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Gainesville woman living with end-stage melanoma warns that skin cancer is potentially deadly

POSTED: April 5, 2008 5:00 a.m.
For The Times/

Kaye Carlton, left, with Hospice of Northeast Georgia Medical Center nurse Sarah Watts.

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It seems hard to believe that what looks like a small discoloration on your skin could kill you.

Maybe that’s why people tend to think skin cancer is no big deal, if they even think about it at all.

Gainesville native Kaye Carlton wasn’t worried when a light-brown spot appeared on her heel a few years ago. She mentioned it to several doctors, but each looked at the lesion and said it was probably harmless.

"It did grow a bit, but it didn’t seem to be a problem," Carlton said.

Then last July, that area on her heel got poked with a stick while she was gardening.

"It became ulcerated and was just a sore that would not heal," she said.

For the first time in her life, Carlton, 67, visited a dermatologist. She went to see Dr. Misty Caudell of Gainesville, who performed a biopsy on the sore spot, expecting to diagnose a serious bacterial infection.

Instead, the tests revealed stage 4 melanoma, the worst type of skin cancer.

"It was an extreme shock," Carlton said. "It was hard for Dr. Caudell to even tell me. She immediately set up appointments for me to see a surgeon and an oncologist."

But there wasn’t much the specialists could do. "We went through every scenario, and there is no good treatment," Carlton said. "Radiation and chemotherapy have no effect on melanoma."

Caudell said if melanoma is caught early, it can be easily removed in a dermatologist’s office and no further treatment is needed. But Carlton’s tumor fooled all of the doctors, because it didn’t look like a typical melanoma.

"I wish we could have diagnosed Kaye Carlton earlier," Caudell said. "It wasn’t her fault. It wasn’t anybody’s fault."

Carlton underwent surgery in August to have the tumor removed from her foot. But the cancer came back within two months, and by November a PET scan showed that it had spread to lymph nodes in her groin.

But Carlton is at peace with her prognosis. She recalls that at the moment she was told she had cancer, "a warmth came over my body, which I felt was the Holy Spirit. It told me, ‘I am OK, even if my body is not.’"

One of her doctors suggested an experimental treatment that might prolong her life for a few months.

"I was not interested in that," she said. "To me, quality of life is more important."

In December, Carlton entered the hospice program of Northeast Georgia Medical Center. The illness forced her to quit her job as an administrative assistant with the Friends of the Parks organization. No longer able to pay her rent, she moved in with her daughter in Suwanee, where she is visited by a nurse once a week.

"I couldn’t do what I’m doing if it weren’t for hospice," she said. "Their social workers have been phenomenal. They’ve been especially helpful to my 10-year-old granddaughter, who is having a hard time with this. And they’ll work with my family for at least a year after I’m gone."

To qualify for hospice, patients must have a terminal illness with a life expectancy of six months or less. Carlton knows her time is short, because the melanoma is spreading quickly. Her pelvis is now filled with fast-growing tumors that are causing her considerable pain.

Yet she continues to stay active and do things with her family. "I’ve been very grateful for the medicines," she said. "The nurses are doing their best to keep me free of pain."

With the time she has left, Carlton is focused on making sure no one else has to experience what she’s going through.

"What I’m hoping to do is to raise awareness," she said. "People do not realize the seriousness of skin cancer. There’s going to be a lot more melanoma (among this generation). I think we’re paying for all the sun exposure we had when we were young."

According to the American Cancer Society, more than 8,000 people die of melanoma each year, about two-thirds of them men. Caudell attributes the gender difference to the fact that men tend to delay seeing a doctor until their cancer is advanced.

Fortunately, melanoma is still relatively rare. The two more common types of skin cancer are basal cell and squamous cell carcinomas. They usually appear on sun-exposed areas of the body, such as the face, and are seldom lethal.

"Basal cell usually doesn’t spread, but if left untreated, it can grow larger and larger and become very unsightly," Caudell said. "Squamous cell occasionally does spread because it can grow along nerves."

Melanoma often appears on parts of the body that are not typically exposed to the sun. But Caudell said the sun’s ultraviolet rays can still play a role because solar radiation triggers mutations in DNA that can cause a cancer cell to start growing and multiplying.

Tanning beds can do the same thing, and Caudell does not recommend them. If people have to be out in the sun for more than about 15 minutes, she advises wearing sunscreen with an SPF (sun protection factor) of 30 or higher.

"But the SPF only refers to UVB protection," she said. "So look for a sunscreen that says ‘broad spectrum.’ That covers both UVA and UVB."

UVA is the kind of solar radiation that causes skin to age; UVB causes sunburning. Both types can contribute to cancer.

Even people who are zealous about wearing sunscreen should check their skin for abnormalities once a month, Caudell said.

"Either do it with a full-length mirror and a handheld mirror, or have your spouse do it," she said. "And once a year, it’s good to have a full-body check by a dermatologist. That’s especially true if you have a lot of moles, because that puts you at higher risk for melanoma."

As Carlton knows all too well, once a person has advanced melanoma, there’s no way to turn back the clock. So prevention is critical.

"All you can do is just watch yourself for changes," she said. "Melanoma is a mean disease."



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