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    Old 09-30-2009, 07:39 AM   #16
    1sweetheart
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    Re: New Melanoma Diagnosis

    Hi All,

    I wanted to let you know that my husband's surgery went well yesterday. They ended up doing the WLE under a light general anesthetic rather than the MAC or twilight sleep that he had initially thought he was going to have.

    The surgeon said she did the 1 cm margin all the way around the lesion and then cut out a "lazy S" shape around it rather than the typical ellipse. This was due to the location of the incision (toward the inside of the left calf muscle, right where it flexes most when you walk) in hopes that he would be less likely to blow out his stitches.

    We should have the pathology report from the procedure in a few days but we are hoping that the remainder of the lesion does not show anything thicker than the part that was biopsied did. The surgeon did say that she feels comfortable that with the 1 cm margin, it should still be adequate in the event there is some difference.

    My husband is feeling good today and has been managing what little pain he is having with Tylenol. We have been putting ice on the area every 20 minutes to help keep swelling down. He slept in a recliner last night with his leg propped on a pillow. Our 12 year old son broke his collarbone in a football game about a week and a half ago, so he is sleeping in another recliner, and I slept on the couch to keep them both in line!

    I will post again as soon as we know more from the pathology report, but I wanted to let everyone know how much we appreciate all the good thoughts and well wishes. Take care everyone!

     
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    Old 09-30-2009, 10:59 AM   #17
    Chele60
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    Re: New Melanoma Diagnosis

    I'm so glad the surgery went well! I'm also glad your husband doesn't have to deal with the side affects of anesthesia. Personally, that's always worse than the surgery itself!

    With a 1cm surround, the surgeon should have it all. I think the problem for a lot us in the US is that we don't have a lot of concept with the metric system, so when doctors talk in milimeters and centimeters, we sometimes get lost. At least I know I do. The surgeon told me what size my incision would be, but when I saw it, my jaw dropped at the size. Ah well. It sounds as if your husband is doing just fine.

    When the dressing comes off, and he starts walking around and flexing that muscle, the skin will probably feel somewhat tight. That is a weird feeling! Like an ultra, ultra tight face-lift! And then you're still freaking out because you think you will rip out stitches. The human body and its ability to heal itself is simply amazing! Well, your husband will find his own adventure awaiting him! (Try not to laugh at him to hard, but it might be amusing to watch him walk - I know it was pretty funny watching me!)

    I'm sorry to hear about your son. Poor guy! Oh well, at least he can hang with dad, and drive mom crazy!

    Try to keep yourself sane, and pass along my get well quick wishes to both your "boys!"

     
    Old 10-01-2009, 01:02 AM   #18
    wasley81
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    Re: New Melanoma Diagnosis

    HI 1sweetheart,

    I have had pretty much the same op as your husband about 8 weeks agon now.
    It didn't bother me in the slightest, its was pretty painless, it did bleed for a while after the op.
    After about a week I was walking around fine, i was a bit worried i was going to purst out the stitches.
    I didn't do too much walking about for 2 weeks, when I had my stitches out I was able to walking with out hobbling about.
    By 5 weeks I was back running 8 miles. I have a nastie purple scar which is still looking pretty red but it will fade after a while.
    I feel much better now this has been removed.
    I had my 1st check up last week and everything looks fine
    All the best to both of you.

     
    Old 10-02-2009, 11:05 AM   #19
    1sweetheart
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    Re: New Melanoma Diagnosis

    Hi All,

    Well, here's the latest...we received a phone call from the surgeon this afternoon with the pathology results. The good news is the margins are clear.

    Now for the other news...the rest of the melanoma proved to be thicker than the portion that was initially biopsied. It has a Breslow depth of 1.4 and Clarks Level IV. No ulceration, no regression, mitotic rate less than 1. My husband is now a stage 1B rather than a 1A. To be specific he is stage 1B (T2A, N0, M0).

    The surgeon said had she known what the results were going to be she definitely would have pushed harder for my husband to have the SNB. However, my husband has said that he still would not have agreed to it as there is still only a 15% chance of the results being positive. Either way, it's too late now because the surgeon had said that once the wide excision is done a SNB is no longer possible.

    As far as future treatment is concerned, my husband will continue to be monitored by the dermatologist or surgeon every three months. The surgeon also mentioned keeping further close surveillance by doing an ultrasound on the lymph nodes at the first three month check up.

    So that is where we stand today. It wasn't exactly the news we were hoping for although we are grateful that the margins are clear. We also know that this news isn't dire and it could have been so much worse.

    My husband is continuing to recuperate well from his surgery on Tuesday. He is having very little pain or swelling. He removed the surgical dressing this morning which seems to have helped with the tightness he had been feeling.

    I hope everyone has a wonderful weekend. Take care!

     
    Old 10-02-2009, 02:03 PM   #20
    Chele60
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    Re: New Melanoma Diagnosis

    This news is more good than bad, and that is much to be thankful for! The surgeon is correct, in that if she had known the true thickness, your husband would definitely have undergone 2 surgeries. But, it is what it is. The BEST news is CLEAR MARGINS! Both you and your husband have to be breathing a sigh of relief at that!

    It's good the surgeon will be keeping an eye on the lymph nodes. Naturally, if your husband notices anything, he will need to see a doctor immediately, but I'm sure you already know that.

    I'm so glad for the clear margins. Great news!

     
    Old 10-02-2009, 06:01 PM   #21
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    Re: New Melanoma Diagnosis

    Hi All,

    Chele,
    Thanks so much for your encouraging words. Yes, we are very grateful for the clear margins!

    Now, unfortunately, we are even more confused following a second call from the surgeon today. She called around 6:30 this evening and said she had been thinking about my husband's case all day. She contacted some colleagues at other hospitals and talked to them about the possibility of doing a SNB after a wide excision. She said as it turns out, her colleagues feel it can be done and the results can be just as reliable as if it were done prior to the WLE.

    So, it looks like the SNB is still an option for my husband if he wants to go that route. However, the surgeon said the chances of it coming back positive are still only about 10-15% (as opposed to the 5% we were thinking before).

    Talk about a roller coaster! I'm not sure what my husband is going to decide as he is very "treatment averse" and said that even if he had the SNB and it came back positive, he wouldn't pursue any further treatment. I know that is a choice that every one of us has the right to make, but I am hoping it's not one we have to deal with anytime soon.

    I have not read much about SNBs that are done after the WLE. I would love input from anybody who may know more about this.

    Thanks!

     
    Old 10-03-2009, 12:02 AM   #22
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    Re: New Melanoma Diagnosis

    Quote:
    Originally Posted by Chele60 View Post
    Hello and welcome!

    First, let me offer condolences on the loss of your parents. It's been so soon since you lost your mother, and I'm sorry to hear that.

    Okay. Melanoma diagnosis. Right off, do me a favor, okay? Take a deep, deep breath, and slowly exhale. I know it seems like your world comes to a stop when you hear the words "malignant melanoma," but knowledge is power, and you and your husband are in a good place!

    Just to let you know: I was diagnosed with malignant melanoma 2 years ago (February 23, 2007, to be exact), and I'm healthy and kicking and plan on being around for quite some time! My melanoma was on my left knee and was .70 mm in thickness, so I guess I have some things in common with you and your husband.

    One thing you can be very thankful for is you two have caught this very early. (I'm not sure if you hounded your husband to have this checked out, or if he did it himself, but that is to be commended!) I know .70 sounds HUGE at this point, but it's actually quite thin. Also, your doctor did a punch biopsy, which is usually better than a shave biopsy, in that a punch goes a little deeper and chances are the melanoma has probably already been removed.

    Your next move, as you stated, is to see a surgeon. The "safe zone" your doctor talked about means the difference between a sentinel node biopsy (SNB) and no SNB. Normally, that dividing line is 1.0 mm - it was 2 years ago, anyway. If the thickness of a melanoma is greater than that, the patient must undergo a SNB to determine if the lymph nodes are involved. With a depth of .70, your husband does not need to do this - the melanoma has not grown far enough into the epidermis to affect the lymph.

    Your husband will have to have surgery. Some surgeons will have outpatient, others can do this in their office. I had mine outpatient, and that's what I would prefer. It's called "Wide Local Excision." What the surgeon will do is cut out quite a bit of skin tissue surrounding where the melanoma was located. Now, I'm sure you've seen where the melanoma/mole was located on your husband's calf, right? And I'm sure you've seen the stitches from the punch biopsy as well? Well the final cut from a wide excision will be approximately 3" to 4" long. Yeah, not very attractive, but necessary. The surgeon will take all that excess skin tissue - and it goes down deep as well - and send it to a lab. The pathologist will analyze it for any extraneous melanoma cells floating around. If the melanoma was completely removed, the surgeon will tell you he/she receive "clear margins." That means the margins surrounding the area where the melanoma was removed are clear of any additional melanoma cells. On the remote chance there are melanoma cells in the margins, the surgeon will need to go back in and a SNB will need to be done to see if the lymph nodes are involves. From what you say here, it sounds like the melanoma was probably removed with the biopsy. (I know mine was)

    It will take a while for the wound to heal completely, because there is quite a bit of "meat" missing from the wound. It will be sensitive to hot/cold, and feel a bit "weird" at times. But before he knows it, he will feel as good as new.

    Now, here comes the words of caution! Since he has had melanoma, his chances of developing another melanoma increase dramatically. From now on he will have to take all precautions while in the sun. This includes sunblock/sunscreen, wearing protective clothing, hats, limiting exposure. He's going to need to take care of his skin. For the next 5 years he will need to undergo regular skin checks with a dermatologist - usually once every 3 months for the first 2 or 3 years, and then twice a year for 3 or 2 years after that. For the rest of his life he will need to do annual skin checks. (As should everyone, really)

    Also, if you have children, precaution should be taken. (Note: NOT panic!) Some say melanoma can be hereditary, others say that it can develop because habits develop in families. Either way, if children are involved, their skin should be checked on a regular basis and sun safety should be practced. Also, any immediate family members (parents and siblings) must be notified of this and cautioned to have skin checks and practice sun safety. They, too, are now at risk.

    I know this is a LOT of information, and I know your head must be spinning, but really, the news you have is not all bad. In fact, as far as melanoma diagnoses go, it could be much worse. Please do try to relax, drink some camille tea, and try to get a good night's sleep! And if you have any questions or anything I can help you with, just let me know!

    Good luck to you and your husband!
    Hello Chele60,
    That was a thoughtful and informative response. I'm new to all this being recently diagnosed with MM Stage 1a, Clark II, Breslow 0.25mm, no ulceration. Just had the surgery at derm's office, 1cm wide excision, got 2nd opinion at U of P pigmented lesion clinic prior to surgery and they said to have it done by local derm and recommended follow-up every 6 months, took total body pictures for diligent self assessment monthly. All blood tests, CXR were negative. Anyway, being a healthcare professional (which I think might not be a good thing in this case) has made me project scenarios that a layperson might not, i.e., potentially negative outcomes based on all the stuff I have seen. I know my case appears to have an excellent outcome but my complicating factor is that I have had, and continue to have, an ongoing case of chronic urticaria which began in mid-July of this year. My allergist is at a loss and my symptoms are being controlled with H-1 and H-2 blockers. It obviously is an allergic response to something but he seems to have ruled out both stress and mold as being factors (which I'm not sure I agree with). I have been under a lot of stress for months due to heavy work demands and also, at the end of June, had a backed-up drain pipe spew water onto carpeting which may not have dried properly and may be harboring mold (testing to be done soon). Anyway, my hives/rash seem to improve whenever I'm away from home and I had no symptoms at all while vacationing in CA for a week in August. Anyway, regardless of all that, I'm a nervous wreck thinking that my immune system is trying to fight off internal melanoma lurking somewhere in my body. Yeah, you would think I should know better. Any words of encouragement you can offer might cheer me up. What is your opinion of all this? In advance, thanks so much.
    Frank

     
    Old 10-05-2009, 09:22 AM   #23
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    Re: New Melanoma Diagnosis

    Hi Frank!

    Thank you for your kind words, but I must state that I am not a medical professional, nor do I work in the medical field. I am simply a woman who has had a melanoma removed and has done quite a bit of research and has talked and listened to a number of melanoma patients of all stages.

    With that, I can only give you my opinion. Being stage 1A, and a thickness of .25mm, your melanoma was caught really early! Your prognosis is excellent, and you really shouldn't have anything to concern yourself about.

    Regarding the skin rash, I looked up some pictures (not sure if the pictures I saw on the Internet reflect what you have), and these do not look at all what melanoma looks like. They don't look anything like any type of skin cancer. I would really put those thoughts out your mind. You definitely have rash/hives, but sometimes this isn't caused from an allergy. I'm not sure what, so I'll let you and your allergist figure it out. I know that mold can be vicious, though! I'm allergic to mold, and it's amazing the places where that hides!

    As to your concerns about melanoma "hiding" out in the body, you are not the first one to suggest that. In fact, many clinical trials for melanoma are based on the idea of building up the bodies immune system to battle melanoma - T-cell research is doing this very thing, and there have been a lot of in-roads with this. Fact is, traditional cancer therapies just do not work against melanoma, that being chemo and radiation. It has been stated by researchers that there is a belief melanomas is one of those cancers that can be fought off by the bodies immune system, if the body's immune system weren't overwhelmed by the aggressiveness of this cancer. So, some might say that a small amount of melanoma might be fought off. However, melanoma is such an aggressive and, sometimes, such a fast-growing cancer, it overcome the body's defenses quickly. It's an interesting concept, though.

    I do know that one has had melanioma, they can never donate blood. Unlike most other cancers that 5 year regression period, melanoma is not in that same category. The reason given by the American Red Cross is that melanoma cells can still be located in the body, although symptom-free, and if the blood is transferred to another individual, that person could then contract melanoma. (The same is true with blood cancers, btw) That has always concerned me, and I suppose it's the reason why doctor's never tell a melanoma patient they are "cured." They are simply show no evidence of the disease, or the surgeon believes all traces of cancer were removed. But there is never any "Congratulations! You're cured!" after 5 years. It does make you stop and think, doesn't it?

     
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