Tuesday, December 8, 2009

"I need to remove a bit more"

Last week I had my annual appointment with my dermatologist. I've been having yearly full skin checks for about 10 years. Before that, for several years, the skin checks were twice annually. That was because about 15 years ago we found my first basal cell carcinoma. The day my doctor called me back to her office and gave me the diagnosis I was crushed. All I heard was "you have skin cancer" and the rest of the discussion sounded to me, and I remembered as "lalalalalalalala."

I finally absorbed the fact that my days as a sun bunny were over, that I had a skin disease that was harmful and dangerous but probably wouldn't kill, disable or disfigure me. About two years later I found my second basal cell carcinoma and redoubled my sunscreening efforts.

From that point on I learned my skin very well. I had found both carcinomas and my doc was surprised each time that they were indeed not benign. There were none of the usual ABCDE signs (A=asymmetry, B=border, C=color, D-diameter, E=elevation), they both looked more like pimples that wouldn't go away. I'm a very mole-y person, especially my multi-sunburned back.

In the intervening years I had several spots that I had my doc remove, several sliced and even more frozen. I'd gotten a bit slack about the "annual" part of the visit and had stretched things to about 18 months this time. I'm careful with sunscreen, I wear a hat with a brim when I run, but I'm still outside for long periods of time. Because I run so slowly my long morning runs often go until mid-day in full sunlight.

My doc has pictures of many of my moles so that she can compare from year to year. When I went in this year I had a few spots that I was concerned with and she decided that one spot we'd been watching for many years looked darker. So I had 3 spots frozen (and lemme tell you, freezing a very large mole on your spine hurts like a bitch) and 2 excised. The slices were on my face near the hairline (the doc thought it was just a cyst but I thought it was ugly) and above my left knee (the mole that looked darker). The doc warned me that the lab she was sending them to requested additional tissue about 10% of the time and I shouldn't worry if I had to return.

So I wasn't worried when she called me Friday and told me to come back and have the knee mole re-excised. She said she'd have to put in a stitch or two and I wouldn't be able to be active for a couple of days. She didn't say, and I didn't ask, whether the lab had given any diagnosis. I had a big weekend ahead of me and I just assumed that everything was ok. In my wildest thoughts I felt it could be another basal cell. Maybe, if horrible things were wrong, it could be a squamous cell carcinoma. But I was pretty confident that everything was fine. Because apparently I also believe in unicorns and pink puppies and rainbows with pots of gold at their ends.

I've been going to this same dermatologist for probably more than 2 decades and I know her, she knows me. So when I was there today and the first thing she did was pause, and look at me, I knew something was wrong. She told me that the diagnosis was "evolving melanoma in situ" and paused again. She started explaining, showed me the lab report and I asked if I could get a copy of the report because after "melanoma" all I was hearing was "lalalalalalala" and all I could think was "I have cancer."

My doc showed me pictures of cross-sectioned skin depicting the different parts and layers, and explained the type of melanoma ("I have cancer"). She talked of the Clark levels, where mine is Level 1 ("I have cancer"), she spoke of stages, where my is actually 0 ("I have cancer"). She told me about the treatment, which was cutting that bad boy away ("I have cancer") and spoke of prognosis, which was that once it was cut away, there was only about a 2% chance that it would reoccur in that spot ("I have cancer").

I had an odd reaction, freaked out and buzzed and focused and nauseous and very calm on top of it all ("I have cancer). I started talking too much, asking lots of questions (most of which I forgot all the answers to), babbling about this that and the other thing. Meanwhile the doc prepped my leg, I lay back and pretended that I was doing A-Ok ("I have cancer").

When she was done I had a long vertical purple line on my leg, held together on the inside with 3 stitches (she used extra strong thread since I'm a runner) and 8 stitches on the outside. She placed a nice dressing on it, taped it all together and I was good to go. I got verbal and written instructions of care and was told repeatedly to call her if I had any questions or problems ("I have cancer"). I was told I can shower tomorrow and can run when then tight wound feels like it won't split.

I made my followup appointment, went to my car and started crying. The same thing that I had done so long ago when I got my basal cell diagnosis. I went back to work and obviously couldn't focus very well. I went to my mom's house to get her mail (which the post office didn't deliver even though my mail-hold specified delivery today). I went into her house, checked a few things, went to leave and couldn't find my car keys. I looked all over for them ("yes, I looked there" "I looked there too" "of course I looked there, six times!") and an hour later gave it up. I had that little temporary key the dealer gives you and tells you not to use in the ignition and I used it anyway. I needed to get home.

Eight hours later I'm feeling a little more focused and a little less freaked out. Thanks to Mr. Google I know that if I had to get melanoma, I got the best type. Chances are very good that every little bit was chopped off today and it won't return. The odds are in favor of my getting more somewhere else, at some later date. But I know my skin, my doc knows my skin, and we'll keep on top of it. Right now I know intellectually, and I'm trying to feel in my heart and my nerves, that "I HAD cancer."


  1. Received my diagnosis today : I've stumped the doc's at DHMC . 6 Pathologists still don't know if it's evolving or thin melanoma. Sounds like you have a good team. I had to call because it had been 10 days and no one had called or sent a letter. Got sent to the nurses help line and a recording . My Doc called me back and unceremoniously dropped the news with no further info into my lap. I had to probe hard to get ANYTHING. She didn't even offer to do the surgery.
    Your blog came up in my research of evolving melanoma. She didn't explain that to me either.
    So thank you for sharing. I needed what you shared , I am trying to find my equilibrium.It-s only been 4 hours. Thank you very much. I wish you wellness. Namaste

  2. I was diagnosed with melanoma in situ at age 34 (two years ago). It was very scary. I try to avoid the sun, but I'm a runner too and sometimes it's hard.