“Am I Going to Have to Get Totally Naked?”

Each year when I write about my skin checks (and subsequent “fuck I’m pre-cancerous again and going back in to get hacked up”) I get quite a few comments and emails from people with questions about the process. I love-love-love this because it makes me feel helpful and for a disease best combatted by prevention and early detection, I feel each person I convince to go in for a check is a little battle won.

So I figured today I’d walk you through my latest appointment to give you a better idea what to expect, and/or convince you it’s not as intimidating as it may seem. And this is coming from a girl who really hates going to any doctor for anything.

(reminds me I should probably hit the dentist… for the first time in three years)

This is by no means a “here’s this post so you’ll stop asking me all these questions” – please PLEASE if you need or want to someone to talk to about skin cancer prevention, detection, treatment, etc get ahold of me! onceuponalime at gmail.com. I’m way happy to help however I can.

Well let’s get to it.


I had visited an insurance in-network dermatologist for acne a few years back and learned they did skin checks, which is how I chose to go there. I believe some family physicians will also perform the exam, but you’ll need to ask. Derms are a pretty surefire bet.

My insurance covers preventative exams, so I pay a small co-pay and the visit is covered. This seems to be pretty standard (think of routine annual physicals, teeth cleaning, pap smear, etc) but do check your coverage before believing my fat mouth.

Annual Skin Check Appointment

After signing in like any other doctor’s appointment, I busied myself browsing all the age-reversing, cold-sculpting, latisse-this, collagen-that flyers and frequent botox’er loyalty programs before getting taken back to an exam room. Ahh, life in the OC. I was given a paper sheet and told to strip down to bra and undies, and lie on the table with the sheet over top of me like a blanket.

A very thin blanket, with a slight draft blowing right on me, made for a slightly uncomfortable 5 minute (?) wait.


2011 at the plastic surgeon for post-op (spoiler alert) – paper gown >> paper sheet

The doctor looked over each square inch – hands, arms, chest, neck, behind the ears – then uncovered ‘blanketed’ quadrants at a time to check breasts, stomach, and pelvis – moved down to legs and feet, then after a flip finished the back side. The whole process took less than two minutes.

Anything a little larger, darker, or misshapen than normal she measured and noted on my chart to keep an eye on in the future. Anything alarming – like the suddenly appeared mole on the sole of my foot and a stomach freckle that had grown since last appointment – gets removed for biopsy to check if the cells are cancerous. Otherwise you’re good to go.

cue last post’s mention of nickname “Abby Normal”. I go in now just assuming something needs taken off. #extremewhitegirlproblems

Skin Check Bonus Round! Biopsy Time!

After a few injections of local anesthetic which stings a teeny bit, she used a flat little square tool with a hole cut out of it (lined I assume with a sharp edge but I did not inspect that closely because, kinda creepygross) to “shave” the area off and send off to a lab for testing. A regular bandage handles the bleeding and a faint scar might be left, otherwise it’s easy peasy. I’ve been told not to workout for 3-5 days, but it’s just a tiny scrape so I say go sweat on just clean it up after (but I’m not a doctor, listen to them not me!)


This bitch on my foot might keep me out of my Brooks a few extra days though. Sad face.

Post-Appointment : In Case of Abnormal Results

After a week the office calls to share the results of the biopsy. I’ve heard:

“cells were normal, nothing to worry about,” and …

“cells were pre-cancerous but margins of the shaved area were clear so it looks like we got it all out – we’ll keep an eye on the area,” and…

“cells are pre-cancerous (blah blah nevus atypia), margins were not clear so we have to hack off a bigger area to get all the bad stuff out – when can you come in?” and my least favorite…

“cells are cancerous, but the mostly non-life-threatening kind (basal cell carcinoma), so you’re probably not dying but we need to cut that shit out like, yesterday.”

I’ve been lucky to not get option 5: MELANOMA and hopefully with regular check ups I’ll never land there, but do keep in mind that is an unfortunately common diagnosis and can be very very serious. Scare tactics – check.

Follow Up : Cut That Shit Out

For my two procedures (four separate removals) I’ve gone two routes:

1) plastic surgeon, full-anesthesia, hospital stay and huge medical bills way my derm suggested and I didn’t know other options existed,

and 2) the “can’t you just do it here in your office? I don’t care if I have a gnarly scar or you haven’t thrown a stitch since medical school, I’m cheap and don’t want to take the time off for full-on surgery” sorta sketchy back alley (but equally effective) way.

2011 surgery

2012 skin surgery

(for the record, both left scars, IMO the more faded ones were definitely not worth $xxx. If it had been on my face, maybe it’d be a different story…)

Depending on your level of atypia, size of the area, and doctor the removal process can vary greatly so I’m not going to weigh in much. Plus the whole not-a-doctor thing. My last two were taken care of with a simple punch biopsy (a circle tool cuts out the bad spot) and sewn together with 3-5 stitches in the derm’s office. That did take a few weeks to heal and get the stitches removed, so don’t plan on any peak training or races post-op.

(since mine were non-metastasizing, I was able to push the procedure back a few weeks until after racing season was over. non-runner doc shook her head but said it was fine.)


And that’s it. I don’t mean to scare or gross you out with the details, but I believe it’s easier going into something like this not completely blind. The initial skin check is easy, painless, and only like, 15% embarrassing, so do yourself and my worried soul a favor and make an appointment. And if shit happens at least you know I’ve probably got a matching scar we can bond over.


or half-taped ankles to hold bottom-of-foot bandages on? so fetch.

Again feel free to contact me with any questions or concerns. I’m no expert of medical professional but I’ve spent enough time in that exam room to shed some light on the process.

And “What Celebrity is a Fan of Cool Sculpting?”

Sarah OUaL, the human biopsy doll

*disclosure – this is my personal experience. Obviously people’s experiences will vary based on situation and doctor. If you are concerned about the process you can always call and ask what type of exam the doctor performs and their typical course of action for any abnormal results. Don’t be afraid to ask ‘stupid’ questions!

The Sun is Coming! (sun safe with Mission Athletecare)

This is going to be pretty rude to those of you covered in a winter encore blanket of snow right now, but believe it or not, Spring is here.

We don’t have a lot of “seasonality” here in SoCal for justification but the calendar tells me it’s true. Sorry if you just got done shoveling your sidewalk or stripping ten layers and yaktraks from your outdoor run.

But the sun will be coming around (if not you can come visit), and all those pasty shoulders and legs will finally emerge from layered hibernation soon.

And with that announcement, it’s time I took my pedestal for another Skin Protection Soap Box Speech.

If you’re unfamiliar with my story, I’ve had two skin cancer scares in the last two years.

In 2011, a week after my wedding, I went in for surgery to remove one pre-melanoma mole and one basal cell carcinoma (a non-metastasizing form of skin cancer). This past December, I went back to have two more pre-melanoma areas excised.

Neither case was life-threatening, but had they gone undetected it’s hard to imagine how quickly they would have sped down the cancer-forming path they were on.

  • As a brief nerd-out, pre-melanoma means there are abnormalities in the cells that have a likelihood of morphing into melanoma, a deadly (but treatable) form of skin cancer. A carcinoma is a grouping of cancerous cells, but the non-invasive kind that don’t normally spread to your other organs or kill people.

I go in for routine checkups every 9 months or so – a quick eyeball body scan by my dermatologist, and if she finds anything suspicious or worrisome she shoots it up with local anesthetic, razors it off (it doesn’t hurt, swear), and sends it to the lab for biopsy. If it comes back abnormal or with unclear margins – meaning a larger chunk needs cut to get all the bad stuff out – I go back. This last round she ‘operated’ in-office, a mostly painless punch biopsy with some stitches. The first procedure was done at a hospital by a plastic surgeon, which I felt was overkill (and expensive) but they were able to knock it all out at once and stitch me up extra pretty.

That’s a joke. All the scars are gnarly.


4 personal advocacy points – great conversation starters. 

Anyway, as your homework for reading this torrid tale (for the umpteenth time, some of you long-term readers) :

1) PLEASE visit your dermatologist for an annual skin check. Or every other year. I don’t care. Just go in – mine was covered by insurance, super quick, and painless. Sure you’re naked and being inspected by a stranger, but I promise it’s worth the peace of mind.

2) DOUBLE PLEASE remember to wear SPF! Even when it’s not sunny or you’re only going to be out “a few minutes”. Not only will you be preventing scary cancer, but you’ll keep your skin young and won’t look like a wrinkly old bag by 35.

Lucky for you I’m not here shoving this down your throats without at least offering to help.

Mission Athletecare sent me some things to keep my skin happy and hopefully out from under the knife this year, and I want to share them with you. Because I love them and hate sunburn (and thigh chafing).

photo 1

5 hour anti-chafe stick, SPF50 continuous spray, SPF30 lotion, SPF30 facestick

I bet you all know how sunscreen works. You put it on – 30 min before exposure, preferably – and it keeps the bad rays from hurting you or turning you into a lobster. Pretty simple, but in case you need visuals here are some really lovely photos of the application process :



ps if your thighs don’t rub together when you run we can’t be friends

The continuous spray makes total coverage foolproof, and I can get my hair and scalp without greasing em up real bad. I add some facestick (feel free to take a moment to admire my 6am beauty) to my cheeks, nose, and lips since I don’t like wearing my daily moisturizer because I get a sweaty slimy mess. Bonus : the stick is kind of tacky so it keeps me from wiping sweat in my eyeballs somehow? And lastly, a gratuitous inner-thigh shot of the anti-chafe balm. Also in constant contact with my underboobs, collar bones, and chicken flapping arms.

Reminds me I should go do some pushups after this.

I think there are HIPAA laws against me calling your doctors to make skin check appointments for you, so I’m going to do the next best thing(s) to help keep you sun safe this summer :

1) Use code “SARAHOUAL30” at missionathletecare.com for 30% off your entire order.  (through 5/15/13)

2) Enter to win! One random reader will win an anti-chafe, continuous spray, and facestick – Summer Running Protection kit of their own. To play :

  • Leave a comment telling me your most exciting spring/summer plans. Something a gnarly sunburn or melanoma diagnosis would put a damper on.
  • Tweet “__(something fun you’re doing this spring/summer)__ will be SUN SAFE thanks to @sarahoual and @missionathlete #FUcancer”
    • ex. “Running Boston will be SUN SAFE…”, “Camping Yellowstone will be SUN SAFE…”, “Drinking margs by the pool will be SUN SAFE…” – you get it
  • Schedule a skin check. Let me know. These entries also awarded a virtual high five and insta-BFF status.

1 entry for each, must leave a separate comment. Winner will be chosen by random on Tuesday 4/2 at noon PST

Good luck! The sun is fun and makes everyone happy so enjoy it, responsibly! (like the alcohol commercials).

Sarah OUaL

An OUaL PSA–Skin Check

Last June I got some news that rattled my world in an “oh I’m not invincible?” way.

A month ago, after another routine check up, I got a similar phone call.

Yesterday, I went in to fight it.

(WARNING : graphic images. they’re meant to be disturbing and make you want to barf.)

photo 3






And in two weeks, I’ll do it again, upping my skin cancer scar tally to four.


Luckily this diagnosis was not as grim as the first – these are preventative procedures, not defensive. But having gone untreated they could/would have rapidly turned into something much more serious.

* enter statistics about skin cancer being the most common cancer, how 1 in 5 Americans will be diagnosed, and how it is the most preventable AND treatable of the cancers * 

Just your friendly reminder to wear sunscreen (even on cloudy days), get an annual skin check, and stay out of the fucking tanning bed. Buy stock in Spray Can Tan.

And yes, all this does have something to do with Zero Month. I’m completely out of sweat commission while these stitches fuse my skin back together. Nothing like starting from complete scratch in 2013.

Health over hobby. New legs, new pre-melanoma-less skin. BRING. IT. ON, 2013.

Sarah OUaL

if you have questions – how to get checked, what the appointment/procedure is like, out-of-pocket costs, etc – PLEASE email me. There are no excuses. Whether you “tan easily”, have never been in a tanning bed, or “aren’t really freckle’y” – do yourself a favor and calm my mother hen heart and go get checked.