I was calmly reading Barbara Streisand’s biography while waiting in a surgeon’s clinic. A few days before, I had undergone a biopsy to remove a mole which in the last months had seemingly cropped out of nowhere on my skin. On that day I was to meet the surgeon to get feedback about it. I wasn’t worried at all. I was sure that there was nothing wrong with the mole as I felt completely healthy. Ironically I was actually irritated for spending more money on such futile tests! Little did I know what was waiting for me. Nothing ever changed my life that much…

    My surgeon greeted me warmly and then slowly but quite directly, he told me that the results of the mole removed were positive. Ah, good then, I thought. Positive is ok, no? But my surgeon shook his head. The results were positive on the reporting of a malignant mole. It was a Melanoma case. In short – I had cancer! I was surprised by the result and could not quite get it. For a brief moment I thought that my surgeon was playing a nasty joke on me to see how I would react to such news. Playfully I even asked him whether I should start saying goodbye to all the people I knew before I got buried? But he did not laugh and instead he started to inform me about the procedures which would follow, whilst reassuring me that I will be in good hands. I left the clinic still quite incredulous. It was the silence that followed as soon as I phoned my husband to tell him the news that finally burned the dire reality in my mind.

    I drove home as if in a dream. I had never ever thought of ending up in this way. I was shocked at how life can change within a few minutes. I was only 37 and definitely not ready to die at all. I thought of my daughter who was only six and of my husband. Then my parents came to my mind and I felt deeply concerned about the consequences of such news upon them. My relatives and friends followed and then the people I had loved and those who had loved me. My life ran fast in my mind as if I was watching a film. I arrived home and my daughter came running happily to hug me as she always does. In the background I could see my husband looking at me thoughtfully. How could I leave all this behind me? How could I tell to such a young child that she could lose her mother in a short time?

    Thankfully this matter was followed up promptly by another small operation in which this time, the immediate flesh that surrounded the area where the mole had appeared, was removed.  The cancer had not penetrated much into the skin and therefore that was all physically, except that I had to attend to regular follow ups with my doctor and obviously I had to ensure not to expose myself too much to the sun and to apply protective sunscreens.

    However psychologically I was badly shaken. I had decided not to tell anyone about my Melanoma until I did the operation and the results proved that I was out of danger… although you never actually have this guarantee. But in this way, I relieved my relatives of all the stress that was involved until the results were issued. There were only a few days of waiting but all along them I felt distraught. It was as if my world had stopped moving and instead I was completely focused on myself. How was I going to survive this? What could I do to help myself? Maybe there was nothing that I could do but pray. I had been noticing and ignoring the appearance of this strange dark mole for months now and I was not sure how much harm I had allowed myself to get into. Warnings of the Health Department kept nagging at my mind but strangely there were always other things which I deemed more important to take care of and I kept postponing in referring this matter to a doctor until one day I found the time.

    Actually, on looking back at my life I realized that I had a regular tendency to ignore my self. I had moved from one job to another without ever doing what I really wanted – to study archaeology. I had stopped writing novels because I never ever found time. Moreover I had for long tried to smother the love I felt for drama because those around me never approved. In a nutshell, I never gave myself the time to do what my soul really craved for. This recognition began to eat me up in despair. I promised myself that if I succeeded to surpass this incident, my life would change. I would never ignore myself anymore!

    Fortunately another chance was in store for me and I surely kept my word. In a few months’ time I managed to introduce my writing to Aleks Farrugia, the Torċa editor, and he allocated me a weekly two-page article in his newspaper. Moreover, I attended to drama workshops and subsequently I was entrusted with a number of roles in various TV productions. I finally allowed myself to study the subjects I yearned for so much and this year I started a BA in Archaeology and Anthropology.

    I must admit that I am finally really living and not simply existing. Ironically it had to be a close brush with death to set me in motion. I am grateful that I was allowed another chance, knowing that not everybody is so lucky. An adequate health insurance was providential to cover such an urgent matter. Moreover I owe my life to our professional local surgeons and to the Health Authorities who constantly warn and inform us about how to protect ourselves from the sun’s rays and how to recognize any suspicious moles and symptoms. Finally I am adamant to use this experience to safeguard others from this potential risk. I want to ensure that this second chance saved much more than one life…

    Interview with Dr Charmaine Gauci – Director, Health Promotion and Disease Prevention Directorate.

    What is Melanoma and how is it caused?

    Melanoma is a skin cancer caused by unprotected exposure to UV rays. It forms within melanocite cells which are found within the skin to give it pigmentation. When these cells are excessively exposed  to the sun, they start to change shape and to multiply whilst also becoming cancerous. Unfortunately Melanoma cases are increasing because of two main factors: the depletion of the ozone layer and a new lifestyle resulting in spending more time near the sea under the sun’s rays.

    What are the symptoms of Melanoma?

    In the beginning an individual feels perfectly healthy. It is only when the cancer grows deeper that some symptoms are perceived due to metastesis. At this point, the cancer would prove more difficult to cure. It cannot be stressed enough how crucial it is that if one identifies a suspicious mole, one must immediately refer it to a doctor. If recognized in an early phase, a Melanoma can be cured in a short time. However, if ignored, Melanoma could be fatal.

    How do you recognize a malignant mole?

    ABCDE Leaflet 2011 – melanoma Regular self-examination is the best way to get familiar with the moles on your skin. Tricky areas such as the feet soles should not be forgotten. Moreover, a family member or a friend can help you check areas which you cannot see yourself, such as the back, the scalp and the mouth. For the identifying of malignant moles, the ABCDE rule is recommended:

    Asymmetry: when a mole is not symmetrical;

    Border: when a mole’s border is irregular;

    Colour: when there is different colour pigmentation in same mole;

    Diameter: when a mole reaches around 6mm (although there are also smaller moles which are malignant);

    Evolution: if a mole starts changing shape, size, colour or if blood comes out of it. Moreover, a mole which appears late in life should always be given attention.

    How is Melanoma cured?

    In case of an early identification, a biopsy and an excision will remove the cancerous area. If the cancer has already spread in the skin, other methods such as chemo-therapy and radio-therapy are used. Eventually each case is treated according to that particular situation.

    What are the recommended precautions to decrease the risk of Melanoma?

    One should definitely avoid exposure to UV rays during the severest hours of the sun, that is from 11:00am to 4:00pm. Even in cloudy weather UV rays are still dangerous. Umbrellas give some measure of protection but never enough. Sunscreen creams/sprays are a must but they should not be considered as sun-blocks because no product actually stops the sun’s rays from penetrating the skin. When choosing a sunscreen cream/spray, a high factor is recommended. Re-application every two to three hours is suggested especially if one has gone for a swim. Light clothing, hats and sun glasses are further protective measures.

    I would like to emphasize that these harmful rays are not only existant near the sea. UV rays are found everywhere and therefore for example a housewife should avoid washing the clothes on the roof during these hours. The same is suggested to workers who’s work is outside like technicians and salesmen.

    From which grade are UV rays dangerous?

    From 3 – 4, one should start taking precautions. From 5 – 6, UV rays are moderate but one must apply a sunscreen. At more than grade 6, UV rays are extremely harmful.

    What is the probability of re-emergence of Melanoma in an individual who has already been cured of it?

    These individuals will have a greater pre-disposition to the effects of Melanoma and therefore they should take stricter precautions.

    How much has this condition spread in our country? Have there been any fatalities in Malta due to Melanoma?

    New Cases in Malta: 1999 – 2008

    Males 163 and Females 196

    Deaths attributed to malignant cutaneous Melanoma: 1999 – 2009

    Males 43 and Females 27

    Our directorate works in different settings including schools, workplaces and the community. Anyone who would like to organize a health promotion program can contact us on tel: 2326 6789 or email: charmaine.gauci@gov.mt. More information is available on our website: http://www.sahha.gov.mt.

    (Note: An edited version of this article was published on FIRST Issue July 2011)