Editor's note: Lou Ann Ladin is a Richmond-area writer who has chronicled her sister's battle with skin cancer.

In 2004, more than 1 million people in the United States were diagnosed with skin cancer. Invasive melanoma accounted for more than 55,000 cases.

My sister was one of them.

On May 25, 2004, just four days after her 49th birthday, my sister Kathy Meadows received the pathology report on a lesion on her right thigh: malignant melanoma, superficial spreading type.

By the end of the summer, she had her third melanoma surgery.

The melanoma started, as so many do, with a mole. It changed color and changed her world forever.

"A couple of years ago, I noticed that this mole above my right knee had turned from brown to black," Kathy recalled. She said her doctor told her they should keep an eye on it for a while, so "I didn't feel a strong sense of urgency about it." On a later visit, the doctor recommended that Kathy have a biopsy.

. . .

For various reasons, Kathy did not get the mole checked. And she admits that "it didn't hurt, so I just kept putting it off." But by last spring, the mole had grown significantly, and the alarm of family and friends was growing right along with it. Kathy finally was goaded into action.

Last May 13, she saw Dr. Algin Garrett, a dermatologist with MCV Physicians at the Park at Stony Point, who is also chairman of the dermatology department at VCU Medical Center.

Kathy walked slowly out of the examining room, her face blanched.

"Dr. Garrett thinks that mole on my leg might be melanoma and two spots on my back could be basal-cell carcinoma," she said, stunned.

I felt sucker-punched. No one in our immediate family whom we knew of had ever had skin cancer, especially melanoma, the most dangerous form.

However, the stage may have been set long ago. My sister, like myself and so many other baby boomers, had been a sun worshipper for decades. Kathy was fair-skinned and freckled and burned easily, which put her at high risk. Little did we know, as we slathered on the baby oil back then, that getting as few as five sunburns can double your risk of skin cancer, according to the American Academy of Dermatology.

. . .

Garrett also noted that two spots on Kathy's lower back, which resembled small eczema patches, could be basal-cell carcinoma. According to the American Cancer Society, this is the most common type of skin cancer. It starts in the basal cells at the bottom of the epidermis, the outer layer of the skin.

Of course, when we were younger we were oblivious to this as we pursued our quest for the deepest, darkest tan. We thought sunscreen was for wimps. If you looked pale in the summer, you didn't look healthy.

Kathy also had used tanning beds a few years ago, buying in to the popular notion that they were safer than suntanning. But studies have linked them to skin cancer, and organizations such as the American Academy of Dermatology and the Skin Cancer Foundation have issued strong warnings about the dangers of tanning beds.

. . .

On May 19 last year, we went to the Nelson Clinic at VCU Medical Center for Garrett to remove the mole for biopsy. In less than 30 minutes it was done, and Kathy's leg was neatly stitched up. The nurse showed us the vial containing the raw wedge of skin and tissue floating in formalin, the dark-pigmented lesion clearly visible.

Along with the repulsion, I felt a sense of relief. Surely, if Kathy's condition had been more serious, the procedure would have taken longer. But as we would soon discover, this was only the beginning of a long and painful journey that would consume the summer months and much more of my sister's skin.

Even though Kathy, our brother John and I tried to brace ourselves for the worst, the pathology report left our family reeling: The mole was confirmed as malignant melanoma, and the two spots were basal-cell carcinomas.

Garrett could surgically remove the basal cells, but because of the thickness of the original tumor, he was referring Kathy to Dr. Brian Kaplan, a surgical oncologist at VCU Medical Center with special expertise in melanomas.

Kathy saw Kaplan on June 10. He explained that she needed a wide local excision and a sentinel-node biopsy -- meaning he would cut deeper and wider to get clear borders of clean tissue around the original melanoma site. At the time of that surgery, radioactive dye would be injected into the area to trace it to the sentinel, or first, lymph node, to where the cancer cells may have drained, and that node would be removed for examination.

Our crash course in cancer education went into overdrive as we prepared for the next operation.

The statistics from sources such as the Skin Cancer Foundation were alarming: More than half of all new cancers are skin cancer. Nationally, there are more new cases of skin cancer each year than the combined incidence of cancers of the breast, prostate, lung and colon. Furthermore, the risk of developing melanoma has more than doubled in the past decade.

. . .

I sought out other cancer survivors, including my sister-in-law, Opal Ladin, who triumphed over advanced melanoma several years ago. She and others generously shared their experiences and offered advice.

Then I got a wake-up call of my own.

After Kathy's diagnosis, I saw a dermatologist, who discovered an "actinic keratosis" on my left leg. The small, scaly spot, also called a solar keratosis, results from sun damage and can be precancerous. Mine was skin-colored, but they can be pink or red. The doctor froze it off with liquid nitrogen. If not for Kathy's experience, I would not have had my skin checked or drastically curtailed my own sun exposure.

Kathy's second melanoma operation took place July 23 at VCU Medical Center.

"It looked like Jaws had taken a chunk out of my leg," Kathy said later, describing the excision. Because Kaplan had to remove a substantial amount of tissue to get the clear margins, the skin was actually sunken in above Kathy's right knee. The entire area was numb from the nerve damage that sometimes results from such extensive surgery.

. . .

Kathy quickly concentrated on getting well enough to return to her job as a customer-service associate. Since her vacation time and sick leave had run out, she would not be drawing a paycheck for several weeks. Her stubborn determination bolstered our family's spirits, even as we learned more bad news.

The pathology report on the re-excised area of the melanoma was clean. But the report on the sentinel-node biopsy revealed "metastatic malignant melanoma, micrometastases of 0.9 millimeters." Micrometastases, as defined by the American Cancer Society, is the spread of groups of cancer cells so small they can only be seen under a microscope.

Kaplan explained that the affected cells, though tiny, might have spread to the lymph nodes in Kathy's right groin area. To be on the safe side, Kathy could elect to have the lymph nodes removed. That could result in the potential complication of lymphedema, a chronic and progressive condition that could cause swelling and infection in her leg.

So now there was even more to worry about in addition to the cancer. "I'll deal with it," Kathy said, gamely agreeing to her third and most involved surgery.

Kathy was released from the hospital on Sept. 4 with a 10-inch incision in her groin. The drainage tube had to be emptied regularly. Her most difficult task was learning how to put on the tight compression stocking that covered her right leg from ankle to hip to prevent the dreaded lymphedema.

. . .

On Sept. 9, we went back for her post-op checkup with two of Kaplan's associates, who were to give us the results of the pathology report. If the cancer cells had spread into the groin lymph nodes, there would be more tough decisions. We held hands and held our breath as they opened the report.

"Of the 14 lymph nodes that were removed from your groin . . . all were clear."

Kathy and I burst into tears. She had dodged the bullet! We clung to each other crying and laughing. We babbled our gratitude to the doctors, then rushed home to share the news.

Our family and friends were giddy with relief. For the entire summer, melanoma had cast a long, dark shadow over our lives. It felt so good to breathe again, to smile again.

But the euphoria gradually dissipated as Kathy came to grips with the changes the cancer had wrought in her body. Her right leg was and still is grossly misshapen. So much flesh was removed from the top of her thigh that the surrounding skin and tissue has shifted and her upper leg has taken on a floppy, lumpy appearance. The skin above her knee remains sunken in and numb to the touch.

Kathy also had to wrestle with the question of doing chemotherapy as a follow-up measure. Knowing she would be regularly monitored by Kaplan and Garrett -- her "early-warning system" as she calls them -- she opted not to pursue chemo for the time being.

At work, Kathy must sit at her desk with her leg tightly encased in the compression stocking. It is difficult for her to walk or stand for very long.

. . .

Like all cancer survivors, Kathy is learning to live with a great deal of uncertainty in her life. That uncertainty has been reinforced by the continuing appearance of basal-cell cancers.

By the end of last year, Garrett had removed eight lesions, each requiring surgical excision and eight to 10 stitches. In March more spots appeared, which he quickly examined. This time they were actinic keratoses, which he froze off with liquid nitrogen. Nevertheless, peace of mind for Kathy remains an elusive goal.

I asked Garrett how we, as a sun-loving society, could do more to prevent skin cancer.

"I think that people are becoming more aware of the risks but still are not maximizing their protection," he said. "It takes time to change behavior, especially in our 'look-good-feel-good' culture that still values a tan.

"Prevention should be a lifelong goal," he said. "Start early by emphasizing the importance of sunscreen and sunblock to children. Manage your time carefully and avoid being out in the sun between 10 a.m. and 4 p.m., when the rays are the strongest. And if you have a spot that looks suspicious, do not hesitate to have it checked out. The earlier it can be treated, the better the rate of cure."

Kathy wanted to tell her story, mistakes and all, to try to help educate others about the dark side of getting that golden tan.

"I know there are cancer patients who have gone through worse, but I had no idea my diagnosis would lead to all this," she said. "If you think skin cancer can't happen to you, look at what happened to me. Then please think twice about sunbathing or using a tanning bed."

Kathy has worked hard to reclaim her life. Skin cancer has taken many pieces of my sister in harsh penance for the sin of careless sunbathing. The scars on her arms, legs and back from the 11 surgical procedures give little indication of how much physical and emotional trauma she has endured.

Though much was taken away over the past year, Kathy has gained a new realization of the strength within her, the fullness of love that surrounds her and a new crusading spirit.

Many lessons have been learned from that one small mole with its dark secret.