This Is Melanoma
My husband has melanoma.
Melanoma cancer is nothing to take lightly and it’s certainly not pretty. Every time you lay in the sun, or intentionally burn so you can fade into a nice tan, or spend 20 minutes in a tanning bed you’re increasing your risk factors. I don’t blame you … I’m guilty as sin. Tanning beds were practically mandatory when I was in high school. I still spend hours in the sun without sunscreen every summer. It’s part laziness, part carelessness, part I-want-a-golden-glow-like-everybody-else. But no more. We’ve had a crash course in skin cancer over the last few weeks. I hereby vow to change my ways — and ensure everyone else in my family does, too.
Melanomas are the most dangerous form of skin cancer and develop when unrepaired DNA damage to skin cells triggers mutations. The mutations cause skin cells to rapidly multiply and form malignant tumors. And what looks like a small, medium or even large mole could be hiding a deadly secret beneath the surface. Melanoma is mainly caused by intense UV exposure (frequently leading to sunburn), especially in those who are genetically predisposed to the disease. According to the doctor, my kids have a much higher melanoma risk because their father has it. Here’s how it all started.
Step One: Examination by a dermatologist.
In my husband’s case, a large mole that looked normal for decades suddenly (over the course of a few weeks) changed color. The smooth surface became bumpy and lumpy in texture. He saw his doctor. The doctor shaved off the surface of the mole (yuck), did a punch test (essentially a core sample that determines the depth of the lesion from surface into your body), and sent it to a lab. Ryan was referred to a melanoma specialist for treatment.
Step Two: Lymphoscintigraphy
Within two weeks he was scheduled for a scan that identifies the first lymph node that the cancer site drains to. This is called a sentinel lymph node. To find this node, a radioactive material (tracer) is injected near the cancer site. The tracer flows from the injection site into the sentinel node.
It’s a painful procedure. A nuclear medicine doctor gave him four 4 injections of radioactive tracer around the skin cancer site. It was done one injection at a time because as he later told me, “It feels like someone is pouring boiling water on your skin for 4-5 seconds.” And then he did it three more times.
The lymph nodes around the skin cancer will take up the tracer material, usually within minutes. The lymph fluid flows and drains through the lymph system and collects in the sentinel lymph node. This does not mean there is cancer in that node. It just shows the node with the highest risk of getting cancer. After the tracer is injected and circulated, a gamma camera hovers above him and takes images. When the sentinel node was found, the doctor used a surgical pen (think black Sharpie) to mark the node’s location on the outside of the skin near his underarm. The marks show the surgeon where to cut. In Ryan’s case, the surgeon took two.
Step Three: Surgery
When the lymphoscintigraphy was complete, they handed Ryan a CD of images to take to the surgeon (the doctor joked that no, everything is NOT digital these days). Next stop, pre-op. The surgery itself lasted about an hour and a half. The doctor began by outlining the tumor with a marker. A “safety margin” of healthy-looking tissue is included in tissue removal to ensure that all extensions of the tumor are taken out. The line has to be extended so the skin can be sewn back together. The spot was about the size of a 50-cent piece on the outside, but inside it was much larger. The doctor told me he took one-inch margins. That’s pretty darned big.
Think of an ellipse — or the shape of an eye. That’s how they cut around a melanoma spot. Everyone is different, every melanoma is different. Ryan’s cut is nine inches long. They use a special kind of stitch “that pulls together like drawstring pants” the doctor told me. It’s then covered with a breathable tape that will disintegrate over time.
After the melanoma and surrounding tissue were removed and things stitched up nice and tidy, the doctor headed north to the lymph nodes. Two were removed — lymph fluid from the area of melanoma drains into those two nodes. They will be tested to see if cancer from the melanoma made its way there. Hopefully not, but results take time.
It’s a lesson in patience. Wait and see. There’s no telling what may or may not happen next.
The only thing I do know, most assuredly, is that God has this. Strangely, or perhaps not, we are calm and held and loved. We are carried in His arms, strengthened by prayers from family, friends and total strangers.
Life goes on until it doesn’t. It’s different for each of us, but it’s a certainty for all of us.
There’s no sense worrying about what-ifs because they’ll either happen or they won’t. And whatever comes, we’ll handle it one day at a time, one sarcastic comment at a time, one belly laugh at a time. Because luckily we don’t write the story — wouldn’t that be a disaster! — but we are comforted because we know the ending.
So … there’s a peek at melanoma. It’s painful. It’s ugly. Wear sunscreen!