Actinic Keratosis Isn't a Foreign Movie Star


Just when I thought nothing could get worse than the presidential campaign, a nasty growth appeared on my head and threatened to sprout into an evil poltergeist of death and destruction. At least it took my mind off of politics.

During the middle of June, I was washing my hair and felt a strange bump the size of a jelly bean on the top of my head. The following week, it grew a topknot that felt like a chocolate chip. My normal mode of operation was to ignore bad things and hope they went away, but this strategy wasn't working. Two weeks later, the bump had grown to the size of an M&M candy, probably a red one but I couldn't see it. Using candy as a measurement was an effective tool to prompt a positive reaction. I'd be happy as a pig in warm mud if my head suddenly erupted with bountiful bouquets of bonbons.

Alas! No sweets came with the irregular growth that became more irritated each time I used a blow dryer on my hair. I scheduled an appointment with my doctor and thought of a hundred reasons to cancel. What if it was just a blemish? What if I suddenly became allergic to hair dye and had to go gray? What if my brain was being eaten alive? What if I imagined everything and the doctor would send me to a padded cell? By then, the growth was morphing into the size of a red-and-white peppermint, so I kept the appointment.

There is a crater on top my head.

The doctor poked around my head, muttering and fussing about lesions and keratosis and surgical excision. Finally, she stepped back and with professional authority said I'd need to return as soon as possible and have it cut out and sent for a biopsy. I envisioned a crater on the top of my head and asked if it would be deep enough to hold fresh flowers or candy because that would be a nice feature. She didn't laugh.

I returned on July 29 and the doctor draped a surgical towel over my head, gave me a shot of wonderful anesthetic, and commenced to cut with a tool that resembled a tiny post hole digger. My scalp bled profusely, and I asked if any brains were leaking. She assured me only blood was escaping and all the essential gray matter was still inside the scull. I mumbled my thanks, grateful that I was still able to coherently speak. She sewed up the wound with bright blue stitches and told me to have a nice day. "No problem," I lied.

My husband and I continued with our plans to join other family members for a short vacation in the nearby mountain town of McCall, Idaho. On August 2, we had just finished golfing and were ready to join the family on a rented pontoon boat when a call came from the doctor. I hesitated answering because I suspected she was calling about lab results from the biopsy. She was calling a week ahead of my scheduled follow-up appointment, so I immediately wondered how many hours I had left to live. I sat down and answered the phone. She got straight to the truth.

"An aggressive actinic keratosis with a high potential for squamous cell carcinoma."

"Damn," I said. "I should have ordered dessert."

Then the doctor offered the magic words of hope: "We dug deep and wide enough that the biopsy confirmed the margins of lesions are clear."

I repeated the strange words. "The margins of lesions are clear?"

"Yes," she assured me. "I'm sure we excised beyond the edge of the keratosis but come in Monday and we'll go over the next procedures."

I can't die now because I just qualified for Social Security!

My grown children and their families were waiting on the boat and noticed my worried look. They asked if my irritable bowel syndrome was acting up again. I told them the biopsy diagnosis, and they immediately began bartering for my jewelry, silverware, and Steinway piano. I stopped their gleeful scavenging.

"Don't get too excited," I said. "It's curable. And my mortgage isn't paid off, so it's best if you wait a decade or two."


We continued our ride around the lake, and I used my cell phone to research important facts. Squamous cell carcinoma is the second most common type of skin cancer and fortunately is curable in 95% of cases, if detected early. Every year in the U.S., approximately 200,000 to 250,000 cases are diagnosed, and 2,500 people die from the disease. While 96% of SCCs remain localized to the skin, the small percentage of remaining cases can spread to distant organs and become life-threatening.

Most types of severe actinic keratosis are causes by exposure to the ultraviolet (UV) radiation from the sun. I was guilty of not taking care of my skin. I grew up on a farm and worked in the fields without a hat. I rode bikes, played outside, and rode my horse without covering my head. As an adult, I golfed and went boating without a hat. I'm fair-skinned and have thin hair. This skin cancer scare was the result my own careless stupidity.

I turned off the phone and focused on the boat ride. Suddenly the sky became bluer, the mountains more majestic, and my children seemed to radiate joy and purpose. Laughter from my grandkids sounded like music, and my husband held my hand as if pulling me out of a looming despair. While breathing and living in the present moment, I had one passionate thought: There is a hole in my head closed with blue sutures, but I'm going to live. I whispered a prayer of gratitude and thanked my weary guardian angel.

Proactive prognosis under my thinking cap.


I watched the wake from the back of the pontoon boat and appreciated the splendid journey through six decades of life. At my age, I've enjoyed more summer days than I'll experience again, but I choose to look forward. There are more mischievous moments to provoke, more words to write, and more hugs to share.

From now on, I'll follow the doctor's orders, get regular examinations, wear sun screen, and purchase a millinery of festive hats. I'll buy a patriotic bonnet to wear to the voting booth, and I intend to vote for many years until we get it right. This negative election season soon will be gone but I'll still be here, wearing jolly hats and eating dessert.