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A Little Bit of Knowledge Both Good and Bad

Last updated: January 2023

While it’s good to know about signs of skin cancer, sometimes a little bit of knowledge can be worse than no knowledge at all. How so? Because once you’ve had skin cancer, your mind can run away from you when you think you see something. It can concoct dire scenarios and jump to unlikely conclusions. This happened twice in recent memory. One time, my imagination didn’t get very far, but another time, the story went on for quite some time.

Taming a wild imagination

Here are two examples. In one, I used what my father used to call “good clear thinking” to nip an unwarranted concern in the bud. The other, though, involved an unwarranted concern that took up headspace for quite some time.

Changes in my nails

Strange things happened to more than half of my nails. They developed horizontal ridges and became discolored and weak. A couple of the nails even died; the sign was that they got totally white. When I went to a dermatologist who specializes in diseases of the nails, she said these were “Beau’s lines.” Harvard Health has this to say: “They usually develop when nail plate growth, which begins in the nail matrix (located under the cuticle), is temporarily disrupted. This can occur with direct injury to the nail matrix; an inflammatory condition such as psoriasis; infection around the nail plate; repetitive picking at the nails or cuticles; or even a manicure.” Systemic causes include nutritional deficiencies and various illnesses. 1

When my nails started to get funky, the doctor said I needed a fingernail biopsy to determine the cause. Here’s where that little bit of knowledge, followed by a quick course correction, comes in.

“I know you can get melanoma under the nails,” I said to the doctor.

One of the signs of melanoma under the nails happens to coincide with what was happening to me: nail lifting from the bed. 2

But wait! After my moment of fear came a course correction. “You wouldn’t get it in so many nails at once, right?” I said.

“Right,” said the resident helping the specialist get ready for the biopsy. So I let it go. I figured that whatever it was, it wasn’t life threatening.

I later learned that the problem is graft vs. host disease of the fingernail, a complication resulting from my stem cell transplant. The treatment: a series of steroid injections near each cuticle. FUN! OK not fun, but better than melanoma.

Flaky spot on my eyelid

I showed my dermatologist a flaky spot on my eyelid. She zapped it by putting liquid nitrogen on a Q-tip. She didn’t seem concerned. It went away. And then it came back, flaked off, and came back again. This kind of pattern is how squamous cell carcinomas act for me.

It was a hard area for taking a photo, so small that my iPhone camera wasn’t doing a good job of capturing it. Then I noticed one day that it had darkened. This time my daughter got a photo of it. It had gone from having no color at all to being almost black. Good for a photo, bad for the imagination. We’re supposed to watch for changes in spots, right? I worried that it had gone from an area of little concern to one that could spell trouble. And the shape was irregular. Was it melanoma?

Then one morning I rubbed it with my finger and saw that something dark had come off.

And I remembered: I hardly ever use eye liner, but before the spot had “darkened,” I put eyeliner on for a special occasion. The change in color was from old eyeliner and not from any skin cancer growth!

At the time when I thought the spot had changed from a potential squamous cell carcinoma to a melanoma, I wrote to the doctor on our patient portal. I said my next appointment was too far away for comfort. I asked if I could come in earlier to have her check the eye and other things. I got an appointment.

By the time I came in, the flake was gone again. Since it is my pattern to sprout squamous cell cancers, I am used to it. I have had more than I can count. I asked if something that was acting like a possible squamous cell (the tell-tale flaking) could turn into a melanoma. She said it could not.

I said it was hard to catch this flaky thing at appointments. If it happened between scheduled appointments, she said, come back in.

No trip to the dermatologist is wasted

Whatever happens, I know one thing. I laughed at myself for making this mountain out of a molehill. And the trip wasn’t wasted. There is always something.

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