Comfortable in My Own Skin

After a diagnosis of basal cell carcinoma at age twenty-eight, Emma Graves Fitzsimmons got smart about being in the sun.

I wish I could say that I’ve always appreciated my porcelain skin.

But for as long as I can remember, I’ve preferred the way I look with a tan and longed to be outdoors with the sun’s rays on my face. That all changed when I was diagnosed with basal cell skin cancer last year at the age of 28.

Throughout my childhood in Houston, Texas, my mother was vigilant about using sunscreen. I have Irish heritage on both sides of my family, and she wanted me to protect my fair skin.

When I left for college in Austin, her reminders continued, but I wasn’t as careful as I should have been. I was young and fearless. I thought skin cancer was something that affected much older people.

I took road trips to the beach with friends and went tubing on rivers. During my senior year, I had a pool at my apartment complex and would catch a few rays between classes. I usually put on sunscreen but didn’t consistently reapply every few hours or wear a hat.

Last summer, I was at the beach in Brooklyn with my brother when he spotted a dark mole on my arm and urged me to make an appointment with a dermatologist. My doctor took a biopsy of that mole and another one on my right cheek. The one on my face was basal cell carcinoma.

A few weeks later, I had Mohs surgery, a procedure where the doctor removes a layer of skin, then tests the borders to determine whether the cancerous tissue is gone before removing another layer. Mine was completely gone in the first take. That same afternoon, I received stitches from a plastic surgeon.

The 1.5-inch scar running between my eye and ear looked pretty bad at first. I was grateful that the cancer was gone, but upset to have a noticeable scar on my face before my 30th birthday.

I learned from my doctors that I’m not alone. All three types of skin cancer – basal cell, squamous cell and melanoma – are on the rise among young women.

Millions of people are diagnosed each year with basal cell and squamous cell carcinoma. These types of skin cancer are usually not life threatening, but the area must be removed because it can spread and lead to disfigurement.

Melanoma is far more serious. Malignant melanoma can spread quickly to other parts of the body and causes about 9,400 deaths in the United States each year.

My grandmother and my aunt on my mother’s side of the family have both had melanoma. Fortunately, they were able to treat it quickly and survived. My aunt, who has beautiful red hair, had melanoma on her arm when she was young, while my grandmother didn’t get it until after she was 70. My grandmother was living with us then, and I remember watching her heal from the complicated procedure she underwent to remove part of her nose and then repair it with skin from her forehead.

My mother and her brother have had basal cell carcinoma as well. We all have fair skin and grew up in places known for hot weather. My mother and her siblings were raised in Phoenix, Arizona.

While our ancestors lived in a rainy, colder climate in Northern Europe, we Texans had almost constant sunshine and could spend 12 months of the year outdoors.

My doctor said that both my upbringing in Texas and my family history made it more likely that I would get skin cancer. My fair skin, blue eyes and light hair were also risk factors.

Now that I’ve had basal cell skin cancer, I have a higher likelihood of getting skin cancer again. Patients with one diagnosis of skin cancer are 40 percent more likely to be diagnosed with new skin cancer than those who have never had it.

I can’t change the damage I’ve already done to my skin, but I can prevent more damage from occurring and try to detect any other problems early. I’m visiting my dermatologist every three months for a full body scan. I examine my skin often to look for changes.

At the same time, I have completely changed the way I interact with the sun. I wear 30 SPF sunscreen on my face every day. I slather sunscreen on the rest of my body if I’m going to be outdoors for more than a few minutes. I avoid the sun during the worst hours of the day for direct sunlight, from 10 a.m. to 2 p.m. I have purchased several sun protective shirts and hats. When I’m at the beach or the pool, I always sit under an umbrella.

My husband Gerry, who also has Irish roots and fair skin, has become more concerned about skin cancer after supporting me throughout this process. He made an appointment with my dermatologist this summer to receive his first body exam in years.

On a recent vacation to the Caribbean with a friend, she teased me for my new beach wardrobe. I wore a pink large-brimmed bucket hat and a blue long-sleeved, almost knee-length sun protective shirt with a zip up collar. She couldn’t even see my swimsuit. I definitely stood out next to the other women in bikinis.

I’m going to have my skin for the rest of my life, and I want it to be healthy. For the first summer in a long time, I am pale — and proud of it.

Emma Graves Fitzsimmons is a contributing writer at The New York Times. She lives in New York with her husband, who also has Irish roots.

Learn more about the risk factors, signs and treatments of skin cancer, and the FDA’s new sunblock regulations, here