Melanoma Surgery

I spent yesterday morning working furiously on a series of posts on going bald (these aren't up yet), and then showered and dressed just in time to make it to my dermatologist's office for my melanoma procedure.

Calling it "surgery" sounds a bit dramatic, but that's what is was, of course. An office procedure called a "wide excision."

My dermatologist, Dr. Richard Grabowski, gave me a copy of the pathologist's report and explained everything to me carefully.

I was right in my recollection of what he had said on the phone. My melanoma was only 0.2 millimeters thick, which is good. But the melanoma had gone into the second level of my skin, making it invasive. Not so good.

The report says I had a "difficult and challenging melanocytic neoplasm with a differential diagnosis of a malignant melanoma..." "Difficult and challenging"? I don't think I want to know.

Dr. G said it was Clark's level II. I looked that up on Oncolink this morning, and this is what it says: "Clark's Level II involves the epidermis and the layer of skin immediately below, the papillary dermis." Which is, of course, what my doctor had said.

The surgery itself involved a larger incision than I had expected, and this is why:

The protocol for a melanoma like mine calls for cutting away 1 centimeter in all directions from the melanoma. So Dr. G drew a circle with a 1 centimeter radius around the original incision from when he had removed the mole for biopsy. But he can't close an incision that is a circle, so then he drew lines outward in two directions until the drawing on my arm resembled an elongated Egyptian eye. The eye is about 2 inches long.

Then he cut along those lines, after numbing my arm (I stopped watching after that point), sewed me up with internal stitches and some on the outside skin, and I was good to go. His nurse made me an ice pack out of a glove to put on my arm as I was driving home.

I felt a little queasy afterward, but well enough to stop by Taco del Mar for a burrito for dinner and a quick trip to the drug store for a few things.

I was in bed by 7:30, asleep by 8:30, and slept till almost 9 this morning. Now, my arm hurts. The incision bled a fair amount into the gauze that's taped onto my arm, but I'm not supposed to remove it for 24 hours.

Also not supposed to exercise or use my arm to lift anything for 48 hours, so I canceled my workout today. But I will walk my dog and work in the garden for a bit (with the other hand) if the rain stops.

Dr. G and I also discussed how careful I need to be about sun exposure in the future. I've been following the debate about vitamin D and moderate sun exposure, and since I live in far-north Seattle where the sun is weak anyway, my practice is not to put on sunscreen or wear protective clothing unless I am going to be out long enough that I might burn. Or on the water. And of course when I am in Hawaii I do the full-meal-deal: hat, sunscreen, and protective clothing.

He agreed that this level of caution was appropriate, so I'll just carry on.

The only thing that's new is that I need checkups every three months to watch for another melanoma and also for the other types of skin cancer, since I am apparently at greater risk for skin cancer generally, now that I've had melanoma.

@ Jeanne Sather 2007.

Comments

[Sara]

You know, the problem with melanoma is that it's a very sneaky and complicated disease which can lie dormant for years and which metastasizes when it metastasizes at a microscopic level through the lymph system. My dermatologist here in Massachusetts is one of the most knowledgeable and competent I've ever encountered, and she has told me that if they knew what caused melanoma, they would know what to do about it. She has many patients here who have never been out of Massachusetts and do not bake themselves in sunlight and have it anyway.

The big thing I want to tell you (besides congratulations on having that little f*cker off, and I hope they got clean margins and that you don't have any others) is "'Don't Panic' in big, friendly letters." :) I'll have had the disease for 28 years this summer, and it went undiagnosed the first 10 years because I was uninsured and busy, so that by the time I had my first lesion off it was way past Clarke's level IV, required a 5 cm-radius excision down to and including the fascia of my calf and a skin graft to cover it all. Everyone was pretty sure I would die in five years, and that was 18 years ago. It's closing in now, but I'm still here.

Women tend to survive melanoma better than men because we tend to get it on our extremities and men tend to get it on their torsos, closer to vital organs. Getting it at all sucks, but it's more than likely there's nothing you could have done to prevent it, and there's nothing to be done about it now that you aren't already doing.

Sorry. I would have piped up with all that sooner, but I got sick for a week. And anyway, best wishes for a really boring outcome. :)

[Lynne Eldridge M.D.]

Jeanne,
It sounds from your comments like you are way ahead of most medical professionals in your research! An article you may want to look up on Pubmed.com since it goes against usual reasoning showed that moderate, sensible sun exposure actually increases survival from melanoma (probably secondary to vitamin D). The reference is Berwick, M. et al. 2005. "Sun exposure and mortality from melanoma". "Journal of the National Cancer Institute" 97:195-199. Best wishes and thoughts -

Lynne Eldridge M.D.
Author, "Avoiding Cancer One Day At A Time"
http://www.avoidcancernow.com

[Ed Buggie]

Read with interest. My son has thin melanoma 0.25mm with similar excision. Our pathologist informed us that 0.25 mm has a very good prognosis but also listed some other criteria, location, any ulceration, Ki67 isotope uptake, degree of mitosis, age (he's 23). For my son all of these were upper arm, no ulceration, no uptake, no mitosis. So we are very hopeful but still pray frequently. How do you stand with these additional criteria?

[jeanne]

Thanks, Sara, Lynne, and Ed for all the information and support.

I finally took the bandage off yesterday afternoon, and the incision is more like 3 inches long and it hurts. Made me feel a bit queasy to look at it so I abandoned ship for the rest of the day and went to bed with a book.

Today I'm determined to have a more normal day. My dog needs a walk, and I have some thngs tp do, plus a massage!

Jeanne

[Judy]

The planet was removed on Monday. The two inch incision is healing nicely but my brain is in high gear over the shock of a melanoma. I've had this mole ever since I could remember. It acted up once when I was about 15. The doctor did nothing. I also had the "mole treatment" years later with the nude pictures and it wasn't suspect even then. Watch those moles. They can sneak up on you.

I been walking around with my heart in my throat since the doctor called with the biopsy results late Friday. My follow-up is Tuesday.

I wanted to say that I've been on the internet alot in the last day checking out melanoma information and the emails I read here have been more informative than any doctors report. I could relate.

I'm hoping for a really "boring outcome" from all of this and will keep reading this website for updates from others that have had successful removal and hopeful futures. Good luck to you all.

[Jeanne]

Judy--I'm hoping for a really "boring outcome" for you too. But whatever happens, please check back in with me and let me know how you are doing.

I had my wide excision not quite six weeks ago, and it's healing really well, and I think this is all behind me, but it's hard not to worry or to wonder if there is anything else I should be doing.

Take care,

Jeanne

[camille]

I have been diagnosed with a melanoma clark level 2 0.5mm my dermatologist told me how lucky I was (?) and that the cure was 100%. Since I am sad, depressed and evrything I read is so negative. Cannot seem to find any long term survivor from melanoma anywhere. i would like to enjoy life again and not looking at my little boy thinking I will not see him grow up.

[Jeanne]

Hi Camille--I'm really sorry about your melanoma. About feeling sad and depressed--I don't think that's surprising. It's scary. And when you have a child it's doubly scary. (If not some much bigger multiple.)

My take on that is that you feel what you feel. And if you try to deny your feelings or push yourself to "get over them" they will just go underground. So just feel what you feel for as long as it takes. (If you get seriously depressed, you might want to talk to a counselor--I have a therapist I see every week and I have since I was first diagnosed with cancer.)

I think the reason you don't read about the long-term melanoma survivors is that they have gotten on with their lives and are not out here blogging about the experience.

My melanoma diagnosis was just a few months ago, but I expect to be a long-term survivor. So you can stay in touch with me if you like.

Take care,

Jeanne

[camille]

Hi Everyone. I was diagnosed with melanoma stage 1 clark level 2. As it is very this 0.5mm mydermatologist assured me of a 100% cure. However everthing I read is scary and I am so scared and worried. Do I have to think melanoma every time i have a headache, flu... ??

[camille]

Thank you Jeanne. My aunt had a melanoma stage 1 clark 2 of 0.45 eight years ago and she is doing great never had a problem since. It is true what you say as someone told me exactly the same. people who ahd a brush with melanoma do not speak about it. It is perhaps better. My margins were all clear and my dermatologist told me I am cured so no longer have cancer. Hope you will all do well.

[Jeanne]

Hi Camille--I read this post re worrying it's melanoma everytime yo- feel sick, and sadly that is the way it is for most of -s who are living with cancer. (Sorry, I have a jammed key this morning.)

I try to walk the line between keeping an eye on things and checking with my doctor and not going crazy over every little thing--it is a hard line to walk! I also have a really good therapist who I see almost every week who has helped me with this.

And having good friends to vent to and to call when I feel scared really helps, as does writing my blog.

[barb]

Hello everyone,
Had my superficial spreading lesion (level 2) removed July, 1988. I have a HUGE hole in my right upper arm - yikes - no sleeveless or strapless for me, but that's it. never had chemo, radiation etc. Stayed out of the sun for YEARS following removal/resection. Now, I am back "in" the sun but with precautions. I check every little speck all the time and those of my family as well. I feel so lucky. So thankful. Prayers to all dealing with this - B.

[camille]

Hi Barb. I also have alevel 2 0.51mm I believe the prognosis is almost 100 % but I am so worried all the time as you read story of relapse and then nothing can be done.How can I know it will not come back? I had no ulceration, mitosis below 1 so all that is good I guess.

[jeanne]

Camille--it is not true that nothing can be done if your melanoma returns. It can be treated.

If you are worried, maybe make an appt to talk to your doctor and ask specifically what he or she would do if your cancer returned.

I am living with metastatic disease, metastatic breast cancer, not metastatic melanoma, but I've lived almost six years since my cancer metastasized ... with good quality of life for most of that time.

Jeanne

[camille]

Hi Jeanne, Thank you for your kind reply. The problem with melanoma is that no cemiotherapy seem to work unlike in breast caner or others. But I keep my finger crossed as many specialised people told me that 0.5 breslow is of excellent prognosis and the rest of my histopathology report is good too. Still worried and I wish I could find a way to get my life back. My surgeon told me to put it behind and get on with life...easier said that done. So if anyone has been where I am please help! I wish you well Jeanne. My friend had a colon cancer 12 years ago with metastasis to the liver and she is doing great with no recurrence so there is hope for everyone!!!

[jeanne]

It is hard to "put it behind you." Maybe you have some more talking to do? A support group might help there. Or more info gathering? The Web is good for that as long as you are careful of the source of the information.

Being told, "Put it behind you," is not that helpful. Feel free to vent to me at any time. I certainly understand your fears.

Jeanne

[barb]

yes camille, i too went thru a period as if i had to look behind me to see if "it" was coming after me: for YEARS. I saw every specialist, read every journal, stayed under umbrellas just getting to the car. Three days after I had my first biopsy I met a woman who told me I had nothing to worry about unless it was melanoma. I wondered what THAT was. She had just lost her 35 year old brother to Stage 4 melanoma. He had it for years and ignored it. Every specialist remarked after viewing my slides of the wide excision done after the biopsy that "I was cured; that all was removed with the biopsy. Well, what was with that huge hole and skin graft?
Now, I am on to total health care. Or at least trying. Organic food, nutritional supplements, exercise, shopping. That's all I can do. If it comes back? I will be very aggressive and make those specialists explain why. Other than that? Life is good. Live it. Enjoy it. Personally I am now more afraid of the expressways taking me away than a peculiar lesion. For I am always on the look out for a strange mole...but driving is just crazy these days. Take care. And I hope calmer days are just ahead for you. Mine took about a year to begin. Prayers and blessings to all.

[jeanne]

Barb--thanks for your input. I just came back from the beach, a three to four hour drive, depending on traffic, and I certainly agree about feeling more at risk while driving than from cancer. But it takes awhile to get there.

Jeanne

[Lindsay]

Hi everyone! I was just diagnosed with a stage 1b (1mm) melanoma on my arm. I am 24..and I am so scared. I went to UVM to have them do another biopsy to make sure thats how big it was, and they said they found no more then what they originally found. There was no ulceration, there however was 1 mitosis, that was low I guess. I'm really not sure of what that means. They said I would need a wider excision surgery and a sentinal lymph node biopsy and to take my lymph node out for caution, I guess. They felt all my lymph nodes and said they didn't feel anything..but I'm still wondering about the chances of it spreading because of the mitosis. What does that mean? Can someone please explain it to me a little better? Also why would they take a lymph node out if there was no cancer in it......?

[Lindsay]

Hi everyone! I was just diagnosed with a stage 1b (1mm) melanoma on my arm. I am 24..and I am so scared. I went to UVM to have them do another biopsy to make sure thats how big it was, and they said they found no more then what they originally found. There was no ulceration, there however was 1 mitosis, that was low I guess. I'm really not sure of what that means. They said I would need a wider excision surgery and a sentinal lymph node biopsy and to take my lymph node out for caution, I guess. They felt all my lymph nodes and said they didn't feel anything..but I'm still wondering about the chances of it spreading because of the mitosis. What does that mean? Can someone please explain it to me a little better? Also why would they take a lymph node out if there was no cancer in it......?

[Lindsay]

Hi everyone! I was just diagnosed with a stage 1b (1mm) melanoma on my arm. I am 24..and I am so scared. I went to UVM to have them do another biopsy to make sure thats how big it was, and they said they found no more then what they originally found. There was no ulceration, there however was 1 mitosis, that was low I guess. I'm really not sure of what that means. They said I would need a wider excision surgery and a sentinal lymph node biopsy and to take my lymph node out for caution, I guess. They felt all my lymph nodes and said they didn't feel anything..but I'm still wondering about the chances of it spreading because of the mitosis. What does that mean? Can someone please explain it to me a little better? Also why would they take a lymph node out if there was no cancer in it......?

[Lindsay]

Hi everyone! I was just diagnosed with a stage 1b (1mm) melanoma on my arm. I am 24..and I am so scared. I went to UVM to have them do another biopsy to make sure thats how big it was, and they said they found no more then what they originally found. There was no ulceration, there however was 1 mitosis, that was low I guess. I'm really not sure of what that means. They said I would need a wider excision surgery and a sentinal lymph node biopsy and to take my lymph node out for caution, I guess. They felt all my lymph nodes and said they didn't feel anything..but I'm still wondering about the chances of it spreading because of the mitosis. What does that mean? Can someone please explain it to me a little better? Also why would they take a lymph node out if there was no cancer in it......?

[jeanne]

Lindsay--I'm not surprised that you're scared. Go ahead and be scared.

Then, I think you should write all these questions down and take them with you next time you see your doctor. Tell him or her that you have some questions, and then pull out your list and a pen and ask the questions. Ask again if you don't understand something. And write the answers down so you don't forget.

When you're scared and stressed it's really hard to remember things, and you might get home and wonder just exactly what the doctor said. That happens to me all the time.

About the lymph node, I can explain.

One way that cancer spreads is through the lymph system. So it is common to remove a few lymph nodes near the cancer to see if it has spread that far.

So when women have breast cancer surgery, they usually have lymph nodes under the arm removed to be biopsied.

With breast cancer, there is now a procedure called sentinel node biopsy, which I had, where only a few lymph nodes (three, in my case) are removed instead of a dozen or more.

My understanding is that it is a judgement call whether or not to check the lymph nodes, so you might ask your doctor why he/she thinks this is necessary. In my case, I didn't have any nodes biopsied, just a wide excision at the site of my melanoma.

Hang in there, and let me know how things go.

Jeanne

[Cory]

Hello,
I was told that I had stage 2 melanoma, clarks level 4 when I was 25 years old (I am now 29) and 7 months pregnant with our second child. I had a wide excision done and a sentinel lymph node biopsy done and got a clean bill of health. However I continue to go to the dermotoligist every 6 months for a check-up and always get moles taken off that "look funny".....almost always they come back atypical. I feel like I am a professional at picking the moles on my body that are pre-cancerous. My questions are these.....I live my life to the best of my ability but there is a not a day that doesn't go by that I don't fear melanoma is somewhere in my body undetected. My anxiety is so high, am I the only one that obsesses and fears this crappy disease this much...is it normal? It feels so bleak. And has anyone else had that experience, so many atypical moles? I get them removed and they are atypical. Fear. I fear I won't be able to stay ahead of the fight with this.
Cancer sucks. I am happy, I love my life but the fear is always there.

[jeanne]

Hi Cory--I think it's not unusual to have these fears. I do, and I've lived with cancer for nine years now.

But there are things that could help. I see a therapist every week (talk therapy), and that definitely helps me. I also take meds for anxiety, and that definitely helps as well. Because this high level of fear can wear you out.

Some people do support groups, but that doesn't work for me.

On the up-side, it's good that you are so diligent and get things checked out.

Take care, and write again if you like,

Jeanne