Out, Damn Spot!

The results are in. The two spots on my back are nothing to worry about. One was just a dysplastic nevus, basically a gross–looking mole, while the other was simply a harmless discoloration of the skin.

Then there was the patch on my arm. It’s skin cancer, an early stage melanoma. Specifically it is a superficial spreading melanoma. Melanomas are the most deadly of all skin cancers and among the most aggressive of all cancers; they frequently and rapidly metastasize. However, my eighty–year–old mother has had three and is still around (although her leg was nearly amputated for one); that knowledge alleviates some of my anxiety. Just 3% of all skin cancers are melanomas.

Fortunately mine was just 0.45mm in thickness, which classifies it as a thin melanoma (anything under 1.00mm is ‘thin’) with no ‘secondary factors,’ which, according to Dr. Moskowitz, my dermatologist, means it has the “best prognosis.”

I am truly a bit unnerved by having to apply that classification to myself. I am used to using terminology like ‘prognosis’ as a result of my mother’s, father’s, sister’s, aunt’s, mother–in–law’s and friends’ bouts with cancer, several of whom, including my dad and aunt, died from it. And my sister right now is undergoing a course of surgery, radiation and chemotherapy; ‘prognosis’ comes up frequently in talks with my mom. (Jennifer’s prognosis is ‘fair.’) My ‘treatment plan’ is benign by comparison. Still, and not to sound self–centered or narcissistic, we’re talking about my prognosis here.

The plan currently amounts to extensive lab work to establish baselines, a prophylactic chest x-ray (melanoma and various lung cancers are apparently reciprocal metastases) and minor surgery to remove a 2.5cm diameter area of the tissue surrounding the site, which will then be stitched closed. This is to effectively create a moat around the malignancy, minimizing the chance that the cancer has spread to the surrounding cells—which is never evident from just visually inspecting the adjacent skin in situ.  An assay will be performed on the excised tissue. These steps are usually all that are required for treating thin melanomas.

I have now moved into a high risk category; melanomas are very likely to recur. Previously I wrote that, during the original examination, I began to consider monthly mole checks after Moskowitz identified three areas of interest that he wanted to immediately excise. Well, now I am on the official ‘melanoma booking list’ and will be seeing Dr. Moskowitz or a colleague every three months for the foreseeable future. I am awaiting a scheduling phone call from the dermatology clinic, as well as calls to set up the surgery and chest x–ray. There is a standing order for the lab work. And I’m daydreaming about bathing in a bathtub full of sunblock.

And so it is cancer. It’s not immediately life–threatening and my prognosis is the best it could be. Nonetheless, it is absolutely nothing to take lightly and its presence in my body is deeply affecting me.

P.S. Notwithstanding my dialogs with dermatologists concerning the merits of biennial mole checks, the Skin Cancer Foundation recommends annual examinations for anybody over 40.