Smark Out Moment

Welcome to another edition of Smark Out Moment WRESTLING DOCTOR'S NOTES where we discuss medical issues that are either being reported in the wrestling world or generally afflict wrestlers.

On this Spotlight article I'll be discussing Bret Hart's recent diagnosis of skin cancer. As always, please review the disclaimer at the bottom of the article.

Background

On 1/30/20 Bret Hart revealed on his Instagram that he had recently been diagnosed with basal cell carcinoma, a form of skin malignancy. He used this post as an opportunity to spread a message of being proactive about one's health and - in particular - wear sunscreen.

Bret's posted photo showing his left shoulder wound and associated sutures. Image courtesy of Bret Hart's Instagram account.

As you can see from the bottom left of the photo, he has a small superficial wound of his left shoulder with two black sutures. This is most suggestive that he had an excisional biopsy to diagnosis his cancer, which is where a chunk of a lesion is removed to make a diagnosis.

Diagnosis Discussion

Basal cell carcinoma is one of the most common skin malignancies and one of the most common malignancies overall. It is so common that most cancer research excludes it from data because it would confound research done on other cancer diagnoses. It most commonly occurs in fair-skinned people in sun exposed areas. No surprise then that the head, neck, shoulders, and upper back are most commonly affected.

Most basal cell cancers are slow growing and it's not uncommon for a person to have one for months on their skin and only get it checked out when it starts to bleed a bit. They almost never metastasize (go elsewhere in the body). And while they can be locally aggressive, chewing into underlying muscle, bone and the like, this is usually only when people leave them for too long.

Typical appearance of a basal cell carcinoma. The central scabbed over area is a concerning finding as is the asymmetry of the lesion. Image courtesy of Stanford University Medical Center.

Considering the size of Bret's biopsy site, this was likely caught quite early. The surgery he will have will likely be minimal with either deep excision and burning the wound or a procedure called Moh's surgery where small slices are taken away and each examined under a microscope until no cancer cells are identified in a slice.

More aggressive case. This is a CT exam of the face. The yellow arrow is pointing to a basal cell cancer that is invading the eye. When these things are in more sensitive locations and left alone too long, bad things can happen. Image courtesy of radiopedia.org.

As an aside, this is a perfect example of how the word "cancer" is not used well in general. "Cancer" is a term for a category of disease and there are hundreds of different cancer diagnoses that are essentially different diseases. People ask "when is there going to be a cure for cancer?" Well some have a cure. Most basal cell carcinoma have a cure, you cut it off. We should be thinking of "cancer" like we do "infection" because we understand that there are innumerable different types on infections with different implications and treatments.

Conclusion/Prognosis

The Hitman is almost certainly going to be just fine. In the rare instance that this is a more aggressive basal cell cancer, the shoulder is a good place for it to occur because there aren't any major life-altering structures near the skin surface there.

Bret gets huge points for using this as an opportunity to promote health awareness and sunscreen use. Let's all be cognizant of our time out in the sun. And please go see your primary physician and/or a dermatologist if you have a skin lesion that is new, asymmetric, changing, or bleeding.

Disclaimer: These articles are general discussions about medical topics/diagnoses. As we are not personally interacting with wrestlers and do not have intimate knowledge of their maladies, we cannot comment specifically on their medical courses unless information has been previously freely reported. These articles reference wrestlers as examples based on what is either reported by them or their companies, but what is said beyond that is only speculation based on the general course of a given diagnosis. Any information here should not be used for self-diagnosis. If you are experiencing medical issues yourself, I advise you to see a licensed physician for a full evaluation.