After his doctor told him he had to stay out of the sun, Thomas Montgomery went home and cried. He had to give up a job he loved -- delivering mail -- because he had skin cancer.
That was 10 years ago, before the 210 surgeries Montgomery, 56, has had on his face, arms, legs, chest and neck. He now works filing papers inside the post office, and enjoys his job, but he still longs to be outside.
He longs to wear short sleeves again. Instead, long cuffed ones go over the skin cancer sores that cover his arms, where the callus-like bumps first appeared 15 years ago.
His doctor at the time said not to worry. Years passed, the bumps got bigger and Montgomery went to see another doctor, who said he had cancer.
"The problem with skin cancer is everyone pooh-poohs it," Montgomery said. "If you have a sore on your body, always, always get it checked."
Now an immune-system suppressing drug for his eczema has worsened his cancer. As he prepares for yet another operation, Montgomery finds comfort in the notion that telling his story may make others guard their skin as cancer rates climb.
A million people nationwide are predicted to find cancerous bumps, sores or moles on their skin during the year. That is a 5 percent increase, or 50,000 more, than last year, said Dr. Allan Oseroff, chairman of the dermatology departments at Roswell Park Cancer Institute and the University at Buffalo Medical School.
Oseroff attributes the rise to blase attitudes about sun bathing that are now a decade or so old -- because it takes 10 years or more for skin cancer to develop. And still there are many people who are not cautious.
"People who get skin cancer once have a very high chance of getting more than one," Oseroff said. "While it may not kill them, it can certainly ruin their lives."
Three kinds of cancer
All skin cancer is dangerous, but there are three kinds and each looks and grows differently. The first two are the most common and can bore through the skin. Montgomery has one of these, called squamous cell. It appears as a scaly, callus-like patch of skin. Basal cell, a
thin red scaly patch, is the most common, making up about 80 percent of the cancers. It can appear in two ways: As a thin red scaly patch, or a slightly shiny, pearly bump, which often has a sunken center.
The rarest and most deadly, accounting for about 50,000 cases a year, is melanoma, which can spread to other organs, such as the brain. It appears as a brown, black or reddish, asymmetrical mole that can be bigger than a pencil eraser.
"We're seeing lots of melanoma in young people," Oseroff said. "In almost all these cases, they're people who've had histories of recreational tanning in tanning beds."
Several kinds of surgeries are used to treat skin cancer -- from simple cuts, scraps, or laser burns to Mohs surgery, named for Dr. Frederic Mohs, who developed the idea of using a microscope to examine the tissue removed from skin and be sure every trace of cancer has been removed.
A treatment from Roswell
A new kind therapy, developed in Buffalo at Roswell Park Cancer Institute, doesn't require cutting the skin.
Photodynamic therapy got its start in the 1970s when Thomas Dougherty, a new researcher at Roswell Park, got an idea for killing off cancerous tissue when someone told him not to leave his cancer cell dishes near the window: The cells died when exposed to sunlight.
"This led to a lot of experiments," said Dougherty, who eventually developed a drug that cancer cells absorb. When a beam of light hits the drugged cancer, the cells die.
The technique is most effective wherever a cancer's boundaries can be detected. "It's best for small lesions," said Dougherty.
The light-activated drug has been FDA approved for lung and esophageal cancer but, at Roswell and other medical centers, it is also being successfully used on skin to treat as many as 50 lesions at once.
And while Montgomery has unusual complications because of eczema, Oseroff does use the technique to treat others who are predisposed to the disease.
"The cancer dies within a week or so," he said. "The skin heals up and it's gone."
He estimated that in the past 15 years, Roswell Park has used this therapy to treat more than 5,000 cancers on more than 200 people who have come from as far away as Europe, South America and the Middle East.
The tanner's dilemma
The modern idea of beauty still includes being tan, partly, Oseroff believes, because of its association with wealth. "It's a sign of disposable income," he said. But it hasn't always been that way. "Being tanned used to be a sign of being in the working class," he said.
People are more cautious in the sun than they used to be and women's magazines now write about sunscreen and the benefits of tanning with creams instead of the sun. But many do still sun bathe.
In addition to provoking damage to the skin's DNA that can lead to cancer, the sun and tanning booth lights destroy the elastic qualities of the skin and cause wrinkles, Oseroff said.
"The tan is not nature's way of making us look more beautiful," said Oseroff. "A tan is a body's way to attempt to prevent damage from the sun."
It's true that people feel better when they're out in the sun, said Oseroff. "Sunlight produces endorphins," he said of the pleasure inducing brain proteins. "Being outside with sunscreen is great."
Surgeries brings pain
Montgomery, who has received a commendation for his upbeat attitude from the postmaster general, has talked to the post office about working on a skin cancer awareness campaign for staff.
The pain from the cancers and surgeries that cover his body grew so unbearable in recent years that he now takes pain medicine.
Cancer had to be removed from his neck and the wound covered with a graft from his chest. Now as he prepares for another, similar surgery for the other side of his neck, he finds solace where he can -- from religion and telling people what has happened to him.
"In the Bible it says the problems I face are common in men," he explained with a smile from the couch. The word "Jesus" carved out of wood rested on the table beside him when he spoke about being careful in the sun.
"It makes your skin very dried out and leathery and most of all it gives you cancer," said Montgomery. "Amen."