Running After Melanoma – Outside

My shoulders grew warm under the sunlight, triggering near vampirical panic. I slowed to adjust my sun hat and noted that my forehead felt slick. Dammit—the sunscreen from ten minutes ago was already washing away. My longtime running partner, a speedy vizsla-pitbull mix named Maeve, shot a look over her shoulder when I stopped short just before barreling up a muddy hill. I dug my Coppertone out of my CamelBak and groaned back at my dog. I felt like a jogging beekeeper in my full-coverage UPF Gore-Tex and full-brimmed hats. It was January 2018, my first run on a daylit trail in two months.

The prior November, my almost daily running routine had suffered a sudden interruption. At 33, I was diagnosed with Stage 1 melanoma. When I got the phone call from my doctor about the nefarious mole my then boyfriend had long urged me to get checked out, I felt great—I’d just run eight miles and downed a Bloody Mary.

Slowly, surreally, it sank in that my otherwise-quite-healthy body had grown cancer cells. They’d been there on my back six days prior, before my doctor removed an inch-long-and-wide swatch of my back flesh and biopsied the mole. Have you ever felt utterly betrayed by a freckle? Mine sat just above my running-tank tan line, and if my dermatologist hadn’t caught the cancer within, its malignant cells would’ve spread along my top layer of skin before penetrating my lymph nodes and blood vessels, where they likely would’ve metastasized and killed me.

“The bad kind?” gasped the first friend I told, my training buddy. I explained that melanoma didn’t work like cholesterol: there was no not-bad kind. While melanoma accounts for only about 1 percent of skin cancer, it causes the most deaths. Skin cancer is the world’s most prevalent cancer, and rates of melanoma have increased 54 percent in the past decade, according to the Skin Cancer Foundation. While no studies have examined the occurrence of skin cancer in outdoor athletes, one shows that outdoor workers have markedly higher rates of skin cancer. Dermatologists predict that, in addition to stratospheric ozone depletion, a warming climate will lead to people spending more time outdoors, in less clothing, which could result in an increase of up to 10 percent of cases annually. Some studies show that marathon runners and other endurance athletes are at heightened risk, not just because of excessive sun exposure but also exercise-induced suppression of the body’s immune system.

Before my surgery, I’d have given myself a B minus in sun protection—OK at remembering to slather on sunscreen before getting on a boogie board, but less likely to do so before jogging up a mountain, which I did all the time. Even after my doctors scheduled a December surgery to excise the cancer cells from my back, but before I actually went under the knife, I kept running. Yes, those once sought-after sunny stretches of trail near my home in Berkeley, California, were reminders of the most deadly form of skin cancer, the one I was seven times more likely than the average person to develop again. But at that point, I’d run three marathons and some dozen halfs. An avid hiker and backpacker, my full-time job was handling outdoor adventure coverage for a nature magazine. I was used to logging time outside.

But after an oncological surgeon cut out a chunk of my back and put me on bed rest, the cancer got real, and my attitude changed—I wanted to be nowhere the sun’s rays could assault me. It wasn’t until I was in searing pain and gauzed up that I actually felt sick. Almost suddenly, the sport I’d always counted on most to reduce my anxiety consumed me with a sense of danger.

The operation to excise the cancer cells was successful, requiring no follow-up immunotherapy or chemo, and I was put under strict orders not to exert myself for the following month. That’s how long they said it would take for my incision wound—a vaguely vaginal two-inch gash—to heal. Eleven days later, I celebrated being cancer-free stupidly, i.e., with a short, slow lakefront jog, which was enough to break my sutures. My mandated month off became two. As a dermatologist later explained, raising your heart rate causes blood to rush to the wound site, which can compromise the hardiest of stitches. It’s why you’re not supposed to have even the most unaerobic sex after surgery. Screwups like mine are why doctors have been known to compare runners to crack addicts: we problem patients tend to think we know our bodies better than anyone else and generally have little patience for recovery.

“Your days of extended adventuring in the sun are over,” my boyfriend told me as he cleaned pus out of my infected wound. I argued back, but thanks to all the horror stories about melanoma recurrence the internet was supplying me, my fears were mounting, as was my comprehension of the fact that I could’ve easily died in my early thirties. (The most common age to be diagnosed with melanoma is 63.) Even after the wound started to morph into a zigzagging scar, my running shoes sat on my closet floor, unmuddied. Poor Maeve took to bringing them to me and, when she was really frustrated, making sure I watched as she chewed on them.

For a time, I hid out in hot-yoga studios, which helped take my mind off running during the day, but some nights I’d take to the trails in my subconscious, waking up twisted in my sheets, sweaty from canine-style sleep running. The truth is that I was suffering an identity crisis. A pasty, nerdy native of the pancake-flat Midwest, I was forever trying to prove to myself that I belonged on trails alongside Patagonia-clad mountain goddesses. I loved when my shoulders were freckle dusted and my arms grew bronze. I was the awkward tomboy who’d found a way to channel my need to get dirty on the cross-country team and eventually as an outdoors writer. I was once asked to leave a hotel workout room on a rainy day because my shoes were leaving dirt all over the treadmill. (I was secretly kind of proud.)

It pains me to admit that I used to judge other girls who acted anal-retentive about sunscreen and hit the trails dressed like they should be on safari. Post-cancer me, however, started to channel their anxiety in my own resentful way, seething with jealousy at friends’ #getoutside-tagged Instagram posts. I’d be consumed with relief when it was overcast for my bike commute. I caught myself editing the adjective “sunshiney” out of a story at work, simply because it gave me shivers. And this was in January—no beach or backpacking invitations to reconcile. Spring and summer, I knew, would be brutal if I couldn’t get over myself.

Fortunately, my therapist is well versed in coping mechanisms more sensible than carrying on like Dracula in a pair of Hokas. She correctly pointed out that my typically generalized anxiety had gotten awfully specific. She said that by avoiding the outdoors, I risked losing a primary source of happiness and health—and the fact that I was letting as much happen already was compounding my solar anxiety. When your foe has an unavoidable, ubiquitous presence, you need to learn to not just block it but live with it.

So I worked to stop catastrophizing and started taking practical measures, like downloading UV Lens, an app that gives by-the-minute updates on the sunlight’s angle, forecasted cloud cover, elevation, and ozone filters. Knowledge is power—I now had tangible evidence that it’s generally safe to be out before 10 A.M. and after 2 P.M. on a wooded trail, and that slowly started to overpower the radiation-oozing boogeyman sun in my mind.

I also came to realize that I didn’t have to dress like a trail beekeeper; UPF clothes have come a long way in terms of comfort and style, and I’ve found some hats that look damn good on me. I’m still working to cede control and accept that I can’t prevent the sun’s every ray from hitting me. I’m grateful that several times a year I have to get naked for a dermatologist who’s charged with early detection of cancer. As she’s repeatedly told me, even if you’ve already been diagnosed with skin cancer, there’s never any good reason to cease activities that give you joy.

More than a year after melanoma, my running shoes are muddy once more, much to Maeve’s delight. But nowadays, I make her wear sunblock on her pale-pink nose before we go running. She used to scowl whenever I finished slathering myself and came for her face. But now it’s become part of the reach-for-the-leash routine, so she pants eagerly as I dab her nose white. I can’t say I’m quite as routine oriented as my dog, but donning hat, shades, layers, and sunscreen is getting Pavlovian for me, too.

In April, I crossed my first marathon finish line since cancer. I wore a big hat and tucked a tube of sunscreen into my FlipBelt. Prerace, I like to eat English muffins and put on my cheetah-print socks. Nowadays, the ritual of doing everything possible to protect my largest organ has become yet another cue that dirt, endorphins, trails, and glory are calling, and I must lace up and go.