Treating Reagan's "Pimple"

By Claudia Wallis

At first there were varying explanations for the small scab on the right side of the President's nose. It was described by White House Spokesman Larry Speakes as the result of "skin irritation, a gathering of skin, a piling up of skin," possibly aggravated by "an allergic reaction" to adhesive tape that had held a naso-gastric tube in place following Reagan's surgery last month for colon cancer. Actually, it was a bit more than that, as the President himself finally admitted. "I had, well, I guess for want of a better word, a pimple," he explained last week. "I was informed that it has been examined [by biopsy] and it was indeed a basal-cell carcinoma, the most common and least dangerous kind [of cancer]."

So common, in fact, that Reagan was not the only American leader reported last week to be afflicted with it. Former President Richard Nixon, it was revealed, underwent treatment two weeks ago to excise a basal-cell growth behind his left ear. In all, approximately 500,000 Americans a year develop skin cancer, and the overwhelming majority of these are basal-cell carcinomas, usually small, pearly nodules that sometimes become red, crusty lesions and appear most often on the face. "The sun is responsible for almost all of them," says Dr. Perry Robins, a New York University dermatologist and president of the Skin Cancer Foundation.

Because of their age, their ancestry and their many years in the California sunshine, both Reagan, 74, and Nixon, 72, are typical victims. The risk of developing skin cancer increases with age and years of exposure to the sun's ultraviolet rays. In the U.S., one Caucasian in seven will be stricken during his lifetime. Skin cancer is hundreds of times more common among whites than blacks and is especially common in those of Northern European extraction, with Irish Americans like Reagan at particularly high risk.

Promptly removed, basal-cell carcinomas rarely pose a danger. There are several methods for getting rid of them. President Reagan's "pimple," and a similar growth on Nancy Reagan's upper lip in 1982, were excised by a procedure called curettage and electrodesiccation (see diagram) that usually takes five minutes. In this method, the dermatologist applies a local anesthetic and then scrapes away the soft, mushy tumor cells with a curette, an instrument with a sharp circular blade. Afterward, an electrified needle is applied to the area to destroy any remnants of malignancy. In the case of Nixon's l-in.-sq. tumor, a method called microscopically controlled surgery was used. The process calls for the removal of successive slices of tissue, each of which is examined under a microscope until cancerous cells are no longer observed.

Other types of skin cancer can pose a greater threat. Squamous-cell carcinomas generally appear as raised, pinkish scaly patches. If not promptly treated, 5% of them metastasize to other tissues and organs. Most deadly of all is malignant melanoma, which typically begins as a dark, unevenly pigmented spot with irregular edges and can quickly spread to invade internal organs. Melanoma afflicts 22,000 Americans a year and kills 5,500. Though heredity and a medical history of unusual moles play a part in it, evidence suggests that serious, blistering sunburns, suffered during the first two decades of life, may also increase susceptibility.

The best way to avoid all types of skin cancer is simply to stay out of the sun, especially during the peak-intensity hours of midday. For those who cannot resist its lure, doctors urge the use of sunscreens designed to block ultraviolet radiation. People who have already had a basal-cell carcinoma run a 25% risk of developing another and must be especially cautious. Last week Reagan admitted that this advice was "a little heartbreaking ... because all my life I've lived with a coat of tan, dating back to my lifeguard days."

Self-examination for signs of skin cancer is simple, requiring little more than a full-length mirror, a hand mirror to see one's back and a blow-dryer to examine the scalp. "The ability of people to detect skin cancers is tremendous if they're motivated," observes Dr. Robert Friedman of N.Y.U. Indeed, many newly motivated Americans went scurrying to dermatologists last week, just as Reagan's colon cancer sent them to gastroenterologists. "We had five patients walk in off the streets who identified their own basal-cell carcinomas," says Friedman. "Four of them were right." --By Claudia Wallis. Reported by Christine Gorman/New York

With reporting by Reported by Christine Gorman/New York