Having a little work done, thanks to the sun

Over Christmas, I had a photodynamic therapy treatment (Levulan) on my face, as a preventative treatment for skin cancer. I had already had a basal cell cancer removed, and my dermatologist recommended this treatment, because of a proliferation of facial "sun spots" (actinic keratoses or AKs) that kept flaking, especially evident on my nose.

He thought it was a good idea given my age and history. All those years of sunbathing on dorm roofs with those tinfoil reflectors? Hah, not so smart! Though I had converted to sunscreen and shade by my thirties, my misspent youth on beach blankets had caught up with me.

The treatment is administered in an office by his nurse. I'd read accounts, and was prepared. I spent two hours with my face coated with goo, then exposed to hot, UV light. By the time I left, the skin was tender and tight but not painful. Unlike my university days, they didn't blast the Dead on their radio.

I rode the subway home covered like a bank robber, a slit of eye showing between my muffler and hat. A mother checked me out, grabbed her kids and held them close.

By nightfall, my face bloomed into a moderately severe "sunburn", with discomfort well-managed by Advil and vodka. Kidding, but would have been nice.

Post-procedure protocol requires 40 to 48 hours in a dim room to promote the effectiveness. Because the light reveals patches below the surface, you can see where formerly hidden sunspots lurk, rather like an archaeological dig down to decades past. The next morning, I took this shot:

See the tip of my nose? That's where the most obvious damage was, but the treatment also raised welts on my forehead and even ears.

Patients are told to expect redness and peeling for up to a month; nearly all of mine was gone within two weeks. Some women cover it with makeup, but I thought that looked worse.

At three weeks:

There's just the faintest tinge of pink at the tip of my nose, and the flaking, persistent AK is gone. The last step is a forty-night application of Aldara cream.

Some patient testimonials claimed the treatment faded their age spots, but I wasn't that lucky. However, I had it not for aesthetics, but to prevent the two most common forms of non-melanoma skin cancer, basal cell and squamous cell.

AKs are also treated with topical creams, cryosurgery (liquid nitrogen), peels, lasers and other methods; see this list. If you are discovering spots that have AK characteristics, talk to your doctor. Those scaly patches are now considered part of the skin cancer spectrum.

Some persons repeat the therapy, but since it is not covered by insurance, I hope this is the only one I need. Cost in Canadian dollars was $650.

I learned that fair-skinned persons who don't tan easily are more at risk. I wish that, back when I wore a bikini, instead of slathering on more iodine and baby oil and turning over for another hour to Let The Sun Shine In, I'd just resigned myself to being A Whiter Shade of Pale.


Bonjour la Duchesse,

I've seen people look far more ruddy than you did from exposure to the cold. Wonder why that isn't covered by public healthcare? I do have a friend who has had several tiny cancerous or pre-cancerous spots removed, but he is considerably older than either of us (80) and all the treatment he had has been covered.

I do tan easily, but I'm happy now that I've never been a sun-worshipper and preferred to hide under a tree with a book.
une femme said…
Duchesse, is that treatment considered a version of "photo laser" or IPL? I've had IPL done to fade the large pigmented lesion on my cheek (what grandma used to call "liver spots") but my derm spray freezes the AK's that pop up occasionally on my back and shoulders (where I rarely had much sun exposure, even in my misspent youth). The IPL I've had seems a little less aggressive your treatment; redness for just a few hours then the sun damage and other lesions darken and flake off in 1-2 weeks.
LauraH said…
I've had those little scaly bumps on my face for the past few years and have been getting them treated with liquid nitrogen....so far. Thanks for sharing the treatment you had, it's something to add to the list of possible solutions. I too have very fair skin and feel rather apprehensive about the sun burns I had as a child. Funny, isn't it, that we know so much more now yet people are still out there tanning....go figure.
Janice Riggs said…
Thanks for sharing, so candidly, your experience with this treatment. I wasn't at all familiar with this, and now am going to discuss with my dermatologist. You're always a source of interesting, thought-provoking, and useful information - one of the best blogs I read!
big hugs,
Duchesse said…
lagatta: I was as red as a cold-weather outing but with considerably more discomfort (short of the pain of frostbite!) and this lasted for days.

une femme: As I am not familiar with IPL can't say. (A click on Levluan link may provide the info.) But, it did not do a thing for my age spots.

LauraH: I also had one treated with liquid nitrogen, but he wanted to reach the ones that are not on the skin's surface; this treatment does that.

Janice: Thank you; it is one of an arsenel of treatments. I read that about one in five persons over 50 has at least one AK, often many more.

Leslie Milligan said…
I agree with Janice. Your posts are always so interesting and I look forward to them each Tuesday and Thursday. You recovered beautifully from the procedure and I hope it does what is intended - no more cancerous skin cells. Despite being a whiter shade of pale, for a few days you were definitely a 'woman of color'.
SewingLibrarian said…
Your skin looks really good in the second photograph. And you must have peace of mind knowing you have done what you can to prevent skin cancer.
Duchesse said…
Leslie: Thanks so much. The tomato colour tok me back to the time of some sever sunburns which, on the whole, •I induced• Mostly I feel foolish.

Sewing: I've had "quiet" skin all my life and it is only now, past 65, that I've required a dermatologist. When I said so, Dr. C. laughed and said, "Well, it's like an old house...they need maintenance eventually."

Duchesse said…
Leslie: Apparently I've also lost the ability to type- sorry, and I hope you can decode that.
Leslie Milligan said…
Yes, madame, I got it. If that's the only thing from your youth that makes you feel foolish...
No need to answer that.
Julie said…
Thanks for being so candid. I've had a pre-cancerous removed by surgery. That was several years ago and methods have advanced and had some later spots removed with laser. Methods are certainly advancing. Reading a blog like yours will encourage other women not to hesitate because of the side effects.

I too have to admit that these were likely the results of sunbathing. I never did much but did try for a few years to get that elusive tan. Now I won't leave home without the sunscreen.

Based on all those browned-up folks, dermatologists will never be out of work.
Mardel said…
Thank you for this interesting and candid post. I agree that your skin looks really good in the second photograph. I was never a hard-core sunbather, but I spent more time than I should have pursuing the illusive tan. Luckily I came my senses in my mid to late 20's, but I am sure there is damage lurking, and it will catch up with me one of these days.
It is wonderful what they can do for our skin conditions with the technology these days...too bad we have to pay so much for the treatments.
Your skin looks very fresh and youthful and if the precancerous cells have been removed that is the best news.

I have had a similar treatment but it was for rosacea... the skin is red for a bit but the results are worth it. The advice that I have been given is that exposure to the sun is forbidden and I have been advised to wear sunscreen every day even in winter.
My mineral make up has an SPF of 30...you might have been similarly advised.
Thank you for keeping us informed Duchesse.

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