Squamous Cell Cancer

I’ve decided I should chronicle my leg problems, to help any other poor unfortunate who might have the same sort of medical dilemma. Mine are so odd that they should be reported in the New England Journal of Medicine. The squamous cancer sites and the psoriasis that showed up later were all confined to my calves, from ankles to just below the knees. How odd.

My first incidence of squamous cell carcinoma was on June 12, 2003. I had what I thought was a pimple on my right calf, but it wouldn’t go away, just kept getting bigger and bigger, with a scaly top that itched. Such a simple little thing, but it turned out to be only the first in a long procession of such cancers. Dr. Salmon, my dermatologist, took a biopsy which turned out positive. My first thought when he gave me the news was, “Cancer! I’ll die of cancer!” Both Dr. Salmon and my plastic surgeon, Dr. Hait, assured me that I wouldn’t die from it, that it was much less serious than melanoma. Good, I thought. So, let’s get it cut out and go from there. Since there didn’t seem to be any concern about the cancer, it wasn’t scheduled until July 28, almost a month and a half after the biopsy. Everything went well and it healed with a neat little two-inch scar.

A year later, July 27, 2004, again from my left calf, Dr. Salmon did an excision in his office instead of sending me to Dr. Hait. And on August 10, he took out the stitches and did another excision on a smaller lesion, also on my left calf. That made three.

I went to see Dr. Salmon on September 24 for him to examine one on my left calf and another small one on my right calf. Okay, that made five. He did the excisions in his office. On November 19, he did a biopsy on a recurring lesion on my right leg. Right. Cancerous. So he did the excision. Now I’m up to six.

I was free of any more for over a year. But in 2005 he cut out three more in his office. Up to nine.

The next year, 2006, had to be the worst year for medical woes for both Rosalie and me. This was the year of Rosalie’s Valley Fever and night sweats and aching joints. And this was the year I first encountered the ugliness of old man Gout, an affliction that kept showing up in one foot or the other for most of that year and the following two years. The pain was intense enough that at one point I bought a walker just to help me get around, especially to help me get to the bathroom during the night. Finally, I was put on a large enough dose of allopurinol that the gout episodes stopped. This was also the year the squamous lesions began sprouting like dandelions. I had so many that Dr. Salmon didn’t feel up to that much more surgery, so he sent me to a Mohs specialist, Dr. Betty Davis. Dr. Davis, when I first met her, looked like a gorgeous seventeen-year-old. How in the world could this young woman be a surgeon? The Mohs surgery involves taking out tissue a slice at a time, each slice lab examined to see if any more cutting would be required. She did two, both on my left calf. The brochure for Mohs said that there was a 90% rate of success for any excision. I found out later that I gave that 90% the lie. On March 27, 2006, Dr. Davis cut out two carcinomas from my left calf. And my squamous count was now up to eleven.

In July, 2006, Dr. Salmon did biopsies on four sites, two on my left ankle and two on my right calf, all of which were malignant, one near the site of the earlier Mohs excision and one exactly on the earlier site. Thus, that one fell into the 10% failure rate.

August 24, 2006, back to the lovely Dr. Davis, four more slice sites, one of which was in exactly the same place on my left calf as where she had earlier excised and pronounced as free of any more cancer cells. My count is now up to fourteen. A wonderful year, 2006. And my squamous count is up to fifteen.

On September 29, I went back to Dr. Davis’s offices to have the stitches removed and was chewed out not only by her nurse assistant but also by Dr. Davis for not, apparently, taking good enough care of my wound sites. Needless to say, that’s all it took for me to say goodbye forever to the lovely Dr. Betty Davis.

On October 30, after four more biopsies proving to be cancerous, two on the right calf and two on the left, I went into the hospital for these surgeries by Dr. Hait. Squamous count up to nineteen.

In December of this awful health year, Dr. Zimmerman, my primary, took one look at my messed up left calf and sent me back to Dr. Salmon, who took biopsies of the two sites that hadn’t healed from the Dr. Davis excisions. Naturally, both tested positive, one of which was the same site that Dr. Davis had cut on twice before. Now I’ve really shot the 90% success rate. Since I would no longer consider Dr. Davis for any more surgery, I again saw Dr. Hait. On February 5, 2007, he had to do a Z incision on the place that had recurred three times because as he said, the flesh there was so fragile. The Z was about two inches long on each segment of the Z and was the ugliest scar I’ve ever seen. In addition to those two, he also excised two others from my right calf. My count is now up to twenty-three.

On August 20, 2008, Dr. Hait cut out five more, bringing my total to twenty-eight.

From January 19 to February 19, 2008, I had thirty radiation treatments on the site with the Z incision on my left leg, and by March 27, my left leg seemed to be clear of any more squamous sites, but I noticed four more on my right leg, all on the sites of previous Mohs surgeries. That doesn’t say much for the success rate of the Mohs technique.

On July 29, 2008, I met with Dr. Hait to schedule surgery for a huge site on the top of my left calf, about halfway between my ankle and knee, and he did that on August 19, taking skin from my left thigh for a graft. On September 9, he cut out four more lesions on my right leg. My totals are now up to thirty-three.

On January 6, 2009, I began a series of twenty radiations on the site of the large excision done on July 29, 2008, and sometime in December of that year, two holes appeared in my left leg exactly on the sites of the two radiations, the smaller hole from the first radiation, the second hole, frighteningly large, from the second radiation. In January, 2010, I began a three-year journey to the Boswell Wound Center to get the two radiation wounds healed. The small wound, about the size of half a dime, healed within three months, but the large wound, the size of a fifty-cent piece, took nearly three years and many varied treatments to heal, including eighty hours in a hyperbaric oxygen tube.

As if the squamous cell cancers weren’t enough, sometime in 2008, I developed psoriasis on both legs, from ankles to knees, leaving me with surgical scars and the ugliness of psoriasis scaling and the skin discoloration that accompanies it. I think my doctors may have misdiagnosed the psoriasis as being squamous. I now believe that huge site that Dr. Hait excised was really psoriasis and not squamous. Who knows? Maybe it was a combination of both psoriasis and squamous. In any case, by May 12, 2009, my legs were looking horrific, with a total of nearly a dozen patches on both legs, ugly, scabrous, growing things that looked like alien creatures sucking on my flesh, my left leg now swollen, purplishly mottled, disfigured, and if it were green instead of purple, it would look exactly like a Shrek leg. My right leg had the same number of squamous (or psoriasis) patches but they were much smaller and the leg wasn't as swollen or discolored.

In early 2009, I began a regimen of very expensive salve, first Efudex and then Taclonex, to alleviate the psoriasis and squamous areas. This treatment, in addition to being very expensive, left my legs scabrous and inflamed. I was suffering from plaque psoriasis in exactly the same areas that had been afflicted by the squamous lesions I had fought for nearly six years. Dr. Flynn, my dermatologist, didn’t think there was any relationship between the two, but I don’t see how that’s possible. Almost immediately after my last surgery for another of the many squamous cell cancers, these patches of psoriasis began to bloom on both legs from mid-calf to ankle. No more squamous lesions, but more and more psoriasis patches. From the literature I’ve studied, this is a disease of the immune system. The disgusting red patches are a result of my system producing about ten times as many skin cells as normal but shedding only ten percent of them (the normal rate). Thus, I get these expanding red areas of thickened skin with a tannish silvery material on the surface, stuff that flakes off or can be peeled off in chunks from tiny to half-dollar size.

I had no more squamous lesions until May, 2012, when a large bump appeared on the left side of my left calf. Dr. Flynn took a slice for biopsy, which showed it to be cancerous. I was scheduled for surgery in July with Dr. Brown. But from the time of the biopsy and the surgery, the site grew like an ugly mushroom, and by the time of the surgery, it was the size of a pingpong ball. Dr. Brown had to cut out an area about the size of a baseball, over which he put a skin graft. He also put a skin graft over the three-year-old wound. The first surgical site healed beautifully, but the wound didn’t seem to take the skin graft. However, it must have taken enough to promote the healing that finally concluded in September, 2012.

This last squamous lesion brought my total to nine surgeries and 34 excisions. And nobody can tell me what caused them except long exposure to the sun. And I always wonder why none have shown up on my arms or back of neck or anywhere on my face, all places that have had more sun exposure than my calves. I went on-line to see what I could find. One article mentioned that scars or burns or chronic ulcers are more susceptible to squamous cell cancer than healthy skin; also psoriasis treated with PUVA therapy; also legs and torsos in workers exposed to arsenic or industrial hydrocarbons; and last, areas of the genitals affected by genital warts. None of the above applies to me. Treatments other than excision, which is what I've had with the two episodes of radiation, include curettage and electrodesiccation, a scraping and then an electric probe; cryosurgery, killing the cancerous cells by freezing them with liquid nitrogen (but this one is used only with very small tumors); radiation; Moh's surgery; laser therapy, using a narrow laser beam to destroy the cancer; and finally injecting interferon alfa directly into the tumor. And one last frightening bit of information: “Once a squamous cell carcinoma has spread, the five-year survival rate is less than 50% even with aggressive cancer therapy.” That's certainly not a happy thought.

I hope I haven't sickened any of my readers with this chronicle, but it could be useful for anyone who might be similarly afflicted.