When that beauty mark on your skin should not be ignored

Boniface* was rudely yanked out of his retirement. This is not how he had foreseen spending his sunset days. He lay on the hospital bed, far from home in a strange country, staring at the ceiling, refusing to look at his new companions — a shiny pair of underarm crutches.

He felt life had been unfair but he wasn’t one to whine. He was barely 30 when his wife succumbed to severe malaria and left him cradling a three-month-old infant with two-year old twin boys to boot. He dedicated his life to raising his children in the best way he knew how and they did not let him down. The twins were now successful career people, starting their families, while the little one was charting new grounds in Europe, where her job had sent her.

Boniface was finally resting after a job well done. He had retired to his farm and was doing beef farming, fattening bulls for the local and export market. In his old age, he had even finally met a lovely lass who loved his bushy salt and pepper beard. Salome* was a joy to have around. She cooked him tasty food, which he joked was intended to make him fat and unattractive to other lasses.

However, Salome was also quick to notice things. She noticed the weird lesion on his shin before he did. It was not painful but she noticed it was getting bigger ever month. She urged him to go to hospital but like most men his age, Boniface put it off. When it became ulcerated, she was finally able to drag him to hospital.

Boniface was repeatedly seen in the outpatient department with conservative treatments, wound dressings and medication to no avail. The ulcer wouldn’t heal. He was eventually referred to an orthopaedic surgeon who sent him for a battery of tests before finally informing him that his leg was going to be amputated.

This was a tough call for an extremely independent-minded man who had never had to rely on anyone all his life. He wasn’t ready to deal with the expected disability that would arise out of the amputation. However, Salome wasn’t going to compromise on this. She summoned his children home and dragged them to the doctor for clarification. Boniface was in surgery the next morning.

This was the bad news. The worse news was that the tests had confirmed that the ulcer on his foot was indeed cancer, a malignant melanoma. The worst news was that the cancer had already spread to other organs in his body, the lungs and the liver. This was a catastrophic blow to Boniface. He did not have a comeback for this one.

Malignant melanoma is a cancer of melanocytes. These are special cells that produce the melanin pigment and are found in the bottom layer of the skin's epidermis, the middle layer of the eye, the inner ear, vaginal epithelium and even the heart.

The cancer has a sneaky habit of quietly metastasising without remarkable changes at the primary site. It can spread anywhere in the body, including the brain. It also has a poor prognosis once the spread has started. More than half of these cancers arise out of existing moles that one may have had even from birth, hence a reason to suspect any change in an existing mole.

All the while, Salome had only one mantra — together, they will face it just one day at a time. While Boniface obsessed over the possibilities, statistics and cost of treatment, Salome only counted the milestones. She celebrated successful surgery, she celebrated the post-operative recovery, she even celebrated his birthday with a family dinner and managed to get everyone to relax, even if for an evening.

They were counselled that amputation grossly interfered with balance and that Boniface would take time to get used to using crutches. In the meantime, he was to use a wheelchair to get around as he continued with physiotherapy to prepare him for crutches. He wouldn’t hear none of that. He went home in crutches only. He would rather fall over than live with the feeling of helplessness that the wheelchair brought.

Six weeks after the amputation, Boniface and Salome were bundled into a plane and sent to India for adjuvant chemotherapy. The doctors were clear that they shouldn’t expect a miracle but his last-born daughter would hear none of that. It was her turn to cradle her father in his most vulnerable state and by God, she would die trying.

Boniface did complete his treatment and it gave him another six years of pure bliss with Salome before the vicious disease reared its ugly head again. This time, they both knew it was time to say goodbye. They both rejected the idea of investigational treatments. They just wanted to sit on the porch and watch the sunset together for the umpteenth time before death separated them.

Dr Bosire is an obstetrician/gynaecologist