Lisa Pace sat next to a projector screen in a conference room in a New York City hotel. She was introduced to the crowd as having 76 cases of skin cancer. “Actually,” she said, stepping to the front of the room. “It’s 77. I just got the results of another biopsy.
“Pace is fair skinned but not pale. A Division I basketball coach at Long Island University Brooklyn, she spends most of her working days indoors, out of the sun. She is healthy, active and wears sunscreen every single day. Yet, at 37, she has had skin cancer so many times it’s hard for most people to fathom.She traces it back to one thing: indoor tanning. And though she stopped years ago, she’ll have to deal with a drastically increased risk of cancer for the rest of her life.
“It scares me more now that I’ve been educated and know what this is and what to do,” she explained. “And it scares me for people who don’t know what they’re supposed to do and don’t get checked [for skin cancer].”
“It was the thing to do.”
Pace grew up in the small town of Hunstville, Tennessee. Like most kids, she played outside a lot, shooting hoops, swimming and looking for buried treasure. She got the occasional sunburn, which she’d soothe with an aloe plant in her family’s home, but she wasn’t especially sensitive to the sun. She ended each summer with a spattering of freckles on her arms. Her mother affectionally called them angel kisses, but Pace hated them and once tried to scrub them off with an SOS pad, leaving her skin bloody and raw.
In 1994 she went off to college at Eastern Kentucky University. Looking around campus she realized there were very few people who had been so liberally kissed by angels. She saw a lot of really tan women — and signs everywhere for tanning salons.
“I was away from home for the first time and tanning was a way to fit in,” she recalls. “I didn’t want anyone to make fun of me or say, ‘you’re glowing in the dark.’ It was the thing to do and I didn’t want to be left out.” So she followed the signs that lined the main road on campus and gave tanning a try.
“The first couple times I went I got burned,” Pace says. Rather than start off with a short session to test her tolerance, “I just went for it and stayed in for 30 minutes. I got burned so bad I couldn’t put my clothes on. It was awful.”She waited until the burn healed, then went back. She visited different salons, learning which beds were stronger, which were weaker and what her skin’s tolerance was. Eventually she figured out the formula that would leave her just dark enough to look like she was always just back from the beach. By the end of first semester she was going once a week, then every three days. “Once I built up the tan I never let myself get too far away from having color. There were points where I was going every single day to keep the exact color I wanted,” she says.
She stuck to her routine throughout her four years at Eastern Kentucky, going between classes and taking advantage of special promotions for Homecoming week to keep the cost down. She was addicted, and lost sight of what her skin was supposed to look like. “I was too dark,” she said simply.
So dark, in fact, that when senior pictures rolled around she used makeup to tone down the color of her skin. In her photo she was tan everywhere but her face, which glowed white by comparison.
A wakeup call unanswered
She continued tanning after graduation and through her graduate studies. In 2000 she got her first job, as a basketball coach at Southeast Missouri State. Her mother urged her to take advantage of the health insurance benefits of the position and see as many doctors as she could get appointments with. She went to a dermatologist, who found two suspicious spots on her right leg and took biopsies.
Pace thought nothing of it, asked no questions, and left the office. Soon after, she traveled to Las Vegas on a recruiting trip. She was in her hotel room, about to go to dinner, when she got a call on her cell phone. The biopsies were both positive; she had to come back and schedule surgery.
But she didn’t: “I didn’t know what that meant. My idea of skin cancer was some little flaky place on your skin and they would put some cream on it and it would come off. I thought, ‘I’m not leaving Las Vegas. It’s my first time here and I’m coaching and having a great time.’ I didn’t call until a couple days after I got back.
“When she finally called, the doctor told her it was melanoma and referred her to a specialist in St. Louis, who was unable to confirm the diagnosis (the results were inconclusive), but immediately scheduled her for surgery. What looked like two small spots the size of pencil erasers — one white, one reddish — required excising significant chunks of skin and muscle from her thigh and calf, leaving deep gashes, and scars that measured nearly three inches across. Pace left the hospital bandaged and unable to walk without crutches for a week.
“You’d have thought it would have been a wakeup call for me,” she says. But it wasn’t. She continued tanning on ocassion. “I still had it in my head that I had to be dark. I thought it was the normal thing to do.” She calls it “the dumbest thing I’ve ever done.”
It wasn’t until her third instance of skin cancer that the danger truly hit home. There was a small white spot in the center of her left cheek, half the size of the ones she’d had removed from her leg not long before. “When they took it out, they took a chunk out of my cheek. It was very emotional because it was on my face and I coach in front of people all the time,” she recalled. “I remember thinking, ‘This is real life, this is scary, this is cancer.’
“The humiliation of walking out of the doctor’s office with a huge bandage on her face underscored how scared Pace suddenly was. She recalls feeling like everyone was looking at her, remembers being too embarrassed to get out of the car, having to change the bandage every few days and later being unable to cover the wound with makeup. “It was red, very noticeable, a little longer than my finger. It seemed like it would never heal.”
It did. But it left a scar. In more ways than one.
A never-ending story
After that, Pace began seeing a dermatologist every three to six months. Each time she moved to a new city, she quickly found a doctor. And each doctor found more cases of skin cancer. By the time she came to New York in the summer of 2010, less than 10 years after her first diagnosis, she had undergone surgery 44 times. The majority were for basal cell carcinoma, the most common type of skin cancer in light-skinned people. Five were melanoma, the most dangerous form of skin cancer, which kills over 9,700 people in the United States each year.
Most of Pace’s cancers have been on her torso, an area rarely exposed to the sun. Whereas skin cancer used to appear most frequently on the legs, in the last few decades, the torso has become the most common site for melanoma for women ages 15 to 20. This is most likely due to the increasing popularity of indoor tanning among young women. Of the 30 million people who go to tanning salons, 70 percent are between the ages of 16 and 19. Forty-three percent of college students today use tanning beds, which emit UV radiation 15 times stronger than the sun. Between 2000 and 2009, the incidence of melanoma among women has increased 400 percent. There are now more cases of skin cancer from indoor tanning than cases of lung cancer from smoking.
Arielle Kauvar is Pace’s dermatologist in New York. She has been doing Mohs surgery, the gold standard for skin cancer excision, for 21 years. “In the first 10 years, the average age of my patients was 60 to 70,” she says. “Now, every day that I have performed Mohs, I see at least one person in their 30s, sometimes more.
“She has also had a half dozen patients like Lisa who have had an extraordinary number of skin cancers. It’s not as unusual as you’d think.
Does having cancer so many times make you an expert on spotting it? Hardly. “In some cases it can be extremely subtle, like a little red spot,” Kauvar explains. “So for people who are susceptible, it’s very important to get your skin checked regularly by a dermatologist. It’s hard for a patient to tell what’s OK and what’s not.”
In fact, just a few years ago, Pace had a basal cell carcinoma on her nose and didn’t realize it. No bigger than the tip of a pen, the lesion would go away and come back, and Pace just thought she was breaking out. “I had had over 60 when this one happened,” she says. “If anyone should have known it should have been me, and I didn’t. I just thought it was a pimple.”
Nor does a long history with cancer make it any less frightening. Pace said, “I’m such a positive person and I try to surround myself with positive people, but it’s hard because you wake up and take a shower and get out and you’re looking for something new. Now I’m looking at all these scars. They’re everywhere. I can’t avoid them. Even when I’m looking for new places, I’m reminded of what was taken off.”