Medical Enigma

Early Monday morning, I’m going to Del Webb Hospital for surgery on another squamous lesion, this one simply huge compared to the other ones I’ve had removed. I went back through my journals to see when all this squamous cancer on my legs began. June 12, 2003, almost nine years ago, Dr. Salmon took a biopsy of a lump on my left calf and a few days later called to tell me it was cancerous. Now I, like most people, go gray when they hear that word. Cancer. He put me in touch with a plastic surgeon, Dr. Hait, who assured me that it wasn’t anything as serious as I’d feared, that squamous lesions were a form of skin cancer, but not life-threatening unless they were ignored. I had surgery in July and all went well, the incision neatly stitched, a little three-inch scar that would gradually fade away. And that was the end of it until more than a year later when more such bumps showed up, this time on both legs, both calves. Dr. Hait again. And after that, more and more of them kept showing up. My dermatologist, Dr. Salmon, suggested that I go to a mohs specialist for the surgeries. Mohs surgery cuts out the cancerous tissue in layers with each layer checked in the lab to see if all cancerous tissue had been removed. Dr. Betty Davis, my surgeon, looked like she was about seventeen and cuter than a bug’s ear. My argument with the mohs technique was that she didn’t use stitches, just left the surgical sites open to heal from outside in. Ugly holes in the flesh that took as long as a year to finally heal. I can’t remember accurately how many such excisions she performed over the next several years, but I remember arguing with her and her nurses about the openness of the surgical sites. I didn’t return to the bug’s ear beauty. I know that I had more surgeries, these times back to Dr. Hait, but again, I can’t remember exactly how many. As near as I can figure it, this one on Monday will be about my thirty-first. All on my two calves, from under the knee to the ankle. And three years ago, to compound the problem, both calves developed psoriasis, from below the knee to the ankle, ugly, scaly, itchy patches. On one squamous site on my left leg, new lesions appeared twice more, each time surgically repaired, only with each surgery, the scar kept getting longer and longer and uglier and uglier. Dr. Hait called it a Z incision because the flesh there was so fragile. Wow, is that ugly.

After the third excision on that spot, I was sent to a radiologist for thirty sessions of radiology on the site. Good, I thought. The end of that problem. But about a year after the radiation, a hole appeared at the spot and it kept getting bigger and bigger. So, off to the wound center where I was told that I had the misfortune of having a radiation burn, a wound that just didn’t want to heal. I wish my radiologist had told me about the possibility of such a wound. I may have said, knowing what I now know, that I’d skip the radiation. I’ve been a faithful visitor to the wound center for almost two and a half years now, with the wound still there, healing ever so slowly. None of my doctors can explain why I’m afflicted with the squamous lesions and psoriasis in such restricted areas. They keep asking me if I’d exposed my legs to a lot of sun over the years and I tell them that I was in my thirties before I ever wore shorts when I golfed and that my neck and arms and ears have had far more sun that my lower legs. I think I’d make a good subject for an article in The New England Journal of Medicine.