Skin

A couple of remarkable things happened today during my skin review visit to the Dermatologists' office.  1) I had a surprise "mole excision"  and 2)  I stole a very informative publication from the waiting room. 

In my routine skin examinations every three months, the Doctor uses her tiny light with a little magnifying glass to look at all of my pigmentation, surgical scar areas, funny-looking moles she keeps journal of, checks through my hair and all over head to toe, actually literally, I have a mole between two toes on my right foot that always freak out my esthetician at pedicure time, I have had it all my life.  She also answers any nervous questions I have conjured up in the weeks since I have seen her.  

She intimidates me like no other, she is my least favourite of all of my medical appointments (no offense to her, it's just the nature of the beast:  she is the one to lay blame on my sun-loving habits and express little sympathy over my willingness to repent in darkness for the rest of my life in exchange for never having to visit a Dermatologists' office again).  

 

I always dread this meeting. Yes, I dread it even more than the ones where I drink the vile stuff sitting in a hospital gown in front of a bunch of strangers and then get poked with an IV needle and exposed to deadly radiation in order to have CT scans and then tummy trouble for a week.  Just saying.

Today we discussed a few moles we are watching, she measures them every visit, and examines any new paranoia spots I may have discovered.  I am to watch for changing skin pigmentation of course, as well as "lumps or bumps" especially around my primary site on my hip.  The melanoma surgeon asked me that as well in December when she was poking and prodding my scars - did I notice any new lumps?  Well no... I never had any lumps to begin with... which has made me think.  

All of this talk of high possibility of recurrence with my disease, and other than being told there is no way to tell if it is recurring except by CT scan, I am routinely told to watch for recurrence.  HUNH??  So today I managed to stutter out my pre-meditated in-writing question to the Skin Doctor:  What exactly am I to be looking for?  Other than CT scan showing metastasis to an organ (liver, bone, lung, brain), what am I to be looking for?  Moles? new or old? Or lumps or bumps?  Cannot find a definitive answer online, so I mustered up the nerve to ask.  

The answer is: lumps and bumps.  With my type of skin cancer it is most likely that recurrence would present itself as spread to an internal organ.  If it did present itself on the surface of my skin it would most likely be near the original site of the mole excision(removal by surgery) on my hip, either on the scar or at one end of it.  

If it was to be a lump or bump, either near the scar or near an organ, it would be something palpable under the skin, not on the surface.    It would be unlikely that a new problem will occur on the surface, either in a new or an old mole elsewhere, or at least it would have the same likelihood of happening that way as it did in the first place.  

Sigh.  Okay, at least I have a definitive answer from a doctor horses's mouth.  There is such little information out there about invasive melanoma, I feel like I am trying to put a puzzle together with half the pieces missing.  I imagine I am not the only melanoma patient out there who feels that way!

Speaking of which, I don't usually pick up magazines at the doc's offices, especially on a day like today with my handy dandy new notebook I could play yahtzee on, but I happened to glance at the tiny table under which I was putting my slush-covered boots and there was a skinny booklet on top with the title: Canadian SKIN, The Official Publication of the Canadian Skin Patient Alliance.  

Canadian Skin Patient Alliance?  What the heck is that... and what the heck is a skin patient... oh wait - that sounds like me!?  I am a Skin Patient.  hehe that's new.

As I was flipping through said publication, I quickly discovered an article about a woman in BC living with melanoma.  I read the one page bio which lead to her website, and almost jumped up shouting hey that's me!! Wife mother melanoma warrior!  Right here people!

I may have mentioned previously how I have been disappointed with other websites, they are mainly about sunscreen sunscreen sunscreen.  Well thanks folks, where were you in the 70's when I was running around in my little red bikini all summer like every other baby was?  I want to find more helpful information, and I want to share it with others.  

  

And voila!  I found it:  Canadian Skin Patient Alliance  - and I have decided to copy and paste some information I want you to know about me, as I have heard these definitions from my doctors but have never seen it in writing like this nor am I able to adequately explain it to people when they ask.  Here goes:  

The information in this section has been gathered from existing peer-reviewed and other literature and has been reviewed by expert dermatologists on the CSPA Medical Advisory Board.

"Melanoma is a cancer that begins in the pigment-producing cells (melanocytes) of the skin. It is considered the least common yet the most serious of the three main types of skin cancer, which also include basal cell and squamous cell cancers.

Skin cancer results from cells that multiply out of control. As a result, tumours, lumps, or masses can sometimes form on normal skin, and can be either benign (non-cancerous) or malignant (cancerous). Some types of cancer are more likely than others to spread to other parts of the body and cause damage. This process is called metastasis. Melanoma is considered the most serious type of skin cancer as it may spread where it continues to grow and destroy tissue."

There are four types of melanoma, based on pathology from my surgery in May, my diagnosis is this: 

"Nodular melanoma (NM) accounts for 15 to 30 per cent of all cases. It most often appears in midlife, usually on the person’s trunk, head, or neck. The onset can be rapid, with NM often developing within several months. Unlike other types of melanoma, it is invasive from the onset and typically appears either as a uniform dark blue-black or bluish-red area, or as an area without any pigment."  (yep, mine was blue-black)

Also I want you to know: 

"The risk of developing a melanoma is greater if a person has a family history of skin cancer, has a lot of moles, or has fair or freckled skin, blue eyes and light-coloured or reddish hair. However, anyone who has had excessive sun exposure, severe and frequent sunburns during childhood, or has lived in a sunny or high-altitude climate is at increased risk of developing skin cancer.

Looking Deeper
Melanoma is caused by overexposure to ultraviolet (UV) radiation from either sunlight or tanning lamps. UV radiation damages genes that regulate cell growth and division. However, genetic predisposition and other factors also play a part. In fact, researchers have identified several genes linked to melanoma. A mutation in the BRAF gene occurs in many melanomas, but is not inherited. In inherited melanomas, changes in genes such as CDKN2A (p16) and CDK4 have been found. Researchers continue to explore ways to treat melanoma based on these new genetic findings."

Melanoma is a disease in which malignant (cancer) cells form in the skin cells called melanocytes (cells that color the skin).

Wow... I'm out of breath, I have skimmed over a wealth of information in these two websites this evening and I have lots to keep me busy reading more!  Linking to the Skin Warrior in BC website, "save your skin foundation"  www.saveyourskin.ca I have found possibility of more support, and new information about my journey.  Check it out if you wish, I will likely yammer on about it more in the near future.  :-)  Especially because I just found the name of my very own stylish-boot wearing medical oncologist from Sunnybrook/Odette listed on the Medical Advisory Committee for this foundation!  Rah Rah I'm excited to get in touch with this group - will keep you posted!

Speaking of keeping you posted, I have yet to tell you about point "1)" of this post, which occurred after the magazine theft but is equally important.  I have a new ouchie... one of the moles causing me concern was removed from the party this aft, poof right there in the Dermatologists office no nurse assisting no nothing.  I had not experienced such a thing, all of my procedures prior have been done at surgeon's office or hospital.  

Local anesthetic was injected and in the blink of an eye my mole was shaved off, placed in a specimen jar full of solution ready to be sent off for analysis, and I have an open wound that is stingy and achy tonight.  It is on my left wrist. No stitches, so the girls were pretty puffed up about the fact that they had stitches for theirs last week and I did not...measly ole' mole removal I had HA!  They're so funny...ha ha HA.  

They did the dishes as I can't get it wet.  So there kids! ;-)

Great news about the girls as well, we got the all clear on their mole excisions from last week yahoo!! I don't have the written report in my hand yet but I will.  Bottom line the pathology confirms their moles are benign, normal, no cancer.  Yah girls!!!! 

We will all continue to watch our skin health, and our lumps and bumps, as I always encourage my family, friends, and acquaintances to do as well.  Check your moles please - I assure you the threat of quarterly visits to the Skin Boss should be motivation enough to stay on top of it.  Ask your family doctor about any spots you may have and they refer you further if they have concern.  

I will also continue to quietly mourn my days of care-free skin love.  I was always fortunate to have sensitive but beautiful skin for which I often received compliments.  It was always one of my favourite features, and I miss it so.  I valued my golden complexion and never suspected it was up to nasty tricks.  Causes me paranoia and self-doubt now, likely more so than any of my other organs.  But... I will continue this journey and see where my skin and I end up.