities that Jimmy (my brother who died at 36 from colorectal cancer) didn't have, and you were able to raise your son to adulthood. Every day past Jimmy's 36 years has been a bonus for me."

The stress and worry began to take a toll on me and prevented me from sleeping at night. My son and a few close friends tried to console and distract me, but the thought of having melanoma was constantly at the forefront of my mind. Even though melanoma is usually treatable, especially if caught early, I could not help but think the worst.

Then, thankfully, the following Monday at noon, I received the pathology report via email:

"During your evaluation in the Department of Dermatology at Mayo Clinic on March 15, 2023, a biopsy specimen was obtained from the skin lesion on your right shoulder. The specimen was examined under the microscope and showed a blue nevus. This is a benign condition of the skin that is not a cancer and requires no further treatment." 

Oh.

My.

God.

It has been a day since I received this fantastic news, but I am still reeling. I feel as if my tectonic plates have been cracked and permanently shifted — I cannot help but feel unmoored. This health scare makes me want to carpe diem a little harder. I cannot fathom what it feels like for those with actual cancer.

I reluctantly and cautiously can still say I am a previvor.

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