Tennessee Archaeology and Skin Cancer

Summer is nearly upon us, the Earth is moving closer to the sun each day, and it is the prime season of the year for field archaeology in Tennessee. All but a very tiny amount of my field archaeology experience was obtained on warm weather projects under sunny skies. Much of this experience came in the middle 1970s. This was a time in American history when sun tans were in maximum vogue; people were California-style sun worshipers; men often went about town with no shirt on to soak up rays; women sunned themselves nearly every weekend to achieve a cosmetic condition known as the perfect tan; sunburns (even severe ones) were so common people did not think much about them; and almost no one wore sunscreen. I was a member of that sun-soaked Baby Boomer generation and failed to think about my own sun exposure in terms of future consequences. That was a really big mistake for me and other members of my generation, and the reward for many of us was skin cancer. This post to the Archaeology in Tennessee blog is written in the sincere hope that you young, up-and-coming generations of archaeologists in Tennessee (and elsewhere) will listen carefully to what I have to say here and protect yourselves from the rays of the sun while doing field archaeology. This post may scare the bejeezers out of you. Make no mistake about it. This is exactly my intent in hopes that you will muster enough good sense to protect yourselves from the sun better than I did during my hot summers in the grid squares. This subject is especially timely for me because tomorrow I am scheduled to undergo my second round of surgery since 2011 for skin cancer on my face.

Most exposure-related cancers take about 25-30 years to show up in the form of a tumor. I was out in the sun quite a lot as a child and got severe sunburns a couple of times during my K-12 years. My initial intense exposure to the sun (day-in and day-out for an extended period of time) was the 1976 summer archaeological field season on the Tellico Archaeological Project. Unlike today’s archaeological field schools, which stay in the field for only five or six weeks, we were out in the sun for the entire summer. My whole summer was spent working on the Tommotley site, which was the third largest of the Overhill Cherokee towns in the Little Tennessee River Basin. Tommotley had no shade trees, except along the edge of the river where the waterscreen pump hummed all day. All of the archaeological work was done out in the direct rays of the sun. I wore a straw hat with a wide brim a big part of the time, and I worked in a Tennessee tee-shirt and khaki pants to avoid sunburn. No sunscreen was used, and to the best of my recollection, high SPF sunscreens like the ones we have today were not widely available. In fact, it was often just the opposite. One of the key emphases in the grand American mystique of the perfect tan was special lotion that acted to intensify solar tanning effects on the skin. Thank you Hawaiian Tropic! Fortunately, I never used any of that special lotion. Nonetheless, my first bout with skin cancer arose on the left side of my nose in about 2007. That was 31 years after my first field season at Tellico, which was nearly perfect clinical timing.

My skin cancer first presented itself as a tiny, round spot on the left side of my nose. It was smaller than the head of a straight pin and did not look at all unusual. It occasionally leaked a tiny bit of water or a drop of blood. However, this was off and on rather than a constant thing, and it was rather unobtrusive in the overall scheme of my life―so I dismissed it for several years. Finally, I scheduled an appointment with a dermatologist for a general examination and happened to remember this weird but occasional thing that happened on my nose. They did a biopsy, and it was a type of skin cancer. This is when I learned that certain types of skin cancer can be sneaky like the iceberg that got the HMS Titanic. The presentation can be very small on the skin surface (like my tiny vent hole), but the bulk portion of the tumor can be spread out much wider under the epidermis as a mass that looks like a cluster of pearls when it is opened up with a scalpel. Such tumors do not usually spread to other areas of the body, but they do grow slowly outwards from their in situ position.

They scheduled me for surgery right away.  I thought this surgery was going to be quick and simple. They would dig out a little area no bigger than the head of a pin, it would all be done in about 20 minutes, and I would be on my way back to work with one of those little round Band-Aids on my nose. Instead, it turned into a grueling 8-hour ordeal, which I am expecting again tomorrow.

This sort of surgery is done with a local anesthetic that numbs the area around the cancer and some of your face. Consequently, you are awake and fully conscious of all the weird medical things they are doing to you, and it is not pleasant at all. It is like going to the universally dreaded, but usually never seen, Dentist from Hell. Periodically, the anesthetic wears off during the surgery, and they have to numb the surgical area again. They had to do it several times for me, and it was no fun because it hurts when it starts wearing off.

In my particular case, under the healthy epidermis, the tumor had eaten up a good-sized portion of the bottom left half of my nose. One of the problems with this kind of skin cancer surgery is that the surgeon really does not know the full extent of the problem until he gets inside. As it turned out, I had gotten into surgery just in the barest nick of time to avoid significant and permanently detrimental physical and cosmetic effects on my nose.

You might think this surgery involves simply cutting out the tumor in a single step, but there is a lot more to it. They have to do a little cutting, and then they take tissue samples to examine under a microscope to see if cancer cells are still there. So you lie there for a long period of time with your skin wide open and bloody while they process the slides and examine the tissue. If cancer cells are still there, they come back and cut more. And they do it over and over and over and over and over and over again, however many times it takes, until no more cancer cells are seen on the slides. To make it all worse, they are simultaneously doing similar surgery on two or three other people, so you are not just waiting on the slides and the microscope. You are waiting for the surgeon to get back to you from his other surgical patients. After about six hours of this ordeal, I finally heard those blessed words, “Well, Mr. Brown, we finally got all of the cancer.” I breathed a sigh of relief and thought, “Thank you Lord. It’s all over. I can go home now because I am exhausted mentally, emotionally, and physically.” And I was indeed just plain worn out. Then the next horrifying words came from the surgeon:

We have run into a problem. We had to cut deeply to get all the cancer. The tissue that is left cannot regenerate properly in such a way as to leave you with a normal-looking nose. Therefore, we are going to have to find another place on your body to get healthy tissue, cut it out, and use it to fill in the trench we made in your nose.

I gasped in horror!!! The surgeon then decided to remove fresh facial tissue from one of those two natural grooves that run from my nose down to the sides of my mouth. (Go look at our state artifact Sandy for the anatomy.)  After even more anesthetic rounds, they had to cut slowly and carefully to avoid significant scarring and move tissue up to my nose―a little bit at a time. As they were cutting, I could feel waterfalls of blood rushing from my face down to my mouth, which is a really crazy-making feeling. This went on for over an hour, and it was grueling. When that cutting was finished, I had to lie there for another hour while they stitched up all of the cuts they had made on my face. This was not a simple case of stitching. It was slow, careful, and painstaking, with tiny stitches like those in early 1800s quilt work. This took another hour, and being fully conscious the whole time, I could sense all the stitching going on, even if I could not feel the pain from the curved needle as it and the thread went in and out. They then put on a bandage that covered nearly half of my face. I would not see how it looked until a couple of days later when the bandage came off. The remnants of all the cutting and stitching looked like something out of a horror movie. It took several weeks to heal up. I was unable to wash my hair or take a shower the whole time. It was truly the skin cancer gift that just kept on giving.

My advice to every Field Director, Field Assistant, and young archaeologist in Tennessee is to take the prospect of skin cancer from archaeology-related sun exposure very seriously. I can guarantee you do not want to go through the ordeals with skin cancer that I am going through. My skin cancers so far have not been the life-threatening kind, but malignant melanoma is a very real possibility for anyone who has undergone long-term sun exposure across many years. It is aggressive, and it spreads quickly, setting up tumors in other parts of the body―and it is every bit as much a killer as Jack the Ripper. One of my friends who took annual vacation trips with his wife to Hawaii came down with a case of melanoma in recent years. Fortunately, it did not spread, and he is still alive. You might not be the lucky one.

Here are some closing thoughts about protecting yourself from sun exposure while doing field archaeology. This is not medical advice because I am not a medical doctor, but I think it is still pretty good advice from an old archaeologist who has seen a lot of life:

1) Use a really good hat or cap that shields your face from the direct rays of the sun as much as possible.

2) Do not be stupid with sunscreen. I define stupid with sunscreen as anything SPF 40 or below. With the skin cancer problems I have had, I would personally use nothing less than 100 percent sunblock products or as close to it as I could find on the retail shelf. Some brands are better quality than others. Check Consumer Reports. They have most likely done a study to identify the best ones.

3) Nearly everyone forgets to put sunscreen on their nose and ears. Put sunscreen on your nose and ears, and never forget it. Skin cancer on the nose leads to bad things. Put it on the other parts of your face too, but keep it away from your eyes. You also need to be aware that sweat rolling down from your forehead can carry sunscreen into your eyes. It stings. Wear a headband to keep sweat and sunscreen out of your eyes as much as possible.  Use sunscreen on your face even when you are wearing a hat or cap.  My wide-brim hat alone was not enough to protect my face.

4) Spread on your sunscreen an hour or so before you arrive in the field each day. Sunscreen does not work well until it has a chance to soak into your skin some. Give it that chance for the best protection. Follow the directions on the bottle.

5) I think bikini tops and going shirtless are a really bad idea in field archaeology. While I know you have to strike a reasonable and healthy balance between keeping cool under a hot sun and avoiding skin cancer, the upper portion of your body is prime cultivation ground for skin cancer in most people. I would wear a tee-shirt made of thin cloth and periodically lift it for a minute or so across the day to let the wind cool off your skin directly. A damp  tee will also help to keep you cool if you can spare the water.

6) I have always thought shorts are a bad idea in field archaeology.  They expose the skin on your legs to the sun all day, and sweaty legs can ruin an excavation surface. I know most of you young archaeologists out there love to wear shorts during excavation work, and they do keep you cool. Some people wore shorts in the old days too. Interestingly, looking back across four decades, I cannot recall a single Field Director or Field Assistant who wore shorts. I will not advise you to wear pants, but if you insist on shorts, be sure to put plenty of sunscreen all over your legs.

7) Take advantage of shade trees and take breaks in the shade if you can. I know this will vary from site to site. Some sites may have no shade at all. A break tent or canopy is a good idea if the project can afford it.

8) I would like to end this list by commending Dr. Tanya Peres Lemons and Dr. Kevin E. Smith at Middle Tennessee State University for their frequent use of man-made shading devices on their archaeological projects. In addition to preventing rapid drying of the soil, which makes it harder to see and photograph feature outlines, it provides much needed shade for their archaeology students on hot summer days in Tennessee.  Blessings to both of you.

This blog has many readers outside of Tennessee and around the world. I can guarantee you one thing. You have never really lived until you have done archaeological excavations on a sunny, hot, steamy, late July day in Tennessee.  It will make any man or woman beg for mercy.

For my first skin cancer surgery, I had good, employer-provided health insurance with a major carrier.  Unfortunately, historically speaking, many field archaeologists who work for CRM consulting companies across the United States have had no health insurance at all.  The cost of my surgery, including doctor fees and follow-up, was between $3,000 and $4,000. Actuaries, those masters of statistical mathematics at insurance companies, had set the deductible on my policy at just the right place to get out of paying for most of my medical bills.  Fortunately, my employer at the time, one of the nicest and most competent men I have ever known, stepped in without my asking and graciously volunteered to pay for a great deal of my medical bills.  For that, I am forever grateful. My major point here is that even small skin cancers that are not immediately life threatening can be expensive to treat.  This is one more good reason for you to avoid getting skin cancer by taking appropriate precautions on your own early in your life.  On down the line, you may not have a health insurance policy, your deductible may be sky high if you do, or your employer might not be nearly as kind and generous as mine happened to be.

Personally, I would hope that all CRM companies could one day find a way to purchase health insurance for their employees, but insurance premiums are already extremely high and going up by huge percentages every year.  One 2015 Obamacare health insurance carrier is asking for a more than 56 percent increase in monthly premiums for 2016.  You read that correctly!  I saw it in a news article yesterday, and it was no mistake. Recently, a person who closely follows the healthcare industry remarked that health care is quickly becoming something the American middle class will no longer be able to afford, and we are on the doorstep of that very moment right now.  Those of you who vote can thank your local Republican politician who is OWNED by the big insurance companies and large pharmaceutical companies.

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