Me and My Melanoma

I’m not a very limber person. I can’t see what happens on my back on a daily basis. It rarely sees the sun, and I’m often surprised that I have a tattoo back there, and it’s Melanoma originalbeen there for about 13 years. So when my spouse told me a few months ago that I should have this spot on my back looked at, I made her take a picture of it with my phone so I could see it. That picture on the left is one taken by her in April of this year.

I work in the health field and am familiar with a lot of aspects of human health and performance, but I’m no expert on moles. Like most people 15 years into the 21st century, the first thing I did was a Google image search. I thought that, yeah, the mole was a little weird, but it was probably nothing. Nonetheless, I went ahead and made an appointment with a dermatologist.

What follows is a diary I’ve written of the process, starting with my first appointment with my dermatologist. Not only does this serve as a bit of catharsis for myself, but I’m hoping this account will help others going through the same thing and younger people to avoid making mistakes I’ve made when it came to skin care.

Tuesday, June 23: First appointment with dermatologist

I’m in the waiting room with about 15 other people, and I’m the youngest person there. I keep wondering if I’m wasting my time since skin cancer usually happens to people older than I am*.

*Not true, as it turns out. Skin cancer is happening to people my age and younger at a faster and faster rate. In fact, most cancer diagnosed to people around my age is skin cancer.

After filling out some initial paperwork, I’m back in an exam room changing into a surprisingly nice gown. The PA comes in to see me. I show her my spot, and she immediately says that it’s definitely something to take a look at. She looks at the rest of my skin for any other suspicious moles, and thankfully didn’t find any. She brings in the doctor to look at the spot, takes a picture, and then asks me for permission to take a sample of the mole for further examination. “Of course,” I say. She numbs the area, removes the mole, cauterizes the wound, and patches me up. It was a painless procedure, very easy and very quick.

I make an appointment for a yearly visit, and they let me know that my results should be back in a few days. Now, it’s time to head back home and get ready for my visit to Oklahoma the next day.

Monday, June 29: The phone call

I received the phone call while in the car with my mom and brother in Oklahoma. The nurse told me it was melanoma and asked me if I was okay. Why wouldn’t I be? I wasn’t sure how else to react. Let’s just schedule something to take it out and we’ll be done with it. But she was saying words like oncology and radiation treatments, and my brain started to scramble. Wait, wait…what’s my next step? “Can you come in for a consultation with a surgeon tomorrow?” Unfortunately, I’ll be on a plane all day tomorrow coming back home to New York. “Okay, we’ll call you back to see when we can get you in.”

I was a little in shock. Does this mean that I have cancer? I’m 38. I lost my dad to brain cancer. This can’t be happening to my family again. This can’t be happening to me. Everything was happening so fast. In a way, I was glad the phone call came with my mom with me. That way, I wouldn’t have to work up the courage to have this conversation with her out of the blue.

We are a family that doesn’t show a lot of emotion. We do what needs to be done and do it and let’s not dwell on it and what were we talking about again? That’s how I want to move on with this issue that’s come up. But first, I need to get this consultation scheduled and over with to put my mind at ease.

Tuesday, July 7: Initial appointment with surgeon

Today is the surgical consultation. I meet with Dr. David Monacelli and his staff. He and his staff couldn’t have been lovelier. We discuss what the surgery will entail and he draws a picture of what the scar will look like. I’m thinking, who cares what it will look like, just take the damn thing out. Turns out that for such a small spot on my back, I’ll have a fairly large chunk of skin taken out along with a 6-inch scar. Since the spot that will be taken out is in a circle, he needs to make straight incisions on the top and bottom in order to properly close the wound. We also discuss the need for the surgery, including removing any remaining cancer and being able to properly diagnose how far along the cancer is.

Wednesday, July 15: Pre-op appointment

We went over a lot of paperwork today in preparation for the surgery on July 27. I’m ready to get this show on the road. The surgeon talks about my consent for the hospital to dispose of the tissue they remove from my body. I’m like, please get rid of it, burn it, incinerate it, and show this traitorous tissue exactly what we think of it, thank you. In the weeks following up to the surgery, I also receive two phone calls from the hospital to discuss paperwork and my pre-op instructions.

Monday, July 27: The Day of Surgery

We check in at 7am at the Cayuga Medical Center in Ithaca, NY. We are led to the surgery waiting room. I had just a very short wait until I was led back to my room for the day. I changed into a very comfortable gown and socks. I’m serious about the gown and socks–they were super comfortable.

My surgery was scheduled for noon. Before surgery, I had a sentinel lymph node scan. One of the things we don’t know yet about my melanoma is not only how deep it is, but if it has spread to any lymph nodes. Before we biopsy any lymph nodes, we need to see which lymph node the tissue around the melanoma drains to. That’s what the sentinel lymph node scan is for.

Before heading back for the scan, the nurse told me I could still have water for another hour and asked me if I’d like some.IMG_0656

 

BRING IT ON.

 

 

 

The first thing that happens is the radiologist injects radioactive dye in an X pattern around the melanoma. In other words, one injection into the skin above, one below, one to the right, and one to the left. The injection wasn’t pain-free , but the pain only lasted a few seconds.

After the injections were given, I was placed in a machine that could track the dye and where it was draining. The technician told me it could take anywhere from 30 minutes to 2 hours to see where the dye goes, but it only took about 20 minutes. Way to go, lymphatic system!

Sentinel Node ScanIt turns out that that part of my back drains to a lymph node in my armpit. It shows up pretty clearly in the scan, which you can see on the left.

After the node was identified, the radiologist marked it with an X.X marks the spot

And now, the worst part of the day: waiting for the dye to dissipate before the surgery. It was the longest two hours. I spent the time playing my new favorite game, Alphabear. Finally, it was time to head back to the operating room.
Dr. Monacelli wanted to take a 4-centimeter-wide circle of skin out from around the melanoma, while also going deep enough to try to remove the whole melanoma. Once we know how deep the melanoma is and if any cancer cells have spread to the closest lymph node (the sentinel node), we will be able to complete the staging process. Unfortunately, we won’t be able to know those results until the end of the week. But back to the surgery.
Surgery road mapHere’s the “map” Dr. Monacelli drew on my back as an outline for the surgery. In addition to numerous nurses and doctors asking me my name, birthdate, and other questions to make sure I was the right person, I had numerous people initial on my skin. You can see the radiologist’s faded initials right above Dr. Monacelli’s initials (DM). The melanoma spot is circled.

I am a fan of all the checking the staff did about my name, birthdate, and what I was there for. More questions mean less mistakes, and for that I am grateful.

As expected, the next thing I remember was waking up in recovery. It’s funny the way anesthesia affects people differently–I have family members who get angry, some who get nauseous, some who get sad, and some who get all of these things. I, however, waved at all the nurses and couldn’t have been happier.

Here’s what my back and right armpit looked a few hours after the surgery. All nice and tapey.

Back post-op
Armpit post-op

Tuesday, July 28: Post-Op Appointment

The next morning at 8am, my spouse drove me to my first post-op appointment. Dr. Monacelli removed the bandages and was pleased with how everything was healing.

Back post-op one dayMy wounds are covered in steri-strips, which will fall away by themselves. Basically, all I have to do is leave them alone. Which is harder than it sounds.

At this point, the only thing I have to do is rest and think about the possibilities that lay before me. The best possible outcome is finding the melanoma is not deep and has not spread to my lymph nodes. Alternatively, the worst outcome is finding out that the melanoma is deep and has spread. I already know a few things about the tumor, but the best predictor for my survivability is the tumor thickness. Friday can’t come soon enough.

While we’re waiting for Friday, here’s some more in-depth information about melanoma staging and all the factors that play a part.

Melanoma–My Generation’s Scourge

Why do some humans get melanoma? As you can see from my pictures, I am fair-skinned. Red/blonde hair, freckles, see-through…a phlebotomist’s dream, but a dermatologist’s nightmare. My ancestors are from northern Europe and lived in a climate that was cooler and less sunny than Oklahoma. Evolution has not caught up with my ancestors’ moving habits.

Author Daniel Lieberman writes in his book The Story of the Human Body: Evolution, Health, and Disease, “Fair skin, for example, does not protect against sunburns but is an adaptation to help cells below the skin’s surface synthesize enough vitamin D in temperate habitats with low levels of ultraviolet radiation during the winter.” My fair skin + Oklahoma’s high UV = a greater chance of melanoma.

Basically, using a tanning bed and being out in the sun without sunscreen is like playing Russian roulette. Except the gun doesn’t go off for another 30 years. Unfortunately for me, that loaded gun went off with a bullet in the chamber.

A lot of  people my age went to tanning beds when I was in high school and in college. In fact, people used to tell us that the more we tanned, the less chance we would have of getting a sunburn. Eventually, I stopped going and began to use more and more sunscreen, but damage had already happened to my skin. Just the fact that I’ve been in a tanning bed increases my melanoma risk by 75%.

I still have this way of thinking, even now, that having a nice tan is healthy. It meant you’ve been outside, working hard. This is something I will struggle with in the future, trying to change my thought process and changing my lifestyle.

Friday, July 31 – My Results

Today’s the day I’ve been waiting for. Today’s the day that will affect the rest of my life. I’ve prepared myself for the worst, but there’s only so much preparation you can do to receive the news that you still have cancer. I know I’ll fight until the day I die, but I honestly don’t want to ever put my family through having cancer. We’ve been there, and I don’t want them to have go through it again.

Thankfully, they won’t have to, at least this time. I’m cancer-free! Dr. Monacelli told me that they found no cancer in the lymph node and all of the cancer was removed. Technically, my melanoma was staged at T1b, which is an early melanoma stage.

I’ll have appointments with an oncologist to consider any further treatment, as well as regular 3-month checks with my dermatologist, Dr. Kim Silvers in Ithaca. We’ll be getting to know each other very well over the next few years.

This will be something I’ll be living with for the rest of my life. My chances of a recurrence of melanoma are fairly high. Just the fact that I’ve been in a tanning bed actually increases my melanoma risk by 75%.


I’m not going to take this great news and just move on. Oh imma take me some great news, but I feel like God wants me to spread the word about melanoma. I want to urge everyone to take care of their skin, put on sunscreen, and for God’s sake, please don’t go to a tanning salon. Please share this post and the message of skin safety. Now, go put on sunscreen and enjoy the summer weather!

UPDATE 1, August 14

Back post-op 8-14-15Hey everyone! Just a quick update on scar progress. It is slowly healing, and we’re being very religious with sunscreen and scar massage. I’ll update again in a few months.

 

 

 

UPDATE 2, October 19

I’m almost 3 months post-op, and everything is healing quite nicely. Here’s a new pic of
my back.

Back post-op 10-12-15

Looks pretty good! I wish I could say everything about the surgery has been picture perfect. I still don’t have a great deal of feeling over a large part of the right side of my back (to the right of the tattoo). All things considered, the loss of feeling in my back versus having a deadly form of cancer, I’ll take loss of feeling any day. It’s more of an annoyance at this point. Dr. Monacelli stated at my last post-op appointment that it could take up to 6 months for feeling to return. I’ll let everyone know in a few months!

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2 thoughts on “Me and My Melanoma

  1. Pingback: The Science of Melanoma | Orders of Magnitude

  2. Pingback: Me and My Melanoma | Orders of Magnitude

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