This Is Melanoma

Fishing in WyomingBefore I begin a sordid tale of blood and cuts (caution, graphic photos ahead), I have to admit I want to run into the scene, above, and smear sunscreen all over that guy. His ears are red, his neck is burned, his arms are tanned and there’s a tumor growing in his side. Of course we didn’t know it at the time. 

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.

photo copy

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.

Melanoma excisionThink 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.

Lymph node removalAfter 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!

Go exploring! You may enjoy these previous posts.

16 Comments

  • comment-avatar
    Barb February 26, 2015 (8:42 am)

    Jennifer – thanks so much for the update. We have been wrapping each of you in prayer during this time of uncertainty and will continue to do so. God is AWESOME and love that you already know that. Continue to lean on him and know that we love you and Ryan and your family beyond measure. Virtual hugs coming your way – since the real thing for Ryan – right now – would be a little touchy! Gods comfort abounds – Love Barb

  • comment-avatar
    Toni February 26, 2015 (8:42 am)

    Continuing to pray for you all during this season!! Much love and peace to you!!

  • comment-avatar
    MAC February 26, 2015 (9:14 am)

    HUGS! Prayers and hope you remembered the pain medicine!

  • comment-avatar
    Sally February 26, 2015 (9:26 am)

    Praying for speedy recovery and negative lymph nodes.

  • comment-avatar
    Nanny February 26, 2015 (9:46 am)

    God’s got this!

  • comment-avatar
    Denise Laubacher February 26, 2015 (10:44 am)

    Oh my gosh Jen…..I’ve had several skin cancers removed through the years and I try to keep a look out….but I do wonder what I may be missing at times. I have facial scars and arms/shoulder scars from some pretty deep removals. God bless your husband a hundredfold! What an ordeal…really makes you stop and take pause…God bless+

  • comment-avatar
    Teara Buren February 26, 2015 (2:02 pm)

    Thanks so much for sharing this information. Continuing to pray for your family and health care providers. May God grant you all peace, comfort and love as you await the results of these tests. “I trust in you, O Lord; I say, You are my God.” Psalm 31:14

  • comment-avatar
    Susanne February 26, 2015 (3:38 pm)

    More prayers for Ryan and the rest of you. It’s so hard to watch the ones we love go through these things, isn’t it? I can’t imagine how people without faith get through these times.

  • comment-avatar
    Jeanie February 26, 2015 (8:03 pm)

    Thanks for the report! You are all in my thoughts and prayers!

  • comment-avatar
    Nancy February 27, 2015 (9:11 am)

    Thanks for the update, continued prayers for the whole family!

  • comment-avatar
    tracy b February 27, 2015 (4:39 pm)

    My prayers are still with you and your family.

  • comment-avatar
    Luann Senz February 27, 2015 (4:51 pm)

    Jennifer, We are praying for a healing for Ryan — GOD IS GOOD !!!!!

  • comment-avatar
    Georgia peach February 28, 2015 (7:13 am)

    Thanks for the updating. Praying for good news, that Ryan isn’t too sore, amd that he heals quickly.

  • comment-avatar
    Rebecca {foodie with family} June 25, 2015 (12:58 pm)

    Oh goodness, Jennifer. Somehow I missed this when you published it. My husband had a melanoma removed from the back of his head a couple of years ago and I have to say you’re dealing with this far better than I did. Lindy is fine, thank the Lord, and it was a lesson in trust and patience, two of my lesser developed virtues. I have some “fruits of the spirit” I need to cultivate better 😀 I’ll be praying for you guys!

    • comment-avatar
      Jennifer Kiko June 25, 2015 (1:10 pm)

      Oh, I was a basket case. The doctors tell you these things and then it’s a hurry up and wait game which I am VERY, VERY, BAD at handling well! 🙂 Ryan’s melanoma had not spread and we are eternally grateful. I’m so glad Lindy’s fine now, too. Thank you for the prayers. Now, pass the sunscreen, sister. We need to keep these guys covered (in lotion and prayers!).

  • comment-avatar
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