Melanoma is a tricky beast. It can spread via blood (inside OR outside on the surface of the vessels) or lymph system. It only takes one wee little rogue mutant cell to begin the process. Fortunately, it is a quite low percentage (roughly 2-4%) of us who progress when caught that early. Things could metastisize out of sheer "bad luck", or it may be because the removal proceedure wasn't handled as well as it should have been. There is even the possibility that there was a second "primary" location which went unnoticed. Additionally… the only difference between stage 1 and stage 3 is lymph node involvement. My thickness was less than .6, so no sentinal node was checked. Might I have been actually stage 3a and not 1a? We'll never know. To add insult to injury, my initial punch biopsy showed "severely atypical" but not "melanoma"… sooooo… the surgeon removed with minimal margins, only to find that his job was incomplete and pathology did indeed show "melanoma" that time… with insufficient margins. I had a second surgery on the same area 2 weeks later. He removed the slab of skin with the stitches from the initial surgery still in place. Might it have gotten into my blood stream when he made the first cut? Maybe. Again, we'll never know. Soooooo… although statistically, my odds of metastasis after that 1a diagnosis in 2007 were very low… there were other risk factors involved that weren't factored in. I can tell you that I was not diligent with sunscreen after that initial diagnosis either. My doc made it sounds as if this was ZERO concern… I was cured. In fact, there was so little concern, that he didn't send me to see a derm… he did the skin checks himself every 6 months. He never so much as flinched when I'd show up with tan lines from my cycling clothes and HOURS upon HOURS of being out on the bike with zero protection.
The fact that you have come to a forum to ask questions, tells me that you are taking this seriously. FAR MORE so than I ever did. This will serve you well. Protect your skin. It has given you a warning sign. Be diligent about watching spots yourself. Nobody… not even a top notch dermatologist, will notice a change as much as YOU will. You see you far more often than any doctor will… aaaaaaaand… you're looking at fewer bodies. 😉 Note changes on your skin. Note any odd lumps, knots, or "cysts" that don't seem to go away within a couple of weeks. Perhaps schedule a physical check up annually or every 6 months. Docs might note a change in how your lungs sound. Your odds of metastasis are low with a 1a catch. Yes, someone "has to be" the outlier statistic… but I get the feeling, that if those of us who have been in that "damn it" pool, were to review the time between 1a and 3 or 4… we'd find a few "complicating"or perhaps contributing factors.
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