When I found out I had skin cancer at 22, it changed how I looked at myself

The scar is thick, pink, and prominent. It stands out — literally. It is a raised scar, larger than the original wound — a keloid scar, the doctors call it, as they remind me I can undergo surgery at any time if I want to “fix” it (I don’t). I love to run my fingertips along it, feel the ridges where the stitches were, feel the smooth not-quite-softness. The reminder of what happened and what is yet to come.

I love making people guess how I got the scar, because they never get it right. Sometimes I want to lie when they ask for the real story. Their versions (motorcycle accident, shark bite, alien parasite embedded under my skin) are always more creative and exciting than the truth. When I tell people the scar’s actual origin, I have to watch their faces fall. I have to accept their pity, concern, even fear — because the scar didn’t come from something outside of me. It came from inside. From cancer.

Melanoma, to be specific. Stage IIA, which means it had extended just a bit further than two millimeters below my skin. As Texas Oncology explains, my cancer “had spread to the lower part of the inner layer of skin (dermis), but not into the tissue below the dermis or into nearby lymph nodes.” That last part is important — if the cancer had spread to my lymph node, it would have reached Stage III or IV. I would have had to undergo chemotherapy. My survival chances would have dropped from 67% to as low as 10%.

But I was very lucky. When she visited me in the summer of 2014, my mom took one clear-eyed look at the mole on my arm and told me to see a dermatologist. Thanks to her and to my doctors, we caught the cancer early. It hadn’t yet spread. I was going to be okay.

The doctors confirmed this by performing a sentinel node biopsy. The sentinel node is the lymph node closest to the spot where the cancer was detected — in my case, the lymph node in my right armpit. Previously I thought that lymph nodes only existed on each side of the throat, where they swelled uncomfortably whenever I had a cold. But it turns out we have lymph nodes all over, working to keep us healthy but vulnerable to any cancer cells that might make their way up and down the rivers of the body. A lymph node is a sort of hub — if cancer makes it there, it’s about to make it to the rest of the body, too.

To make sure this hadn’t happened to me, the doctors removed a thin slice of the lymph node in my armpit at the same time they removed the cancer in my arm. But first, nurses “stained” the node so the doctors could see if any cancer had spread to it. They did this by injecting ink directly into the lymph node, by way of an enormous needle. For reasons I still don’t fully understand, this had to happen without anesthesia. Laying back on the hospital bed, I squeezed my hands into fists, digging my nails into my palms. I didn’t make a sound as pain roared through me.

“Wow,” one of the nurses said, after she removed the needle. “You handled that really well.”

“Really?” I said, blinking back tears.

She nodded. “A lot of people scream.”

I gave out one harsh, short laugh, flooded briefly with pride and a sense of superiority over all those other, “weaker” cancer patients.

Then, I felt terrible again.

There are a lot of ways I talk about my cancer, both to strangers and loved ones. All of them make up only part of the truth. I’m so lucky, I am, because they caught it super early and my parents’ insurance paid for almost everything. I didn’t even have to do chemo, and I got a badass scar out of it. Just before and after the surgery, I refused to even discuss the issue by its real name; instead, I said the word “Melanoma” with the tune and emphasis of the Muppets song “Manamana”: “muh-LA-nuh-muh, do-doo doo-do-doo.” With friends from home I joke with political self-deprecation that skin cancer was just the natural consequence of growing up as a white person, a haole, in sunny Hawai’i, a place where people like me were never meant to settle like we did, anyway.

It’s a joke, an inconvenience, a cute song, and one tiny consequence among many huge injustices resulting from the American overthrow and annexation of the Kingdom of Hawai’i. These are all valid ways to talk about my cancer.

But there is another truth I rarely voice: I fear my body, now.

I got cancer at 22 years old.  My instinct is so strong it feels like fact: It’s going to come back.

Melanoma is the result of cumulative, irreversible damage done to the skin by UV rays — AKA, the sunlight that blessed my childhood in Hawai’i. Somehow, despite my parents constantly reminding me to use sunscreen, despite the hats and sunshirts and indoor kid tendencies — somehow, in just 22 years, my skin endured enough damage to turn cancerous. As my life continues, my body will only see more sun. The damage will only grow. And I have this fear that the cancer will come back.

Here again the I’m so lucky mantra kicks in: after all, knowing my risks means I can stay vigilant and catch it early if it does. I can be informed, aware, vigilant. Melanoma is one of the deadliest cancers once it spreads, but if you catch it early it’s among the most treatable. The doctors can literally scoop it out of you: it’s only skin-deep.

I am no stranger to dermatologists. Back in middle school, before I ever understood that I could get cancer (although my father, uncle, and great-grandmother had all battled it), I hated my skin for different reasons. I always had at least one swollen, painful zit that just wouldn’t pop, and my nose was so red that classmates nicknamed me Rudolph.  I obsessed over — and hated — my appearance every time I passed a reflective surface.  

Seeing how upset I was over my acne, my mother and grandmother decided to take me to a dermatologist. I didn’t tell them this at the time, but going to the “zit doctor,” as I mentally called him, made everything so much worse. The visits were painful; they involved needles and liquid nitrogen and they never seemed to improve anything. This is how ugly I am, I thought, a doctor has to treat me for it.

Back then, I thought that chronic breakouts were the worst thing that the outer surface of my body could do to me. But now “bad skin” has a more sinister meaning.

In bed, in the shower, in front of mirrors, I examine every part of my body I can see. Shortly after the surgery that saved me and gave me the scar, I thought I saw something. I was soaping my legs in the shower when something dark red and angry-looking revealed itself just past the curve of my calf. Its sudden appearance frightened me so badly I nearly fell, and as I threw out my hands to catch myself, the thing disappeared.

It had only been my fingertip, turned unfamiliar by the heat of the water and my fresh fear.

I am still afraid. Any freckle or mole that looks a bit too dark or asymmetrical, too big or too different, could mark a recurrence of cancer. I run my fingertips over my skin to feel for bumps; melanoma can sometimes manifest without color, burrowing invisible and deep. Whenever I find a suspicious spot, I circle it with a ballpoint pen and take a picture, saving it on my phone so I remember to ask the doctor about it.

This obsessive examination of my own body feels like middle school again, except this time it’s necessary. It is, ostensibly, a healthy thing to do.  

It does not feel healthy.

I love my scar. I do. The texture, the stories it helps me collect, the way its color changes with the temperature and my heart rate, ranging from the same soft pink as the inside of my lips to an angry stand-out red. It’s a physical reminder of what I’ve survived. And it’s an odd comfort — my scar is the one place the cancer won’t come back. The one patch of skin that has already been through the worst and come out okay — better, even, because it looks pretty damn cool.

After years of working to accept and celebrate my body, my scar is the only part of my appearance that is easy for me to love.

The rest of my skin scares me. Where will the next scar be? Will I be lucky enough to get away with surgery again, or will I have to undergo chemotherapy? Sometimes I get melodramatic. Sometimes I feel certain that I’ll die before I reach 50. That something inside me will eat me up, take me from my life and my family far too early.

I was 22 when it came, and I’m nearly 24 now. I go out at night sometimes, and if it’s warm, I wear short sleeves. Boys run their hands up my arm and stop when they feel it. I’ve learned to tilt my head, eyes half-lidded, and tell them with a smile to guess how I got it. It’s a game. It’s a test. Sometimes I allow myself a joke at their expense, and let these boys (I never do this to the girls I meet) think that their guess is right.

And I am easily seduced by my own lie. It’s easy, it’s funny, we’re young and yeah, something bad happened and it left a strange mark — but now it’s over. It’s done.

The next morning, though, I always put on my sunscreen. Daylight demands that I be honest, and watchful. If I am lucky, this will buy me some time. A whole lifetime, I hope. If I am lucky, given enough time these fears of mine may even fade.

But for now, after working so long against hating my own skin, I need to be scared of it. For now, that’s what keeps me vigilant. That’s what keeps me alive.

Natalie Thielen Helper was born and raised in Hawaii, and currently lives and writes in Washington, D.C. You can find her on Twitter as @fruitbatalie, where she talks mostly about dogs.