Late Post Treatment Strategy?

Hi Wendy, as always go with the advice that Janner gave you!!! That being said is sounds like a dermatologist playing Oncologist, did they give you a reason??? Maybe they had to hit there yearly quota of scans!!! I would rather look at your situation of something to celebrate and put the worry in the back window of life. As long as Derm is checking your nodes by physical exam and you are being sun smart and following advice that Janner always gives about keeping photographic records of your moles, I would really ask Derm what they are thinking ordering x-ray and blood work and why!!!! Best Wishes!!!Ed

At the risk of sending you into an unnecessary flurry of concern……… I was 1a. Nothing to indicate it might be in that "likely to spread" risk area. A few years ago, I was brought into a So Cal Derm Conference as a "learning tool" about the dangers of skin cancer, and how seriously derms should be taking proactive measures. I had my original pathology report with me. As the derms came into the room to speak with me about my current condition, and they read the report, there were several who got rather wide eyed and said "Wow. You're like a one in a million chance of spread. How did this happen?". Yeah… wish someone could explain that to me too. Just an oddball unlucky in the looooow odds zone. That said, I think at least a few of them left the conference with the idea that perhaps a chest xray and some follow up blood labs once per year miiiiight not be such a bad idea for their patients with a known melanoma diagnosis…. no matter what their risk level. ALLLLL of that aside… I never had a sentinal node biopsy. The depth wasn't enough for the standards to call for it. So, technically, I may have been an oddball that had a stage 3 diagnosis with early infiltration to the lymph nodes, that we were unaware of… because the diagnostic difference between 1 and 3, is nodal involvement. If we haven't checked any nodes… how do we really know? Or, it could have gone straight to the blood and made its way through the body that way. 

There are statistics that show folks with minimal depth and early catch are very unlikely to spread. Your only concern, is whether you're in that pack of outlier oddballs who like to ruin doctor's clean statistical curves.

Let's see… I had an "atypical" punch biopsy from my family doctor's office. That was why he sent me off to a surgeon for removal. Looking at my surgical report (from the FIRST time the surgeon cut… June 2007), I was: superficial spreading type, clarks level III, .6mm breslow, growth phase radial, epitheliod cell type, mitotic count "low" (1 mitotic figure per 10 high power fields), tumor infiltrating lymphocytic response "absent", ulceration absent, vascular invasion absent, neurotropism absent, satellite metastasis absent.

The report then stated: "Additional surgery at this site should enhance the likelihood of local control"  Sooooooo…. nearly a month to the day later (July 2007)… the surgeon went in and cut out larger margins, scooping out everything down to the muscle level. Sadly, at the time, I thought "No biggie. Doc and surgeon feel like this is all that is needed, so I'm good to go.". I never even bothered to get the path report following the second surgery. You can imagine my surprise when I woke up on the floor at work, after having a VERY unexpected grand mal seizure in April 2013. At the ER, I had brain CT, followed by brain MRI (for a better look at what they'd found), and a chest x-ray followed 2 days later. There were 5 brain lesions… the largest measuring 1.2 cm and loaded with edema (that caused the seizure). My chest xray showed 3 additional lesions. The largest being a 5 cm "golf ball sized" beast in my right lower lung lobe. THAT is the one we probably would have seen prior to the spread to the brain. FIVE cm… how long had it taken to grow to that size? Would it have FOR SURE been caught on a chest xray before any additional metastasis? We can't say for sure… buuuuuut… would it have been worth getting a chest xray or two each year along with my regular follow up skin checks? YES. Because if we had seen "something"… it would not likely have been the size of a golf ball when it was first spotted. If I could have had the lung surgery and gotten some treatments prior to brain metastasis, I may have been spared the two craniotomies and 10 rounds of gamma radiation. Maybe. Sooner is always better than later when it comes to melanoma. If your derm or doc want to take the occasional peek inside your chest walls…. why not? 

My primary was on my right shoulder… direct center on top. Right lower lung lobe was the biggest blob of metastasis. The left frontal lobe of the brain had the biggest bit found in my head. Right shoulder to right lung makes sense…… settling into the left region on the brain… that had to have followed the closer proximity of the lung invasion.   THANKFULLY, it's all becoming a rapid blur behind me these days, as I've been clear for almost 2 years (brain) and 3 years for the body. 

Funny thing….. I did go back in 2014, and ask the pathology lab for my report from the second surgical removal from July 2007. They somehow "lost" the one from July. Uh huh. Whaaaatever. I'm thinking someone was doing some "I don't want to get sued" save your a** thing. OR… the surgeon never bothered to send the removed skin in on the second go round…. hmmmmmmm. ALWAYS ALWAYS ALWAYS get copies of your reports.