"You might want to be careful with that DVD—because technically those images are considered porn,” Terry, my melanographer, joked as she handed me the disc containing my full-body Molesafe scan. I snickered uneasily. Since I’d just spent the past 30 minutes contorting my naked body into a string of awkward poses (“Now turn to the wall and salute!”) while she snapped pictures of every single one of my moles, breaking the Internet with my middle-aged nudie pics was not my most pressing concern. “Are you sure none of them looked suspicious?” I asked. Terry smiled indulgently. “With 40 moles, you’re a walk in the park. Some people come in and they’ve literally got hundreds.”
Assurances aside, it didn’t take long for Terry—or to be more specific, the Molesafe questionnaire she administered—to determine that I was “high risk” for melanoma. Blue eyes? Check. Fair skin? Check. Several blistering sunburns both as a child and as a teenager? I’m afraid so. And let’s not forget the “dark ages,” those four years in high school when my friends and I would slather on baby oil and lie out for hours after school (if I recall correctly, one member of our squad used a reflector made of tinfoil to turbocharge her UV damage). We didn’t avoid the hours when the most dangerous rays peaked, between 10 a.m. and 2 p.m.—we stalked them as if they were a Kylie Jenner lip kit.
At the time, it never occurred to me (or any of my friends) that there was anything reckless about our behavior. Back in the ’80s, when someone said, “Nice tan!” you didn’t shudder with embarrassment and swear you wore SPF 30. You basked in the compliment. Conversely, in the dead of winter, when my skin reverted to its natural coloring—a shade that can best be described as boiled gefilte fish—I felt like I looked sick (and the universe seemed to agree). Google “80s tanning ads” and you’ll find image after image of mostly blond women sporting “savage tans.” Politically incorrect? Absolutely. Hazardous to a pasty white girl’s self-esteem? Well, not if you could get your hands on some Tropical Blend dark tanning oil. Or so suggested the prevailing teenage logic. For someone like me who has spent the better part of 20 years writing about beauty and skin care—and who has also seen her fair share of sun spots and saggy skin—it’s hard not to cringe at the irony of the taglines. “Beautiful Tan Today, Young Looking Skin Tomorrow,” promised one ad. Needless to say, we now know unequivocally that the opposite is true: Ninety percent of skin aging is actually caused by the sun.
“Have you ever used a tanning bed?” Terry asked.
“Has anyone in your family ever been diagnosed with melanoma?
“Yes,” I said. “My grandfather. He died of it.”
I was 6 years old when my grandfather was diagnosed. Like me, he had blue eyes and fair skin. As an orthopedic surgeon at Montreal’s Royal Victoria Hospital, he spent most of his days inside. However, for one full month every winter, he vacationed in Jamaica. “He never wore sunscreen,” said my mom. “And he spent all his time in the water.” Indeed, the one picture I have left of my grandfather was taken on the patio at the Round Hill resort. He is wearing a white tuxedo, his skin the color of a well-oiled chestnut.
His first melanoma developed years later, after he had retired to Palm Beach. It started on his right cheek, where he had a congenital mole—a nevus similar in size and appearance to one he had surgically removed from my mom’s cheek because he “didn’t like the look of it.” Medical records from the time (1978) describe my grandfather’s lesion as Grade 4. His doctor recommended excising a huge chunk of his cheek. He opted not to do it, allowing only the mole and a narrow margin around it to be removed. The melanoma soon spread to his lymph nodes, his ear, his back, and finally his brain. By the time he died, seven years after his initial diagnosis, he had undergone half a dozen operations.
Needless to say, my grim family history eventually tempered my enthusiasm for the sun. I stopped sunbathing in college and have been something of an SPF vigilante ever since. But when I recently came across a Mayo Clinic study showing that melanoma rates were skyrocketing among both young and middle-aged women in the U.S. (a spike researchers speculate may be related to tanning-bed use), it got me thinking. Was I being careful enough? Sure, I wore sunscreen every day, but when was the last time I got a full-body skin check? I made a decision: Though I couldn’t undo the damage done by my teenage baking habits, I could keep a close eye on it—a task medical science has made much easier in recent years.
And so it was that I found myself standing in front of a wall, wearing nothing but my birthday suit. I received my report from Dr. David Polsky, director of the Pigmented Lesion Service at NYU Langone Medical Center, seven days later. “Number of lesions requiring action: 0.” Phew! I briefly considered canceling my follow-up appointment with my dermatologist for a skin check. After all, I wondered, what was there to look at? But the literature from Molesafe (call 877-665-3723 for info) was clear: This technology—though helpful in flagging dangerous moles and establishing a baseline so you can compare future images—is not intended to replace a consultation with a dermatologist. Feeling like a sun-safety overachiever, I headed out the next morning to see Macrene Alexiades-Armenakas, a well-known skin-cancer specialist, in N.Y.C.
“The field of melanoma detection is evolving rapidly,” she said as we sat in her office, discussing MelaFind, the FDA-approved computer imaging system she employs in her practice (find participating dermatologists at melafind.com). “The machine uses wavelengths to take a 3-D image of a mole and compares it with thousands of melanomas,” she noted. It then creates a numerical value showing how disorganized the mole is. Anything with “low disorganization” has little risk of malignancy; high disorganization (a mole with a score of 2 percent or more) has an elevated one. “Now, let’s do your exam!”
As she explained the ABCDEs of melanoma (A for asymmetry, B for irregular border, C for mottled color, D for diameter bigger than a pencil tip, and E for evolving), Dr. Alexiades-Armenakas combed over every inch of my body, the obvious places (stomach, back, legs, arms, chest) and the not so obvious (between my toes, along the soles of my feet, under my nails, all through my scalp). The whole time she was reciting the ABCs, my mind was processing what she said through the prism of my scariest mole. “The mole on the back of my arm is not bigger than a pencil tip,” I said triumphantly.
“It’s small. But it has asymmetry, an irregular border, and three colors. So even though it’s less than 6 millimeters, we’re going to want to check it, given your family history. What concerns me is that one of the colors inside it is red.” She looked at me with satisfaction. As a prospective melanoma patient, I was doing great.
“I’m almost sure it isn’t melanoma,” she said, seeing the naked fear on my face. “But this is a great opportunity to image it and see how the device works. It’s a lot of fun!”
Somehow, this wasn’t feeling fun anymore to me, but I went along, cortisol levels whirling like a broken fan.
“See, it’s bouncing the wavelengths! Now they’re going into the computer …” A dark splotch flashed onto the screen. It looked like a black starfish sketched by a 2-year-old.
“Good!” Dr. Alexiades-Armenakas said. “It’s only about 1 millimeter deep.”
“High disorganization,” I read.
“2.1,” she said.
“So we should remove this,” I said.
“Yes. We want the disorganization to be low, 0 or less. From 0 to 9, it’s marching on its way. It’s 20 percent there.”
The doctor did a deep punch biopsy to remove my mole and a 1-millimeter margin around it, explaining that you never want to do a shave biopsy on a suspected melanoma because you risk slicing into the tumor. “Staging is based on depth. So if you cut a mole in half, you destroy that possibility.”
A week later Dr. Alexiades-Armenakas called. “Good news,” she said. “Your mole is benign. What you have is a compound melanocytic nevus, congenital type.” In other words, a benign mole present since birth—exactly the type that turned malignant and killed my grandfather.
As I thanked her and hung up the phone, I wondered what would have happened to my mole if I hadn’t gotten a skin check. It was on the back of my arm, a place I could see only with a hand mirror. Without the scan, would I have known it was there? And if Dr. Alexiades-Armenakas hadn’t cut a chunk the size of a gumdrop out of my arm, how long might it have taken that disorganized clump of cells to march the last 80 percent of its journey toward melanoma?
Luckily, I’ll never know. And now if you’ll excuse me, there’s a Tory Burch rash guard in my shopping cart that needs my attention.