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Old 09-08-2009, 06:40 PM   #1
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what should I expect?

just looking for some advice from someone who has experienced melanoma before, I am 42 y/o male, recently returned from iraq and had a mole removed that came back as melanoma,It was located on my back .90MM superficial spreading clark level IV.it was removed 6 weeks ago, and i have been getting the run around from insurance trying to find a plastic surgeon, I finally got to see him last week and much to my surprise he cannot treat me, he said it was past his level of expertise and I now will see another plastic surgeon next week. The first one told me I would need the SNB, a skin graft, and the rest of my moles checked, my family physician identified 16 others he would like to have removed. I am still in the service and am scheduled to re-deploy in 16 months. I hope this will be completed soon so I can begin recovery but not sure how I will be able to be closely monitored as suggested in the future

 
Old 09-08-2009, 09:24 PM   #2
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Re: what should I expect?

Hello, I would make sure you get those 16 checked and off if necessary before you deploy. Very important to do that first. Do you have a good VA Medical Center near you? My father had a great Melanoma Clinic at the Long Beach VA in California. He got the Best care there.

Please make sure you follow up on those suspicious moles and make sure you keep your skin check ups on time until you are in the clear. Make it a priority.


Sincerely and thank you for serving our Country..... Oleander

 
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Old 09-09-2009, 10:53 AM   #3
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Re: what should I expect?

Hello and welcome!

I had a melanoma removed in March 2007, and so far I'm doing well. My melanoma was nodular with a thickness of .70. I did not have a SNB.

In searching for a surgeon, it must be made clear that you need one that specializes in melanoma, and specifically SNB. I'm never clear why some patients are referred to plastic surgeons for this procedure, when a surgeon at a hospital with an excellent melanoma department far exceeds a plastic surgeon. At 6 weeks out, you should already have had your SNB. I know you are probably doing the best you can, and insurance companies are frustrating entities in their own right, but this is something that you must stay on top of daily, if not twice daily. This is your life!

As to what to expect? Even though I've not had a SNB, I am familiar with the procedure. You don't state if the procedure completed 6 weeks ago was a biopsy or a wide excision, so I'm going to assume it was a biopsy. If that is the case, the surgeon will first complete what is called a Wide Local Excision at the site where the mole was removed. This involves removing a wide swathe of skin and tissue around the mole (a few centimeters) and down to the muscle. They do take a chunk. If you can see the wound where the mole was removed, the excision from the WLE will be about 3" or 4" long and quite deep. (I'm saying this because it was a bit of a shock to me)

Then, while the wound is still open, the surgeon will inject a dye-type solution into it, and will follow where it goes in the lymph system. See, if the melanoma has spread to the lymph nodes, it will enter the lymph system and follow a certain path. The surgeon will hope to replicate that path to the lymph nodes most likely to be involved, IF they are involved. Certain lymph nodes will "light up" from the dye. Being that the melanoma was removed from your back, the most likely spot for the lymph nodes will be in the shoulder areas. But it might be the groin area or even the neck - it just depends on where the lymph system travels from that particular spot. Once the surgeon determines what has "lit up," another excision will be made where the lymph nodes are located, and he/she will remove several of the lymph nodes for biopsy. And, a warning: this excision isn't all that small, either. Then, you are stitched up, and sent home. This is all done as outpatient surgery.

Recovery for WLE and SNB is longer than for WLE, because of the missing SNB. I do believe there are drains inserted where the lymph nodes were removed, so that might be a bit of a hassle to contend with. But hey, this is your life, you know?

Full recovery shouldn't be that long, however. A WLE does take some times, as there is quite a bit of skin gone, and it's stretched pretty tight. Now, mine was on my knee, so that meant I couldn't bend it, so getting in and out of a car was almost impossible, sitting was difficult, walking was hard, etc. So keep this in mind. Plus, you will also have the additional excision where the lymph nodes are removed. However, I would think within a few months, you'd be just fine. You'll have some fine scars, though. And hopefully, the SNB will come back negative, and the WLE results will achieve "clear margins!"

As far the 16 moles your physician wants to remove (that is alot!), you can start having that done now. I would imagine most, if not all of those, will be atypical, and probably nothing to worry about. Best to get those taken care of and out of the way.

When you are re-deployed in 16 months, you should be fully recovered from the surgeries and good to go. BUT! Monitoring yourself will be VERY important! It would be best to be able to have a dermatologist look at you every 6 months, if possible. But, if that simply isn't possible, at least do regular skin checks yourself. Seriously. After this, you are at a much higher rate of recurrance than anyone else. And I don't mean to be a total "downer," but do you realize that, at .90 thickness, if lymph nodes are NOT involved, you will probably be stage I. BUT, if the lymph nodes are involved, you will automatically be stage III cancer?? That is serious. I really hope your SNB comes back negative, because melanoma is a beast. But I do urge you to take this seriously. I've encountered too many people who didn't do the follow-up care, and they aren't here any longer.

Keep us posted on what happens, K? Good luck!

 
Old 09-09-2009, 06:33 PM   #4
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Re: what should I expect?

Thank you both for the info.,and to answer your questions I do not live near a va treatmant center, that has been one of the problems with the insurance. It was just a biopsy that lead to the discovery, and even that was a fluke, I had my daughter who is 21 at the dermatologist's office for removal of suspiciuos moles and he asked me why I had'nt been there to see him so I made an appointment, turns out she may have saved my life.

I will see the plastic surgeon in 5 days (who specializes in SNB) so i am looking forward to that, also I will talk to my flight surgeon in a few days to be temporarily removed from flight status until I have recovered. Should I also need to see an oncologist? or is that not needed?

Thanks again and I will keep you updated

 
Old 09-10-2009, 08:50 AM   #5
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Re: what should I expect?

Wow, thank the heavens for your daughter! You are indeed correct when you state she may well have saved your life. What a blessed man you are!

Also, good news on the surgeon! I shouldn't be surprised if you find yourself in surgery by the end of the month or sometime in early October. I'm not familiar with military-speak, but I assume that you mean you are taking sort of a "leave of absence" while dealing with this? That will be for the best - you will need to concentrate on you and getting yourself healed for the next couple of months.

As far as an oncologist is concerned, that might be up to you. I didn't see one. I know others with melanoma who did consult with one to go over their treatment just to be assured they were on the right track. In your situation, I would probably wait until after the results from the SNB were discussed with your surgeon. If you feel any unease whatsoever regarding the results of the SNB, suggestions regarding further treatment, or if you just want another pair of eyes to look at the results of your surgery, by all means, consult with an oncologist. You can also bring this up with your surgeon, and see what he/she says. Some surgeons will refer you for consultation with a oncologist, others will advise you to wait until results are in. Ultimately, the decision is yours and your level of comfort with where you are at in this process.

Please do keep us updated! I'll be sending good thoughts your way!

 
Old 09-15-2009, 08:49 PM   #6
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Re: what should I expect?

Just a quick update, it seems more waiting for me. I saw the surgeon, and was impressed by him and his staff.(it seems all they do is take care of melanoma patients).

He recommends that the original site be re-excissioned in an attempt to find the actual tumor size, the first biopsy (shaved)showed it extended to all borders and was in the vertical growth stage, He also identified 5 other sites he wants to biopsy before scheduling surgery and SLN removal, so it looks like next month before the full removal will take place.

So I am in the waiting mode again, still working, but not allowed to fly anymore untill this is overwith and I can present a clear biopsy report.

 
Old 09-16-2009, 08:08 AM   #7
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Re: what should I expect?

I'm glad that you are finally under the care of a surgeon that you feel comfortable with and who specializes in melanoma. That makes all the difference.

I know playing the waiting game is not all that easy, but it is what it is. Will the surgeon biopsy all 5 sites at once? It might be best to get it over with at once, but you might feel a bit like a turkey at Thanksgiving with all that carving!

I'll be keeping you in my thoughts for a good outcome!

 
Old 09-23-2009, 04:23 PM   #8
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Re: what should I expect?

Well, I had my original site recut yesyerday in order to try to find the true size of the melanoma, also I had 5 other areas removed for testing, in all I have about 30 stitches but not feeling too bad. I will have the stitches removed in two weeks and get the results then

 
Old 09-23-2009, 08:52 PM   #9
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Re: what should I expect?

Good luck to you and please let us know how you are healing up and how your results come back. Think positive. Much Love, Oleander

 
Old 09-24-2009, 08:10 AM   #10
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Re: what should I expect?

Glad to know you are holding up well. That is certainly a lot of stitches! Hang tough - I'm sending lots of positive thoughts your way. Concentrate on healing, and looking forward. And, as Oleander says: please do let us know how you are doing!

 
Old 11-05-2009, 02:59 PM   #11
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Re: what should I expect?

Hello again,

Well, the biopsy's from the re-excision came back clear, I had the wide excission completed last week along with the SNB, They took 5 nodes from under my arm, the cut on my back is very large.

I returned today and received the news, cancer was detected in one of the nodes, and the melanoma was detected again at the margins of the large excission, which doesnt make sense to me since no melanoma was detected during the last re-excission.

The nodes have been sent to another lab for a second opinion, but the WLE will have to be redone to try to find clear margins. Interfureon treatmants and referal to an oncologist was discussed and surgery is scheduled for 1 month from today, he wants to wait for the wound to heal some before surgery.

This has came to a huge shock, I never expected for the possibility of the melanoma to re-appear in the excission.

The Army has been very suppotive so far, and I will keep you all up to date, thank you for your support, and I will now begin researching the interfureon treatmant.

 
Old 11-09-2009, 08:54 AM   #12
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Re: what should I expect?

This news is very hard to take, and my heart goes out to you. Getting a second opinion is the best advice. As far as melanoma appearing in the margins of a previous excision, well, melanoma is extremely aggressive and basically goes where it wants to. If melanoma has spread to the lymph system, that's the same as the body's highway.

Actually there has been some really good results with interferon and melanoma. If this is the route your doctors place you on, it won't be easy, but then when one is battling cancer, when is it ever a walk in the park? But I do know lots of people who have had melanoma detected in the lymph nodes, been treated with interferon, and are free of melanoma years - even decades - later.

I know this news can be absolutely stunning, but you can get through this. You will definitely be in my thoughts & prayers.

 
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