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The Skin We’re In

Fifty percent of us will develop a form of skin cancer by age 65. I’m one of them.

The actual biopsy didn’t worry me too much.

After all, it was just a coffee bean-colored spot on the back of my upper left arm. It wasn’t raised or lumpy, and was no larger than a pencil eraser, really. The only reason I even had it checked out, in April, was that my friend Jane and my mama adamantly insisted that I do so.

Jane first noticed it when we fished together in the summer, me bare-armed and bare-legged. She brought it up whenever we spoke. My mother noticed it the following Christmas, as we dressed together, saying “How long has that been on the backside of your arm?” I reply that I’m 50 years old, and I don’t look at my rear view unless I have to.

“I’m not going to stop bugging you until you get it checked out,” Mama says.

Jane’s bugging me, too, I tell her. Mama is pleased.

They’re calling and e-mailing every week. Okay, I’ll go, I tell them. But since it’s not like an ache or pain, I delay seeing a doctor until April, and even then, it’s mostly to get my mama and Jane off my back.

Out, Out, Darned Spot

I visit Willis Cottel, a dermatopathologist trained in the Frederic Mohs method. Mohs developed a technique in the 1930s that trains doctors not only in surgery, but also in pathology and aesthetic repair. And Cottel’s been practicing it for 45 years or more.

“It’s suspect,” Cottel says without inflection. To my alarm, he immediately swooshes me into his operating room and excises a neat little quarter-sized plug around the offending spot.

I tell myself it’s over.

He promises results in two days. Cottel, a robust, beaming gentleman, loves to fish, as do I, and we share our favorite angling adventures as he cauterizes and bandages the open wound where the spot sat moments before.

That’s that; Jane and Mama can go on to worrying about other things. Cottel’s office will send me a note in the mail saying that everything’s fine.

But I get a phone call, not a letter. You need to be here at 9 a.m. tomorrow, the cheery, assertive voice tells me.

That’s when I start getting scared.

Fear overcomes me the following morning in the waiting room. Seated around me are several others; one, a Lucchese-booted rancher with an ear missing, his wife stroking his hand and murmuring softly into his good ear. Nearby, a Dallas debutante, perfect in every detail except that half of her nose is gone, half-heartedly flips through a magazine.

I feel very alone.

When my name is called, Cottel emerges as soon as I am in the examining room.

It’s Cancer

“It’s positive,” says Cottel, with just the right mix of professionalism and compassion. It takes a moment for his words to soak in, and he waits for my mind to catch up to what he has said.

“The good news,” he continues, “is that it’s Stage I melanoma, with a 95 percent cure rate with the Mohs method. I’ll excise tissue until it shows no more cancer, then we’ll do the reconstruction afterwards.” As Mohs-trained surgeons do their own pathology in their own labs, everything happens fast. “Be here at 7 a.m. next Monday,” he directs.

“Will it set me back to wait a week?”

“No, but why?”

“I’m going spring turkey hunting with some friends next Monday,” I tell him. “I need this.”

 Cottel rubs his forehead and chuckles. “You’re the one with cancer and the hole in your arm; another week won’t matter.”

In the Wild

Only my good friend Steve, among the other hunters and friends I meet in Paris, Texas, knows that I have a gaping hole, swathed in gauze, in my shooting arm. I have sworn him to silence.

Life breathes and pulses around me with each step; the flight of a red-tailed hawk, the mockingbird’s chatter somehow more vivid. A gobble clatters through the woods. I hunt with total concentration but never touch my trigger. Cattle laze in the shaded meadows as we slink through vivid pastoral lands where Davy Crockett first entered Texas. I drink up the landscape and let it engulf me. My mind explodes with thoughts of my children, whom I feed and nurture, and my senses flood with the wild world that feeds and nurtures me.

The land restores my spirit; I am ready to face skin cancer surgery.

The Surgery

In the Mohs surgery, Cottel excises a large circle around the original offending spot that looks to me as large as a coaster. He immediately takes it into his own pathology lab.

I lie on the table, numbed with only local anesthesia, waiting. The smell from his cauterizing tool reminds me of branding cattle, but it’s my own seared flesh I smell. Fear engulfs me.

“We got it all,” he says, smiling like a double-wide, when he re-enters from the lab.

The reconstruction of my upper arm goes well, especially considering the folks I had seen with parts of noses and ears gone. Cottel cuts a 7-inch crescent swath above and below the gaping circular excision and pulls the skin together. I watch as he slices my flesh away and drops it into a receptacle. With dozens of stitches, he sends me out the door, with instructions for immediate care. He says to return every six months for the rest of my days.

I will.

Susan L. Ebert is an outdoorswoman and associate publisher of Western & English Today.