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A Warning from a Dying Friend

Thursday, May 24, 2012, 15:28 EDT Leave a comment Go to comments

My heart is heavy today after learning that one of my old friends is going into hospice and has days or weeks to live. I met Jake in college via Linda, one of my classmates in the architecture program who began dating him that year and just never stopped. They got married on a Tuesday in 1989, Independence Day, the irony of which Jake enjoyed. Linda wore a beautiful formal wedding gown and veil that was remarkable mostly because it was pale pink, and Jake spiced up his tuxedo with a psychedelic bow tie. They proceeded to have two children before moving from New Hampshire to the island of Bonaire, in the Netherlands Antilles, where they lived until coming to Boston a year ago for treatment of Jake’s metastatic melanoma.

This weekend, I will have what will likely be my final visit with my friend. As I process my memories of our friendship and my thoughts about his impending death—maybe I’ll blog about those another time, maybe I won’t—I also want to say something about his particular kind of cancer.

Jake’s story is a warning about the importance of skin cancer awareness. He was diagnosed in March 2011 with amelanotic melanoma, a particularly tricky skin cancer because it might not look like what dangerous skin cancers are supposed to look like. Jake’s didn’t. Melanoma is usually characterized, the experts say, by the ABCD rule:

Melanoma vs. normal moles

Melanomas are on the left; non-cancerous moles are on the right. Image from the American Melanoma Foundation. Click to view larger.

A for Asymmetry
One half is different than the other half.

B for Border Irregularity
The edges are notched, uneven, or blurred.

C for Color
The color is uneven. Shades of brown, tan, and black are present.

D for Diameter
Diameter is greater than 6 millimeters.

Other Warning Signs:
• The appearance of a new bump or nodule
• Color spreads into surrounding skin
• redness or swelling beyond the mole
• pain
• tenderness
• itching
• bleeding
• oozing
• scaly appearance

Jake's moleCompare all that with Jake’s melanoma lesion, seen on the image at left (taken from Jake’s blog). It was symmetrical, had smooth and even boundaries, was the same color as the normal surrounding flesh, was smaller than 6mm, and showed none of the other warning signs. Except that it grew noticeably and quickly, taking less than two months to exceed the 6mm size. Had it been in a less visible place than the front of his thigh, he probably wouldn’t have noticed it at all.

In his particular circumstances, Jake did all the right things. All his life, he was careful in the sun, using sunscreen and appropriate clothing to protect his fair skin.  Upon noticing the growing mole, he went to a doctor for a biopsy. Based on the biopsy results, the surrounding tissue and nearby lymph nodes were excised and biopsied. Despite having done everything he was supposed to, Jake learned that the cancer was in the lymph nodes. That was 14 months ago, and it’s been downhill since then.

Thus my warning, provided by Jake’s situation, about the importance of actively monitoring your skin for any visible changes. For the areas you can’t see, ask your partner or your friend to do it. It could save your life.

But Den Mother, you might be thinking, what kind of a warning is this? This guy went by the book, but he’s still going to die, so what’s the point? The point is that even though he had rotten luck, he and his family don’t have to wonder if things might have been different if he had been more diligent. And if he had been luckier, if the cancer hadn’t spread to that first lymph node before he got to the doctor, his diligence might have saved his life.

Not every skin cancer is as dangerous as melanoma. Most are superficial and non-invasive. There is no disadvantage to getting something checked that turns out to be no big deal. But if it’s something more, you don’t want to deprive yourself of every available chance to beat it.

For more information about melanoma, visit the American Melanoma Foundation or melanoma survivor Shonda Shilling’s SHADE Foundation. The National Council on Skin Cancer Prevention has informatin about awareness and prevention of skin cancers generally.

Categories: health/safety
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