My Melanoma Story By Al Cato Oct. 09, 2001

The dermatologist called on Friday afternoon around 2:00pm. She said that she was very sorry to call just before the weekend but the news could not wait. The biopsy confirmed that I had a malignant melanoma! I listened intently as she told me more. " It is very important to get the melanoma removed as soon as possible. Time is just one of the enemies you are fighting." She tried to be encouraging but I could tell from her voice that she was extremely concerned. She gave me the names of doctors to contact immediately to begin the process of removing the melanoma, assessing its progression and determining next steps based upon the pathology findings.

To say that I was scared is an understatement. I have a family history of melanoma. My father died of liver cancer caused by melanoma. As a result, I have gone every year to my dermatologist to be checked for any signs of early skin cancers. I have had many basal cell skin cancers frozen and eliminated. I have also had Mohs surgery for two lesions on the right side of my face for squamous cell cancers. I thought I had this process under control. Little did I know?

It was blind luck that I found the melanoma! A number of months ago, I bumped my head on my car door while getting into the car. I checked to see if I had cut myself, saw no signs of any damage and went on my way. I really forgot about this incident. One evening after showering, I was drying my hair and noticed a dark spot in my left temple area just into my hairline. I looked as closely as I could with my wife's magnifying mirror to see what the spot was. It was small but dark. I asked my wife to look as well. She said that it looked somewhat like a bruise. I told her that I had bumped my head some time ago and it was probably a bruise as a result of the bump.

Some months passed and the spot did not go away. I decided that this didn't seem normal. I went to my dermatologist to have her check it out. At the time of the visit, she did not seem too concerned. She did the biopsy and sent me home. Then came the results!

Even with the names of the doctors I had been given, I didn't know really how to proceed. I called my internist and insisted that I get in to see him on Monday morning. I told him that I had melanoma and needed his help in getting a plan of action in place. I took my HMO booklet with the names of all of the doctors from whom I could choose to my appointment. My internist did some preliminary screening - checked my lymph nodes in my neck and abdomen, did a chest x-ray which was negative and took some blood for further testing. He took the HMO booklet and together we went down the list of names of doctors in my HMO. The one surgeon, recommended by my dermatologist, was not in my HMO plan. After much conversation, we decided to select a plastic surgeon to do the removal of the lesion because plastic surgery would be required to repair the wound. I gave him the oncologist's name that I had been given. He said that if he were in my situation, this is the oncologist he would want. Everything seemed to be set. His staff made the appointments for me.

Over the weekend, I read a lot about melanoma. There is an excellent web-site (www.mpip.org) for melanoma patients. I read that there was a relatively new procedure called a Sentinel Node Biopsy that was recommended for my stage of melanoma, early Clark's level IV with .95mm of thickness. The very first node in a bed of lymph nodes into which the fluids of your body drain is called the Sentinel Node. The value of the Sentinel Node Biopsy is that it can eliminate the need for a radical dissection of the neck if the Sentinel Nodes are free of cancer cells. The more I read the more I became convinced that this procedure made sense. At my initial visit with my plastic surgeon, we talked about many things - what he could do, the seriousness of the situation, possible outcomes, the Sentinel Node Biopsy, how quickly could the surgery be done, etc. We decided that the Sentinel Node Biopsy was the way to go and he would find a surgeon who could do this procedure. Once again finding surgeons who participated in my HMO and who could do the Sentinel Node Biopsy became an issue. Finally one was found. Surgery was scheduled on a Friday morning.

Before surgery, my visit to my oncologist was somewhat encouraging. He reviewed the initial pathology report generated from the biopsy my dermatologist had done. He said that my stage of melanoma and based upon the initial pathology, there is a 90% chance that no cancer cells would have made their way into my lymph nodes. But there is always the chance. The Sentinel Node Biopsy was his recommendation as well. He took out some textbooks and showed me the survival percentages based upon the various stages. Mine looked encouraging but it was still on the borderline based upon an early Clark's Level IV assessment. The level of penetration of the tumor was .95 mm. He was cautiously optimistic. He outlined what the next step would be if there were cancer cells in my lymph nodes - a year of interferon plus perhaps other chemo as well. Off to surgery I go!

I thought I knew what lay ahead for me on the day of surgery but I was in for some surprises! To identify the Sentinel Nodes, a radioactive substance is injected around the lesion and is then tracked via a scanner and a computer to see where the radioactive material goes in your lymph system. The procedure was uncomfortable but successful. The technician had tracked the radioactivity to 5 spots on the left side of my face and neck. I thought there would only be 1 Sentinel Node but lucky me, I have 5 X's on the left side of my face and neck Surgery is next.

I am plugged into my IV's, on my gurney and ready to be wheeled off to surgery. The doctors come in to see me one last time before proceeding. The surgeon who was to perform the Sentinel Node Biopsy took one look at the X's on my face and said that he was very concerned that my salivary gland as well as facial nerves could be involved during the procedure. He also said that he thought a specialist should do the surgery in this area. He would assist the specialist by identifying the Sentinel Nodes while also guiding him in the removal of the Sentinel Nodes. After much conversation about alternatives and choices, another surgeon was contacted, an Ear, Nose and Throat specialist. He said that he does this type of surgery very often and would be glad to do this for me. Unfortunately, he could not do it until the next week. After much discussion among the doctors about the best approach for me, we agreed that it was best to wait, even though I wanted this "thing" off of me. Surgery was cancelled and I was sent home to wait until the next week. What a long weekend it was!

The day of surgery finally came and the same procedure was followed to identify the Sentinel Nodes. This time only 4 appeared. Just prior to surgery, the Sentinel Node surgeon injected some blue dye into the same area around the lesion as had been the radioactive material. The blue dye helps the surgeon identify the Sentinel Nodes during surgery so that he can remove only those nodes and so that he "gets" the Sentinel Nodes. It is critical to remove the Sentinel Nodes so that the pathology comes back correctly. I'm wheeled into the operating room for this 4-½ hour procedure and the room goes to black.

I awake. I'm being wheeled to my room for my overnight stay. It is now around 11:30pm. Everything seems to have gone well so I'm told. I feel as though I had just gone a few rounds with Muhammad Ali. Fortunately, I am discharged the next day in the afternoon to go home. I now know more clearly what was done - the lesion was removed and a skin graft was completed to close the hole in my temple area, the Sentinel Nodes were removed and by good fortune, the 5th node was found embedded in the portion of my salivary gland that was also removed, the left portion of my face around my ear has numerous stitches and my jaw area is sunken in slightly where the upper half of the salivary gland used to be. All in all, not too bad considering the alternatives.

This is Wednesday, the day after surgery, and the wait begins! What will the pathology show? What if this and what if that? I have never been so afraid. The demons of the night are the worst. I continue to say my prayers. I ask for strength but I cannot turnoff my mind. My fears seem to overwhelm me at times. I know that I will fight to live but I wonder is this the beginning of the end of my life in this world. Prayer is the only thing that brings me peace if only for brief periods of time.

Friday is the day that we will know the results of the pathology. My wife and I had decided that we would not call until after lunch expecting that we would receive a call with the results sometime in the morning. The morning came and went. Still no call came. We placed a call to the Ear, Nose and Throat surgeon's office and asked if they knew anything. Nothing but they would check on it. We placed a call to the surgeon who removed the Sentinel Nodes. We explained what we were seeking. He was not in the office. The wait continued. His office must have contacted him because he called us from Northside Hospital to say that the nodes were free of any signs of cancer. We were elated and we sat together on the couch and cried. I could not express to the doctor how happy we were, relieved and thankful to be so blessed. Calls were made to everyone who knew our situation and whose prayers and support helped us through this difficult time in our lives.

The recovery is going well. I will now go for follow-ups every 3 months for a year with my oncologist and every 6 months for the next year. I believe that everything is ok and regular follow-ups can only help.

I am very fortunate and I don't take it for granted. I had an excellent team of surgeons who came together to do their best for me. I have an oncologist who took the time to educate me about my situation and the possible next steps and the percentages of success. He was encouraging but yet realistic. I have a dermatologist who trained me over the years to know what to look for. In spite of her training, I almost waited too long before taking action. One doctor said that if I had waited another 3 months that it would be likely that the melanoma would have spread into my body. I have an internist who marshaled the resources of his office to help me and took the time to be personally involved in getting me started on a path in selecting the right doctors. I am indebted to them all.

We have a network of friends who rallied around. We thank them for their support. Just knowing that they thought about us brought us comfort. Our kids, who'll be forever young in our eyes and probably treated as such, were there when we needed them. Their support is unending.

Lastly, I have a wife who is a pillar of strength. She is always there when I need her especially in times of crisis. She has been my nurse too many times. She was very determined and demanding to be sure that we clearly understood everything that the doctors were recommending - procedures, outcomes, side-effects, etc. She was persistent in getting answers to our questions in terms that we could understand. She'll cry a little from time to time but don't mistake that for weakness. If there is one person in the world I can count on no matter what, it is she. Her love, comfort, care and support are always there when needed. I am truly blessed.

Once you are diagnosed with cancer and even when the results of the pathology show that it has not spread, the thought of cancer will linger always in the deep recesses of your mind. We will never forget but we will not live in fear. We will live our lives and be thankful that we were so blessed!

Contact: alcato@aol.com