Following her pastor’s suggestion to visit the dermatologist 8 years ago was the spot-on decision that saved Barbarella Grady from skin cancer complications.

 

Working with the Houston Health Department for 17 years as an immunization senior data entry operator, Barbarella Grady promotes the importance of immunization and makes sure Houstonians update and keep records of their vaccines. Even though she‘s an advocate for the community and their well-being, her personal experience with cancer brought home the importance of disease prevention and detection in her own well-being. 

When it comes to our health it’s easy to leave things for later. Between children, parents, partners, busy jobs, housekeeping, and other day-to-day tasks, adding a doctor’s visit on top of all might be overwhelming. 

One day Grady noticed a pimple close to her nostril. Not thinking much of it, she washed her hands, applied warm water, and alcohol, and proceeded to pop it. Later it turned into a scab and eventually something that was “just there, didn't bother, and didn’t need attention; it was there for a couple of years, and it didn’t bother me.” she said.  

Years later, in 2016, conversing with her pastor and cousin, he asked her about it and suggested getting it looked at, just to be safe. A suggestion that Grady, being a person of faith took as a signal from God: “That was a signal to me, a word from God to get it checked … I think that was my warning,” she said. Not long after, she booked an appointment with the dermatologist. 

It didn’t take a meticulous examination for the specialist to know what was happening and give a diagnosis: “You have cancer,” he said. Shocked and not thinking straight, the first thing that came to her mind apart from chemo and radiation was her appearance, thinking she would have a scar on her face forever. “I was scared because it was in my face, above my upper lip,” she said "I just had all these different thoughts running through my head.”  

The dermatologist noticed her reaction and calmed her down, he told her they would need to send a sample to the lab to confirm the diagnosis, get more details, and determine how to move forward. 

Moles, brown spots, and growths are natural and can be harmless – especially if they are birthmarks – the ones that appear over time are ones to be more careful with particularly if they change.  When doing a self-examination look for new, changing and unusual spots. 

Early detection makes a difference  

Finding melanoma at an early stage increases the chances of being cured, 99% of patients in the U.S. whose melanoma is detected early have a 5-year survival rate, a 74% survival rate when the disease reaches the lymph nodes, and 35% if it spreads to the organs. 

Noticing changes is the most important part of early detection. An easy way to remember common characteristics of melanoma is by following the ABCDEs for skin cancer: 

ABCDEs for skin cancer 

A is for Asymmetry. Most melanomas are asymmetrical. If you draw a line through the middle of the lesion, the two halves don’t match, so it looks different from a round to oval and symmetrical common mole. 

B is for Border. Melanoma borders tend to be uneven and may have scalloped or notched edges. Common moles tend to have smoother, more even borders. 

C is for Color. Multiple colors are a warning sign. While benign moles are usually a single shade of brown, a melanoma may have different shades of brown, tan or black. As it grows, the colors red, white or blue may also appear. 

D is for Diameter or Dark. While it’s ideal to detect a melanoma when it is small, it’s a warning sign if a lesion is the size of a pencil eraser (about 6 mm, or ¼ inch in diameter) or larger. Some experts say it is important to look for any lesion, no matter what size, that is darker than others. Rare, amelanotic melanomas are colorless. 

E is for Evolving. Any change in size, shape, color or elevation of a spot on your skin, or any new symptom in it, such as bleeding, itching or crusting, may be a warning sign of melanoma. 

Credit: The Skin Cancer Foundation 

Diagnosis and procedure 

01A few days after her doctor’s visit, Grady received an official diagnosis: malignant basaloid sclerosing epithelial neoplasm, also known as basal cell carcinoma or BCC,  a nonmelanocytic skin cancer that arises from the basal cells of the epidermis. BCC is a slow-growing malignancy usually caused by long-term exposure to ultraviolet light from the sun. 

The doctor inquired about her family history to assess if her cancer was genetic, but that wasn't the case, in fact, she only knew little to nothing about skin cancer. “Skin cancer is not something we really hear about, it is more about the other cancers,” she said. “People don’t think it's serious.” 

Grady – 41 years old at the time – following the doctor’s inquiries about family, habits, and sun exposure, couldn't think of a particular situation that may have put her at risk in the last few years.  Thinking back, she remembered her high school senior year when she was 18 years old while in a pre-military school, most of the projects she collaborated on took place outdoors with direct exposure to the sun for continuous hours. She also remembers having a heat rash and having to go to the emergency room during that same year.  

The most common cause of skin cancer is exposure to the sun, and it can happen due to long-term exposure and short but intense periods. The ultraviolet light in sunlight damages the DNA in the skin cells. For women, melanoma usually appears on the legs, while for men, is more common to develop on the trunk area. But this doesn't mean other areas of the body are exempt, melanoma can arise even in sun-protected areas, and the damage may even happen years before cancer develops. 

For Grady, the melanoma was detected at an early stage and no chemo or radiation would be necessary, a Mohs surgery would be the most effective. He also told her that the surgeons would do their best not to leave a scar but that was a possibility. 

Mohs is the common procedure for BBC type of skin cancer, the surgery consists of cutting thin layers of skin, and each layer is looked at closely for signs of cancer – a process that keeps going through the layers until there are no signs of cancer. "No one wants to hear you have cancer, no matter how big or small it is - no one wants to hear that," she said. Concerned by her appearance after surgery but focused on her health and overall well-being she felt lucky and blessed for not having to take chemo, “I took a deep breath and thanked God!” she said. 

02To this day, 8 years after the procedure, Grady still remembers the pain from the anesthesia injections as the worst part of it all. During Mohs surgery, patients receive local anesthesia around the tumor area and are awake during the entire procedure.  

Once the surgeons were done, they sent the tissue to the lab for tests, and within the hour the doctors came back with bad news, they found signs of cancer in the tissue, and had to perform surgery again – this also meant another anesthesia injection. After the second time, the lab tests confirmed there were no more signs of cancer, they stitched her up and gave her instructions to ensure a safe recovery and a fast-healing scar.  

Following all the recommendations, Grady’s scar is only noticeable when she points it out. “As you can tell, no scar! Every once in a while I can feel a little numbness.” She said. 

Conscious and aware 

03After her close experience with cancer, she became more conscious about her overall health. "I use sunblock as a lotion every day.”  

She said and added that she wants to bring more awareness to skin cancer for everyone, especially her daughter, to understand the effects of UV light on our skin and how easily and often we are exposed. “If you're going in the sun, it doesn't matter your skin color, protect your skin,” she said. 

“This is about sharing and awareness, anything could have happened, and this could have gone a totally different direction, but I have a reason to smile every day!” said Grady. 

Apart from working at the Health Department, Grady has published three books: “Perfect Timing,” a compilation of simple daily prayers; "Numbers, Sizes, Colors, and Shapes Learning and Activity Book," educational book for children; and "Emotions Within," poems inspired by feelings of love, hope, peace, faith, and the release of internal hurts. She also participates in Black History Month at HHD where she recites her poetry.