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Overnight it appeared as a small, pink, circular area on my left forearm. Within a year it became a melanoma, the most aggressive form of skin cancer.
At first I thought my arm was irritated and wasn't concerned because the area was not the usual dark color associated with melanoma. When it didn't subside I consulted a dermatologist who performed a skin scraping that was negative for cancer.
Several friends told me how scared they felt hearing the word cancer, but I had no idea how frightened I would feel hearing about melanoma. Of the nearly 69,000 melanomas diagnosed each year, 9,000 are deadly, according to the American Cancer Society.
After some months I noticed the area was becoming somewhat larger and had changed from a circular to a rectangular shape and asked my primary care physician to look at it during a routine visit. Aware the skin scraping was negative for cancer, she said I had two options - cosmetic surgery or leave the site alone.
Taking Charge
As basal cell carcinoma runs in my family I assumed the growth may be cancerous now and made an appointment with my dermatologist for early June 2009.
After examining the area and comparing digital photos taken during June 2008, she noted the photos showed changes in the growth that warranted a punch whole biopsy.
When I got the call to discuss biopsy reports I assumed I had a basal cell cancer.
"This can't be happening," I blurted after hearing I had melanoma. "Last year the skin scraping was negative for cancer."
The dermatologist grabbed my hand. "We're going to get it," she said, letting me know she'd made appointments the next week with an oncologist who would direct my care and two surgeons. One would remove the melanoma and the other to remove the sentinel node, the first site cancer cells invades after leaving the original site, she said.
The Diagnostic Process
The diagnostic process included three doctors' visits, the usual preop tests and a CT scan and scinatigraphic imaging procedure I had not experienced before.
Reviewing the punch hole biopsy report, the oncologist said the surrounding tissues were not ulcerated, a good sign. My tumor was a 3.7 mm, thick, stage 11B melanoma, but indications that it had metastized would not be known until the melanoma and sentinel node specimens had undergone extensive pathology tests.
He ordered a CT scan, using the Somaton Sensation Scanner, to rule out other melanomas that may be present in my body.
Prior to using this scanner a radiology nurse injected 100 millimeters of Optiray 300, a contrast dye, into the inner aspect of my right forearm via IV. The dye is necessary to contrast and highlight tissues that are areas in the body where melanoma(s) might be present.
To meet this goal the Somaton Sensation scanner uses radiation to create a series of spiral, sequential, 3D images of organs and blood vessels as the body passes through the machine, according to Kathleen Schorpp, BSN, RN, a radiology nurse in Wilton, NY.
Surgery Approaches
To remove the melanoma, the surgeon explained he would perform a skin flap, making a wide excision around the melanoma down to the deep fascia sheath that lies over muscle tissue.
Until surgery was performed he didn't know whether or not he would have enough skin to close the flap. If not, I might need a skin graft that would require taking tissue from the outer aspect of my right thigh or upper arm.
I had not anticipated the possibility of a skin graft but decided not to add more anxiety worrying because the graft may not be needed.
Next, I saw the general surgeon who would remove the sentinel node located near my left axilla. He pointed out if cancer had invaded the sentinel node more surgery would be required to remove several other nodes. Aware of this possibility I decided not to conjure up more unnecessary concerns.
Therapeutic Listening
During the month-long wait prior to surgery, friends and relatives shared many unasked- for opinions and advice about melanoma, as people tend to do in similar situations.
As this information tended to cause more anxiety I took the time to meditate in an effort banish negative thoughts. I also relearned the value of therapeutic listening.
An RN friend, who, for the past 10 years, has been treated for an aggressive type of breast cancer, listened quietly as I voiced my concerns and talked with me instead of at me during her many telephone calls. Her use of therapeutic techniques not only allowed me to voice my concerns but also allayed most of my fears.
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