Carol Helton has been doing hair for 38 years.
Tuesday through Saturday, you can find her in her Orangeburg salon, chatting up customers, clipping hair and sharing her thoughts about what the South Carolina Gamecocks are doing.
Lately, though, she's been talking about something else: melanoma.
"I've been talking to my clients, saying, 'You need to go get that checked out,'" she said. "They say I'm scared. I said, 'You're talking to the queen of scared crapless.' I put it off for years. My dad had melanoma. My brother had melanoma. My dad died from letting it go."
Helton was diagnosed with melanoma after she went to see a doctor about a lifelong mole that had started changing. After surgery, she's been declared cancer-free. Now, she wants to make sure that others don't ignore suspicious moles or spots.
"Maybe God is using me as a vessel to look at people and say, 'You need to get that checked,'" she said.
The ABCDEs of melanoma
As a hair stylist, Helton is perfectly placed to look out for melanoma. Dermatologists recommend that, in addition to full-body checks by a doctor, people ask their hair stylists, barbers or massage therapists to look for unusual moles in all those places that they can't see themselves.
The ABCDEs help to identify what is suspicious:
- A – Asymmetry. A mole whose two halves look different.
- B – Border. An irregular or poorly defined border that "fades" into the surrounding skin.
- C – Color. A mole that is a lighter or darker color than most of the other moles on your body or has different colors within itself.
- D – Diameter. A mole that is larger than 6 millimeters – about the size of a pencil eraser.
- E – Evolving. A mole that is changing in size, shape or color.
Helton's mole fit the definition of evolving. It was on her arm and had been there all her life. But then it started changing.
"It got bigger – rose up over the surface. And it started oozing," she said.
Helton went to a local dermatologist, who performed a biopsy but told her he was sure it wasn't cancer.
"Two days later, I get a phone call from Hollings Cancer Center saying, 'Mrs. Helton, we've got to talk to you quickly because you have a significant malignant melanoma,'" she recalled. "Of course, I about fell out."
A plan and goals for surgery
Helton's first contact at MUSC Hollings Cancer Center was with Jeffrey Sutton, M.D., a surgeon who specializes in several types of cancer, including melanoma.
By the time most patients see him, the suspicious moles have usually been removed by Dermatology. Sutton will then examine the residual scar and surrounding skin in that area to determine whether it's likely that cancer cells remain.
"I'm looking at what's left over," he explained. "In addition to the biopsy scar, is there any residual pigmentation where the mole used to be? Are there speckles of pigmentation surrounding it that may suggest tumor spread?"
Because patients have just learned that they have a cancer diagnosis, they're often emotional and on edge. Helton said the few days between that phone call and her first visit with Sutton were overwhelming.
"The emotions were all over the place. How is this possible when I just got told that it wasn't cancer?" she said, referring to the first doctor's assurance. "All I can say is I just prayed about it. I let go, and I let God. Because the more you think about it, the devil can win. And he was winning those few days, I promise you!"
"I said, 'My goals are I want to live life to the fullest, and I want to see my grandchildren grow old. And Dr. Sutton came over, and he patted me on the leg, and he said, 'We've got this.'"Carol Helton
She found Sutton to be a calming, reassuring presence. He told her that she would need surgery, and that he would use a technique called sentinel lymph node biopsy to trace the probable path of any cancer cells that may have traveled away from the original site. This technique would enable him to remove only those lymph nodes most likely to have cancer cells, for additional testing.
"Dr. Sutton explained everything thoroughly. He made you feel at peace," she said.
But there was one thing that threw her off.
"He asked, 'What are your goals? What do you think, Mrs. Helton?'" she recalled. "I said, 'I don't know; y'all are the doctors!' And my daughter said, 'Don't ask me, Mama. I don't know.' Even though she's a nurse, she said, 'This has got to be your call.'"
After thinking for a moment, Helton had her answer.
"I said, 'My goals are I want to live life to the fullest, and I want to see my grandchildren grow old,'" she said. "And Dr. Sutton came over, and he patted me on the leg, and he said, 'We've got this.'"
A clinical trial
As part of her treatment course, Helton also enrolled in a clinical trial. Clinical trials give doctors information about the best way to treat patients. In this case, Helton's melanoma fell into a gray area, and the clinical trial, called MelMarT-II, seeks to answer the question of how much margin of extra skin should be removed at the time of melanoma surgery. This ultimately determines how large the final incision will be.
For melanomas that have grown less than 1 millimeter deep into the skin, surgeons cut out a 1-centimeter radius around the tumor site to ensure all of the tumor is removed.
For melanomas that have grown 2 millimeters or more deep, they cut a 2-centimeter radius.
But there's no standard recommended margin for melanomas in that in-between zone of more than 1 millimeter but less than 2 millimeters deep. This trial is testing whether people who get a smaller incision fare just as well as people with larger incisions but with fewer side effects.
Sutton pointed out that whether a patient gets the 1-centimeter radius or the 2-centimeter radius incision, the final cut will end up being quite a bit bigger. That's because a circle can't be closed up neatly. Instead, surgeons turn the circle into an ellipse – rather like a football shape – so that they can pull the skin back together and neatly sew it up. The resulting scar, though, can be several inches.
"One of the downsides to taking larger margins is – especially on an area of the body like the shin that doesn't have a lot of extra skin or on an aesthetically sensitive area like the face or the upper chest – the larger margin you have to take, the more skin you have to take," Sutton said. "The larger the incision becomes, the less likely you are for a primary closure. Oftentimes that increases the need for additional surgical procedures like a skin graft, rotational flap or even plastic surgery in order to close the surgical wound."
In this trial, patients with intermediate and deep melanomas are randomly assigned to receive either the larger or smaller margin at the time of surgery. Helton was part of the group getting the smaller incision.
"So we were able to spare a lot of her skin, resulting in a smaller incision, quicker healing and less morbidity," Sutton said.
Of course, "smaller" is relative. The surgery still left quite a scar.
"Today's my first day wearing a short-sleeved T-shirt, and I'm OK with it," Helton said back in February. "I've got a scar, and I'm proud of that scar."
Back to work
Helton took two weeks off after surgery, then returned to her salon. She surprised herself by not needing any of the prescription pain pills, though she did use Tylenol and Advil.
Now, she's an extra pair of eyes on the lookout for suspicious moles. That's important, Sutton said, because, even though sun exposure over many decades is one of the main risk factors for melanoma, melanomas can also develop in places that don't get sun exposure. They can also happen even without decades of sun exposure – for example, he's treated some 17-year-olds with melanoma.
He also wants everyone to get regular full-body skin checks.
"The full body skin exam, to me, is analogous to the screening mammogram looking for breast cancer or the colonoscopy to screen for colon cancer," he said. "If you find these lesions early, they're very treatable and curable."
