We are getting ready to head North. It would normally take us 10 days to sail from St. Thomas to the Chesapeake Bay, but the weather pattern right now is unsettled, with lows spinning off Florida right across our path, so we will probably take it slower and more carefully than normal.

A CLOSE CALL - A CAUTIONARY TALE

In the past few weeks, we have had a very close call. Not, as you might immediately assume, with the boat. This is Beth's story, so she's going to tell it.

Three weeks ago, my sister, Leigh, and brother-in-law, Steve, joined us for a week of cruising around the US Virgin Islands. Leigh and Steve are sailors too, though they normally sail a somewhat smaller boat. In fact, they are the 2008 national champions in the Inland 20 scow, a 20-foot, keel-less, planing dinghy that they sail on the inland lakes of the Midwest. We love having such accomplished sailors on the boat. Not only do they get us out sailing, but they help us sail the boat better than we normally would. And they do all the work! Our week included a movie on the beach under the stars, an upwind sail in 30 knots of wind, hours spent chatting and catching up, and, for Leigh and Steve, lots of snorkeling and lots of relaxation.

While my sister was visiting, I asked her advice on something that had been bothering me. When we reached St. Helena in December and started wearing shorts for the first time in more than a year, a small mole on the outside of my left calf started changing. The mole was about half the diameter of a pencil eraser and the color of a dark tan with a slight thickness and texture to it. I had first noticed it the year before when cruising Mexico, Costa Rica and the Gambiers, and it looked no different than a dozen other small, brown moles on different parts of my body. While we were in St. Helena a small area of skin on one side of the mole took on a strawberry color, as if the mole were leaking red. The area was no more than a thin border along one edge of the mole and the skin felt the same with no thickness or texture. It seemed benign, but it bothered me. I didn't like looking at it, didn't like how the color seemed to flare when I sat out in the sun. The mole gave me the willies, which seemed downright silly.

Between St. Helena and Antigua, the colored area of skin advanced out from one side of the mole until it was almost the same diameter as the mole. When we got to Antigua, I looked up how to diagnose melanoma on the Internet and discovered the ABCDE of melanoma identification. Melanoma moles tend to be asymmetrical, with irregular borders (blurred or scalloped). They are usually more than one color with a diameter greater than a pencil eraser and evolve over time. For more details and pictures of melanomas, go to http://www.mayoclinic.com/health/melanoma/DS00439/DSECTION=symptoms.

My mole was not asymmetrical, though by the time we reached Antigua it was oval in shape instead of round as it had been the previous year. It had a clear border between it and the surrounding skin. The only slight scalloping in the border occurred where the brown mole joined the redder lesion. It definitely did consist of two slightly different colors, though once we got to Antigua and were not in the sun as much as we had been on passage the strawberry-red color faded a bit to a reddish-brown that more closely matched the old mole. The total diameter was still a bit less than that of a pencil eraser. It had been evolving, though that too seemed to have come to a halt when we got to Antigua. With only two of the five indicators definitely positive, I concluded it was not a melanoma and told myself to stop being a hypochondriac. But I continued to find the mole distasteful and didn't like to look at it.

Melanoma is one of the deadliest of all cancers. So long as the tumor is removed before it has advanced beyond the surface layers of the skin (generally, a mole thickness of 0.2mm or less), long-term survival rates remain near normal. But once it has penetrated through all of the skin layers, and especially if the surface of the lesion is ulcerated (has broken through the top layer of the skin), 10-year survival rates drop to less 60% or so (http://www.cancer.org/docroot/CRI/content/CRI_2_4_3X_How_is_melanoma_staged_50.asp). If any of the cancerous cells have reached a lymph node at the time of diagnosis, very few treatment options exist and five-year survival rates drop to around 50%. What starts as an easily removed surface lesion can, in a very short period of time, penetrate surrounding tissues and go on to invade the lymph nodes - sometimes in a matter of months.

I showed the mole to my sister because I knew she wouldn't laugh at me but would give me her honest opinion. Not only did she not laugh, she took my concern very seriously. She urged me to visit a dermatologist right away and reminded me that we have a family history of melanoma, which is one of the main risk factors. I contacted friends who live on St. John and asked for the name of a good dermatologist. I had lots of things going on, but I dutifully put seeing a dermatologist on my list. The day Leigh and Steve left, I heard back from my friends who told me that there was only one dermatologist on the island and that most people went to Tortola in the British Virgin Islands, to a clinic that specializes in skin diseases. When I got that news, I crossed seeing a dermatologist off my list. It didn't have most of the characteristics of melanoma, so it seemed like it would make no difference to wait six weeks or two months until we were back in the States.

My sister and I have written one another once a week for the past fourteen years. In my sister's weekly letter, which I received on the Sunday after she and her husband flew home, she said, "Please don't wait to get that mole checked by a dermatologist... I know you already know what a difference it makes to catch any possible melanoma at the very early stages. Treatment gets so much more complicated and is less effective once it gets into even one or two lymph nodes." I groaned when I read that, but I couldn't ignore what she had said. I looked up the phone number for the only dermatologist in Charlotte Amalie and put calling him at the top of my list for the week.

Unlike in the US, there was no hassle about getting an appointment - I didn't need a reference from my regular doctor or insurance documents and there was no six week wait. I went to see Dr. Robinson on Thursday. He examined the mole and thought it was highly unlikely to be melanoma. But when I explained my family history of melanoma, he decided to remove it just to be sure. It took fifteen minutes and cost me $300, and when I walked out of the doctor's office, I felt like I was walking on air. I hadn't realized how much that little piece of skin had been worrying me and weighing me down. I was so glad to have that darned thing of my leg, I was practically dancing.

I thought that would be the end of it, but Dr. Robinson called me the following Tuesday. "I'm really surprised to be calling you back," he said. "But it was melanoma." I saw him again last Thursday, and he did a wide excision around the original site of the mole, removing several centimeters of skin and underlying tissue in each direction from the mole to ensure that the cancer had not spread. Eight sutures and $500 later, I left his office for the second time, hoping that this biopsy would be negative. Yesterday, Dr. Robinson called me back with good news: no sign of melanoma in the second biopsy. If I had waited until I got back to the States, it could easily have been several months before I got situated, had an appointment with my regular doctor, got a referral to a dermatologist and got an appointment. Those months would have been critical and might well have been enough time for some cancerous cells to make their way to my lymph nodes.

Living on a boat, Evans and I get far more sun than is good for us. Like many cruisers, we never seek out the sun. We wear hats and sunscreen most of the time, and stay below during the hottest/sunniest part of the day. I hope that my experience will convince anyone reading this who has been worried about a mole to act as soon as possible. Here's what I've learned:

1. Take extra care if you have a family history of melanoma. One of the single biggest risk factors for melanoma is having a blood relative who has already had the disease (http://www.cancer.org/docroot/CRI/content/CRI_2_4_2X_What_are_the_risk_factors_for_melanoma_50.asp). If I had not had a close relative with a melanoma, the doctor probably would not have removed my mole. Now that many people over 50 or so are getting small moles removed, most of which prove to be benign, it's important to check with near relatives to see if any of their lesions were melanoma.

2. Trust your instincts. I knew something was wrong with that particular mole, as have several other people we have met who have had moles removed that proved to be melanoma. I will be far more decisive if I have a similar feeling about another mole in the future.

3. Use sunscreen on your whole body. I always put sunscreen on my face, even after I've tanned. I usually put it on my arms, though I get less diligent as I get more tanned. I only put it on my legs at the very beginning of the season. If most women are like me, it might explain why the most common site for melanoma on women is the lower leg (http://www.med.umich.edu/1libr/wha/wha_melanoma_crs.htm). The most common site for men is on their backs and torsos - so use that sunscreen, guys, when you take off your shirt! Not only is it important to put sunscreen on in the first place, but it is necessary to reapply sunscreen every two hours that you remain in the sun.

For more information, check out the following sites:
http://www.mayoclinic.com/health/melanoma/DS00439
http://www.cancer.org/docroot/CRI/CRI_2x.asp?sitearea=LRN&dt=39
http://cancer.about.com/od/melanoma/Melanoma.htm