I had a follow-up appointment at Moffitt Cancer Center last month.  My boyfriend came with me for moral support.  It's not an easy place to walk into.  I was my usual sarcastic self with the nursing staff - they make sure you're alive before you see a doctor.  Surprisingly, I was called in within 15 minutes.  The doctor looked at my neck, asked my a lot of questions, including if I had been seeing a dermatologist.  I said, "No, I was told to come back here and then after this appointment, I would be sent to them for regular check-ups."  Or, something like that.  Well, I guess (surprise, surprise) I heard wrong.  I should have been seeing a dermatologist every three months.  After scheduling another appointment in six months, I called USF Dermatology and scheduled an appointment for Monday, August 4th with Dr. Robyn.

The 4th rolls around and I head in there.  This is the first time I've seen her since my operation, so I thank her for finding the melanoma in the first place.  She was pregnant the last time I saw her, so I tentatively ask how her little one is - he is doing well.  I explain the Moffitt situation to her and she agrees that I should be seeing her every three months.  She looks me over, and finds two moles that are darker than the others - the "ugly ducklings" as they call them - one on my left forearm, and one under my right ear, an inch away from my scar from the previous surgery.  She's going to have to take them off and send them to be tested.  I wasn't too thrilled to hear this, but it's better to know sooner than later.  The prick of the needle is nothing compared to the burn of the anesthetic.  I joked, "9 out of 10 patients prefer the prick over the burn."  She cut the moles off and said the results would be back in three weeks.  She would call me either way (good or bad), but I would get a letter if I needed to come back in.

I had a notice in my mailbox that I needed to pick up a certified letter from USF Health.  Crap.

I made my boyfriend get up early with me on Saturday morning, so we could go pick it up.  I was prepared for the worst.  However, I had no need to be.  The letter said I had a dysplastic nevus - or what the NIH wants everyone to call, an atypical mole.  It is a type of mole that is more likely than a normal mole to develop into melanoma, though most atypical moles will not become malignant.  Although, numerous studies indicate that half of the melanoma cases arose from atypical moles.  In any case, for someone who has had melanoma before (me), the answer is to chop it off.

I waited a few days to see if Dr. Robyn would call, and after not hearing from her, I made an appointment to go in and discuss my options.  About 30 minutes after this call, Dr. Robyn called.  She wanted to let me know that the one on my forearm was nothing, just a mole, and the one on my neck was a dysplastic nevus.  She wanted me to come in and have the rest of it removed.  I told her I had just made an appointment and I would see her tomorrow.

On August 18th, same thing as last time.  I used the same joke on a different nurse about the prick of the needle versus the burn - I had a better reaction the first time.  Dr. Robyn cut it off and said I'd get the results in three weeks.  To be clear, they took a much larger area than last time.  It looks like something tried to crawl out of my neck and left a hole.  She just wanted to be sure that they got all of the atypical tissue - getting clear margins, as they call it.  I am hopeful, and I'll just have to be (a good) patient.

I had my vitals and blood taken yesterday - I was there 45 minutes before my appointment time and was admitted another hour after that - so, I think they're always busy.  After the wait, I was in and out relatively quickly - I spoke to a nurse practioner about my anesthesia.  Of course, when they drew my blood, I asked about what gauge needles they were using (21) in order to compare with what we bleed the rhinos (23).

Today was my lymphoscintigraphy - a process by which the lymphatic system is mapped through use of a radioactive isotope that was injected into my neck/jawline in four areas proximal to the melanoma.  The needles here were 25 gauge.  After several minutes passed - letting the isotope spread through my lymphatic system - a few five minute scans were taken using a SCENT CT (google failed me on that one) in order to find the sentinel lymph nodes (lymph nodes closest to the site of the melanoma and if my cancer has spread, the most likely to indicate as such).  I will not know if the cancer has spread (or not!) until the tissue and lymph nodes are removed during surgery and tested (I've been told results will take a week).  The technologist marked the two sentinel lymph nodes with blue paint (as shown below).  I then had a 20 minute 3D full body scan - during which I fell asleep...hehe.  This gives a much clearer image...blah blah blah.  I asked questions, but it was a lot of information.

Surgery is tomorrow at 7:15 am.  We have to be there at 5:15.  Yay!  My parents flew in just before my appointment today and we had a great dinner at Gino's.  I'm very glad they will be there tomorrow.  Time to pick out some cute underwear for tomorrow in case a nurse gets curious.  ;)  Who knows?  Maybe I'll meet the love of my life.

I'll post another update as soon as I'm home.

I suppose the alternative title for this post could be "I Had Cancer, Part 1," but that remains to be seen.  My surgery has been scheduled - it will be Friday 1/31 at 7:15 am.  My parents should be getting here on Thursday.  I have two pre-operative appointments this week - one on Wednesday for bloodwork and normal pre-op tests, and one on Thursday for lymphoscintigraphy - a procedure involving radioactive staining of my lymph nodes, so the surgeon can detect those closet to the melanoma site.  It appears to involve multiple stinging injections, so that sounds fun!  In any case, I'm glad I was scheduled so soon and hopefully all goes well and they do not find anything in the removed lymph nodes (though that apparently does not mean it hasn't spread...going to have to ask about this).

Well, it’s not bad news!

I had my first appointment with my oncologist – Dr. Wayne Cruse – this morning at “9am.”  Sara, my friend and co-rhino keeper, picked me up at 8am.  I showed her my newly painted apartment wall and we headed to get some breakfast.  There was a little traffic, but we hit up Panera and headed to the  Moffitt Cancer Center – just a few miles down the road from my apartment.  They have valet parking – invaluable, as the place is enormous and busy.  It felt like we were on the streets of Boston's medical district.  I will bring a camera next time – it’s really quite beautiful.  But, we were slightly late – supposed to be there 30 minutes before the appointment - so as soon as we entered the front door, I asked the receptionist where the cutaneous unit was.  We had an escort show us the way there –though he didn’t quite give us the right directions, we were close.  I signed in, filled out the paperwork 30 minutes later and was finally called to go in just before 10am.  I guess it was a busy day.

So…down to the details.

He told me that my skin cancer is a nodular melanoma and it is 1.95mm deep – an “intermediate depth, not great news, but not the worst news.”  I will be receiving a call from the surgery scheduler in the next few days to schedule my procedure.  He will surgically remove the skin and underlying/surrounding tissue – about 1-2 cm in diameter – and also the sentinel lymph nodes (10-20 nodes).  There will be a significant scar, but he is also a plastic surgeon, so that’s something.  It’s kind of ironic that I got the mole removed because I didn’t like how it looked and now I may have a worse-looking scar – but I believe not having cancer is the better of those two evils.  The removed
lymph nodes will be sent off for cancer screening.  There is a 10-20% chance that they will have cancerous cells (i.e. the cancer has spread) and further surgery (remove all my lymph nodes) and treatment (TBD) will be needed.  This also means that there is an 80-90% chance that the lymph nodes are clear and I will need no further treatment.  For those of you that are like “What the hell are lymph nodes?” – I googled it for you and found this on Wikipedia.

A lymph node or lymph gland is an oval-shaped organ of the lymphatic system, distributed widely throughout the body including the armpit and stomach and linked by lymphatic vessels. Lymph nodes are garrisons of B, T, and other immunity cells. Lymph nodes act as filters or traps for foreign particles and are important in the proper functioning of the immune system. They are packed tightly with the white blood cells called lymphocytes and macrophages.

Lymph nodes also have clinical significance. They become inflamed or enlarged in various infections and diseases which may range from trivial, such as a throat infection, to life-threatening such as cancers. In the latter, the condition of lymph nodes is so significant that it is used for cancer staging, which decides the treatment to be employed, and for determining the prognosis. When swollen, inflamed or enlarged, lymph nodes can be hard, firm or tender.

Lymph nodes are not part of the body's system for handling illnesses stemming, for example, from environmental toxicity or personal injury— those tasks are handled by the liver and kidneys in the former and the muscular-skeletal system in the latter. The lymphatic system is structured to address biological infection by other organisms as well as biological breakdowns/ errors within the same body (i.e., cancer). 
 
So….not sure how they’d remove all of them since they are throughout the body - that doesn't seem pleasant.  It is also odd to find that lymph nodes help combat infections like cancer…but are also possible hosts for my cancerous cells.  But, I don't write this stuff, so...?  I’m not sure what would happen to my immune system if my lymph nodes were removed, but I can cross that bridge if I get there.

There are still a few “What if…”s, but on the whole, it is relatively good news.  I will post an update when I have surgery scheduled.  It should be just day surgery– in and out – and my parents are coming down for it.  I had sinus surgery in 2011 (my 5th one) and they did not come down for that – mistake on my part (I told them they didn’t have to).  I had to wait so long to go in for surgery – I had too much time to think about possible bad outcomes and my parents getting a terrible phone call.   Long story slightly longer…I had a mini-breakdown though I was also drugged at the time, in a state of hyper-emotionality and hitting on the male nurses via the female nurses, so there’s that.  I do think I look good in a hospital gown (pretty much like the image below - I'm in the next bed over) and those little socks they give you are wonderful.