Cancer…better the devil you know?

09 June 2021  |   Michelle Baker and Dan Frith

What happens when a surgeon receives cancer diagnosis? Does fully understanding the pathway make it easier, or more daunting?

Daniel Frith is a consultant trauma & emergency general surgeon at St Mary’s Hospital in Paddington. Here he explains how melanoma caught him off guard, offered him a new perceptive, and set him on a crazy challenge.

“I have always been a ‘sun seeker’ and during my teens and early 20’s traveled extensively, seeking adventure in warmer climes. As with most of Generation X, during the 80’s I didn’t think too deeply about my health, and when it came to sun protection, only bothered with sunscreen at the very beginning of holidays, simply to avoid the ‘inconvenience’ of sunburn before tanning.

I remember vividly flying off to Majorca at the tender age of 14, and in a fit of the maverick, decided not to bother with sunscreen for the first 3 days. This resulted in pustular blisters on both my shoulders, which were both painful and unsightly. Little did I know that this incident would come back to haunt me 30 years later.

Fast-forward…

At the start of lockdown in 2020, I noticed that a mole on my left shoulder appeared to be quite a bit darker than I remembered it to be. Although I believed it had always been there, I decided to get it checked, not really registering that it could be cancerous, but understanding from my training that ‘change’ in a mole is a signal to act.

I am of course aware of melanoma; a relatively rare, but also deadly form of skin cancer, and one that is certainly best caught early. Looking back at this time, I think I was caught off guard as the examples we study are often late-stage cases, with pronounced signs (large, bleeding, black, crusty) rather than the subtle, ‘innocent looking’, early cases (small, slightly irregular) as was mine.

Nevertheless, I diligently sent a photo of my lesion to my GP and after this, to quell an unexpected rising panic of ‘what ifs’, I went for a run. It was on the run that I got thinking about the probable diagnosis, and slowly but surely, looking at the facts staring me in the face, the realisation struck me that I was heading for trouble.

Three weeks later I was called in for an excision biopsy, the histology results of which took 2 weeks to return. By then I was fully prepared and expecting a diagnosis of melanoma, however my greatest concerned was the stage I was at. Melanoma grows down and relatively quickly, and can get into tissues, bones, and lymph nodes within weeks or months, which makes treatment nearly impossible, so the depth of the growth is everything.

During this period, I gathered all the evidence I had, and finding a photo from holiday 18 months earlier, I discovered to – my surprise – that I was mistaken; there had not been a mole there previously, it was a new lesion that I had not recognised. It seemed that subconsciously I had got used to the mole and failed to notice it growing.

Although the results came back as I had expected, I was relieved to be told the melanoma was only 1mm thick, and had only a 20% chance of metastasis, due to the high mitotic rate (a measurement of how fast tumour cells are dividing). However, by this time I had feared the worst, so this low risk of spread seemed comparably tolerable.

Three weeks later I underwent a ‘wider excision surgery’ and axillary lymphadenectomy. The surgery was trivial, my concern was fixed on the outcome. My surgeon had promised to call me if there was any good news, therefore, when I received a message that my histology result was back and did not hear from him, I assumed the worst. This being that the glands were positive, and he was waiting for the MDT meeting to plan chemotherapy.

Life changing

I cannot stress enough how a diagnosis of cancer, whatever type it is, impacts your life. Your world goes into a tailspin, your needs get compartmentalised into priorities (family, friends, and treatment) and nothing else matters, but painfully, life must go on. You need to work, be a dad, husband, be strong, dependable, pay the bills, and function.

When my surgeon eventually called, I was sitting in the park with my 15-month-old daughter. Taking a deep breath, I answered, expecting a frank talk about chemotherapy. So, when he advised that my lymph glands were negative, I just sat there and cried. I simply couldn’t speak. The relief was palpable, and I shared this with my daughter who had no idea about why daddy was so emotional, or the massive relevance alternative news could have made to her life.

Looking back on this, my perception of life and time have changed irrevocably. I have always loved life, but now I see it through different eyes. The psychological trauma created by facing death is very personal and deep, and it highlighted to me that nobody never ever gets cancer, until they get cancer.

It also made me realise that I was lucky. I had the support of friends and a loving family, I was financially secure and in good hands. Cancer is never easy and a great leveler, but to add it to a life that is already complicated or fractured, solitary or with other health concerns, then it becomes painfully difficult.

Taking skin cancer seriously

Further to my experience, I believe that the NHS is well placed to treat presentations of melanoma which are relatively easy to treat surgically. However, there is a lack of understanding and recognition of the signs of early disease. In addition, the cancerous potential of UV light is highly underestimated, compared to smoking, alcohol, and obesity.

This may be to do with the thought that skin cancer can simply be ‘cut out’, which is not true. Even forms such as basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) which are at epidemic levels on a global basis, can deeply scar both emotionally and physically and can potentially spread. There is no ‘just’ in skin cancer, particularly melanoma, rates of which are rising rapidly in the UK.

The good news is that skin cancer, unlike some other types of the disease, is mostly preventable and so obvious if it is looked for, however, most of us simply do not. When was the last time you got a sunburn and shrugged it off, or bothered to carry out a full-body skin check, or even educated yourself on what to look for?

Luckily, my training provided me with the intuition and insight to act fast, however even I nearly missed the signs, which is easy to do. This made me realise on a deeper level, how many lives are avoidably lost or destroyed, simply due to lack of awareness and bad habits.

Making a difference

When touched by cancer many do something positive to counteract the experience, and I am no different. As my diagnosis was linked with that severe sunburn during my youth, I researched charities actively creating awareness of this issue, and discovered the Melanoma Fund; a small but passionate charity, which runs three national prevention campaigns, including the Outdoor Kids Sun Safety Code.

Designed for sports coaches and outdoor activity leaders, their mission is to enhance the provision of sun protection to primary-aged children, highlighting the importance of sun protection at an early age, helping create good habits that can last into teens and beyond.

They also run Watch Your Back! a campaign for gardeners and horticulturists and Slip! Slap! Swing! for all in golf, both not just reminding high-risk groups on how and why to sun protect, but how to skin check and educating on what to look out for.

Coniston2Coniston

With my cause established, my next task was the activity. Having been previously involved in physical endurance events, I felt a serious test of mental and physical resilience would reflect on the threat I had experienced, and help raise funds, with the support of the friends that have been there for me throughout my life.

Inspired by a fundraiser I completed in 2013 called ‘My House 2 Your House’ (a five-day cycle, swim and run from London to Amsterdam for Parkinson’s), I developed the idea of ‘Coniston2Coniston’, a challenge starting and finishing in the same place in the Lake District, featuring a 6k lake swim, 45k hill cycle, 11 km kayak, and 27k fell run.

So here I am today, ‘alive and kicking’ supported by a team of 15 close friends, pushing my body to crazy extremes, to help raise awareness of a cancer that could have so easily taken my life, but at the same time could so easily have been avoided, and for that, I am profoundly grateful.

Join us

Just one blistering sunburn, especially in childhood, will double the risk of melanoma in later life – and I am proof. Our aim is to raise £20k to help ensure ‘outdoor loving’ children develop healthy sun protection habits and avoid becoming a ‘14-year-old me’.

To donate and find more about the team, the cause, and our challenge, visit https://www.justgiving.com/fundraising/coniston2coniston



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