Lightning Strikes Twice

Yesterday morning I had a half dozen phone messages on my answering machine. I worked my way through them, quickly fast-forwarding and deleting, pausing on the two from doctors, my oncologist and the dermatologist who had removed a mole from my arm last week, both saying they needed to talk to me about some test results.

I returned these calls immediately, but of course was only able to leave messages, not speak with the doctors. That sent me into a bit of a tailspin, because there is no way that, "I need to talk to you about your test results," is going to be good news.

Long story short: I have melanoma.

Longer version: I really didn't believe that lightning could strike twice, that I could get another unrelated cancer. That's why I haven't worried too much about getting an MRI on my remaining breast. (Just a mammogram once a year.) That's why I haven't gotten a colonoscopy, even though I'm past 50 and my brother has colon cancer. (In both cases, I discussed these issues with my medical oncologists, and in both cases had their blessing not to get the tests. Still, the decision was always mine.)

But this mole. It's been looked at twice in the past two years, once by a dermatologist and once by my previous medical oncologist, and they both told me it was fine.

But I wasn't convinced. It was very dark. It had an irregular border. And a couple of months ago it got scabby and bled a bit.

So I asked my new medical oncologist about it. She sent me to a dermatologist. He didn't like the looks of it, so he removed it for biopsy, and then the phone call.

Quite honestly, I thought it was skin cancer, but I didn't think it would be melanoma, which for all my writing about cancer I only remembered vaguely as "the bad one."

Treatment
When the oncologist called me back to tell me that the mole was melanoma, he said that it was very, very thin. That's good news. He said he would do a larger excision next week, and then just follow me closely.

And that's it. Pretty simple, compared to the treatment for breast cancer.

The Facts About Melanoma
Yesterday afternoon, after I came out of my tailspin, I went to the Skin Cancer Foundation Web site to read about melanoma. It is, as I thought, "the bad one." Melanoma is the most deadly type of skin cancer, but if caught and treated early, it is almost 100 percent curable. Let's hope mine is considered "early." I think so, since it is so thin.

Then there are those risk factors:

Sun Exposure Yup. I lived in Hawaii for four years.

Moles The more moles you have, the greater your risk for melanoma. I have a LOT of moles.

Skin Type People with fair skin are at greater risk. I have pale freckled skin, green eyes, and blonde hair.

Family History About one in 10 people who get melanoma have a close relative who has also had melanoma. I don't think any of my relatives have had melanoma, but my dermatologist suggested that I warn my siblings, and I've already done that.

Personal History If you've had melanoma before, or another type of skin cancer, you are at greater risk for a second one. This is my first one, but it means greater vigilance on my part.

Weakened Immune System I didn't know about this risk factor, but a weakened immune system can increase your risk of melanoma, according to the Skin Cancer Foundation. Well, the chemo certainly qualifies, so I have this risk factor.

That Other Phone Call
Oh, and then there was the other phone call, the one from my medical oncologist. Apparently, my creatinine was high on my last round of blood tests. Creatinine is a measure of kidney function, and the cytoxan that I've been on for a year or so may be damaging my kidneys.

But for now, I am supposed to drink a lot of water and we will repeat the test in a couple of weeks.

The fun never stops!

Update:
Chemo and Melanoma Risk?

@ Jeanne Sather 2007.

Comments

[Katrina]

Wow. I'm so glad you followed up on this mole. It sounds like you did catch it at stage 1. My husband was diagnosed at stage iv last year with melanoma. There is a great resource for melanoma patients. it's http://www.mpip.org/. There is a very active bulletin board there and people to help with any questions you might have. There is also a email circle, I think for stage 1 and 2 patients. Someone there will be able to direct you to it if you're interested.

So sorry about this news. I'm sure it was a shock after all you've been/you are going through.

May is melanoma awareness month. Just in time for summer.

GET SKIN CHECKS EVERYONE!

[jeanne]

Katrina--thanks for the information. I really appreciate it.

I agree: Skin checks, everyone!

Jeanne

[Brian]

The most important thing is to find potential melanoma lesions early while removal can be a cure. People at high risk (especially if you have already had a melanoma) need to follow their skin closely. The traditional ABCD criteria can help guide risk assessment. A, for asymmetric lesions; B for moles with irregular Borders; C, for colors in the lesion; and D, for diameter greater than the tip of an eraser.

More recently physicians have recognized the importance of moles that are new or getting larger in predicting high risk lesions. They have now added E for enlargement to the criteria and many recommend following the ABCDE’s.

Although dermatologists almost always ask if you have any new or changing moles most people cannot accurately answer that question (particularly those with numerous moles and the greatest risk). One way to approach this problem for people at high risk is to use Total Body Photography to document the moles on your body. However, this is an expensive procedure (often costing $400-$600) that most insurance providers will not cover.

There is now an inexpensive software program that allows people to use their own digital cameras at home to take their own body images at different time intervals (maximizing privacy). The images can be scaled and aligned and compared using a personal computer to allow for the efficient recognition of new or growing moles. This software was developed from funding provided by the National Cancer Institute and can be obtained by going to the website http://www.dermalert.com

[jessica]

i'm so sorry this had been added to your plate, jeanne. i don't have as much to offer in the way of information as those above, but know that you are in my thoughts and i am sending much strength over the miles.

[BetteJo]

I just posted about going to a dermatologist who looked at me like I had 3 heads for going to him to "have moles checked". It was a horrible experience and from what I am hearing - good dermatologists can be hard to find!
Good thing you have a good one!

[jeanne]

Isn't that weird? The dermatologist I saw about two years ago to have mine checked missed the one that turned out to be melanoma, and also told me I didn't need to come in once a year to have my moles checked. He said that they didn't find that many skin cancers that way and it wasn't worth the cost!

Anyway, if you need a good dermatologist in Seattle, let me know.

Jeanne