The goal of this article is to provide useful information while relating the experiences and treatment of a current patient at Dermatology Associates of Kentucky.

       While growing up in Florida, I experienced many intense sunburns. For years, I have known that someday this overexposure to the sun might result in skin problems for me. I am very fair-skinned, and all of my family has had precancerous lesions removed from various parts of their bodies.

       As an adult, I have tried to examine my skin on a regular basis because I knew that early detection of irregularities that may need medical attention is essential. I have discovered suspicious areas on my face, scalp, the tops of my hands and my lower legs. These are common areas for the emergence of skin cancers. In each case, I’ve set up an appointment with the dermatologist immediately. As a result, I have avoided more serious complications because I received treatment early in the development of these lesions. If left untreated, even less dangerous forms of skin cancer may cause progressively serious damage.

       Recently, the importance of early intervention really hit home. In early 1998, I had a flat, light pink area on my right cheek identified as keratosis. As the year passed, I noticed that the color darkened and seemed to spread a bit. In January 1999, I was concerned and returned to the dermatologist. He decided to biopsy that area immediately.

       The biopsy results were surprising. The lesion was identified as lentigo maligna melanoma, amelanotic. Lentigo maligna is one of the rarest melanomas and is more common in people much older than myself. Amelanotic means without melanin or color; it is a rare form of melanoma that is difficult to recognize without a biopsy.

       I was dealing with quite an unusual situation, which required immediate action. Melanoma is the most aggressive, and therefore most dangerous, form of skin cancer. For a positive outcome, melanoma must be detected and treated in its earliest stage.

Fortunately, my melanoma was identified early. It was melanoma in situ, which means that the cancer is confined to the epidermis, or top layer, of the skin. When a melanoma is confined to the top layer of skin, surgical removal usually will cure the disease. My physician recommended immediate surgery. He also gave me the details of the surgery, so I would know what to expect, and informed me of my prognosis.

I was encouraged because my prognosis was excellent. My mental attitude was also positive because my physician made sure I was well informed, and he was willing to answer all of my questions. I had never experienced such a serious medical situation, so this was a crucial time with regard to my outlook.

       The following week, I underwent excisional surgery to remove the entire lesion and a small border of normal skin. The incision was quite large, about three inches long. The incision was a bit larger than the lesion, which was necessary in order to pull the edges back together after the excision. My physician had discussed this possibility with me beforehand, in detail. So there was no surprise when I saw the results after surgery.

       The stitches were removed a week later. I was informed that tissue analysis revealed more melanoma cells, indicating that not all the melanoma might have been removed. There was a possibility that the melanoma had spread beyond the upper edge of the tissue that had been removed. Therefore, more surgery was necessary to ensure complete removal of all cancerous tissue.

       Admittedly, this was an emotional time for me. I had not expected a condition as dangerous as melanoma. I had coped with the first surgery, which was unanticipated, but I was shocked when I learned a second surgery was required. Seeing my distress, my physician and his nurse responded with patience and compassion, which helped me to cope with the unexpected news.

       A few days later when I had regained composure, I set up an appointment for discussion of my situation – to learn more about my condition and further required treatments, what to expect, etc. I arrived at my appointment with a list of questions, and my physician patiently answered each one. As I gained more information and began to understand more about my condition, my fears began to ease. I began to feel more in control and empowered to meet the challenge.

       Your physician should be sensitive to your fears and be willing to answer questions thoroughly and to your complete satisfaction. He/she has dealt with these issues and should be able to offer support and helpful information. Feelings of fear, helplessness, vulnerability and invasion of personal space are common and natural. Receiving a diagnosis of melanoma may be overwhelming even for a well-informed person. Allow yourself time to come to terms with your situation.

Second Surgery

       My second surgery would involve the area on my upper cheekbone, near my eye and ear. This area of your face is more sensitive, due to a denser concentration of nerves, so I would need general anesthesia. My dermatologist referred me to a surgeon.

       Before the surgery was scheduled, my husband and I met the surgeon at his office. Again, I received ample information, ahead of time, regarding my diagnosis, prognosis, the procedure that would be used, and what to expect after surgery. This thorough preparation and information gathering helped me to approach the surgery with optimism.

       This surgeon also performs a relatively new procedure that was first recommended by my dermatologist. This procedure identifies the sentinel lymph node, the first node to which the melanoma would spread. Although it was highly unlikely that the cancer would spread, because the lesion had been removed in its earliest stages, I wanted to take advantage of this opportunity. I wanted the assurance that my condition was treated as thoroughly as possible.

       The surgery was performed at a local hospital on an outpatient basis. The lymph node biopsy and skin excision were performed during the same procedure. Two lymph nodes were detected as a possible site for cancer spread, and they were removed by the surgeon.

       The second surgery successfully removed all remaining melanoma cells. Additionally, no sign of cancer was detected in the lymph nodes. Therefore, my prognosis is excellent. Because I had watched diligently for any lesion change, I received appropriate medical treatment early enough to achieve a positive outcome. I am truly fortunate and very grateful to have received excellent medical care from two skilled physicians.

       The surgeries left two scars. A long scar has resulted from the first two surgeries to remove the lesion on my cheek. It is not as noticeable as you might expect, because it is far to the edge of my face. Also, the physicians who performed the surgery are very skilled and achieved impressive results. The skin along the incision site is flattening out very well. The lymph node removal left a scar located just under, and horizontal to, my jawbone. It is not very noticeable.

       With proper care, the scars will heal very well. There are new products available that promote healing. I am currently using one, and the early results are very encouraging. Another important form of scar care is sun protection. Sun exposure will cause the tissue to darken, so scar tissue should be covered with sunscreen.

       The facial scars are not devastating for me. I know they will continue to fade and can be covered effectively with makeup. Actually, they serve as a reminder that I am very fortunate to have an excellent prognosis, in spite of a diagnosis of melanoma. My scars serve as motivators for appreciation of the present and the future.

       If you encounter a similar situation, you may be inclined to seek care from a dermatologist. A recommendation from a friend or relative can be helpful. Word of mouth can be a valuable tool in locating quality medical care. Satisfied patients will spread positive news. Also, seek a medical facility that offers a wide variety of services: general dermatology, Mohs micrographic surgery for skin cancer, laser surgery and phototherapy. It may be beneficial to find a dermatologist who offers cosmetic procedures. You want as much versatility as possible in available services.

       It is crucial for the patient to feel confident in the medical qualifications and technical skills of his/her physician. Seek a board certified dermatologist, which means that a physician has completed specialized training and passed an examination given by specialists in the field. Find out what kind of experience he/she has in relevant surgical techniques and treatments for various skin problems or conditions.

       Your skin condition may be a cause of real concern to you. All medical personnel with whom you come in contact should show support and make you feel valued as an individual. If you have a condition for which surgery is recommended, you may feel ambivalent, or even fearful about the procedure. This is a normal reaction and should be treated as such by all involved in your medical treatment. A caring environment will have a positive impact on your emotional and physical healing. The best medical outcome can be achieved when you receive support and you are well informed and optimistic about your care.

       Articles from medical journals also assisted me in learning about my condition. My physician provided articles for me that contained detailed information on early melanoma, including diagnosis, treatment(s) and prognosis. I learned about the procedure that my physician would be using during my next surgery. It was a relatively new procedure, which was unheard of by most of the general public. Having the ability to learn the details of the procedure made the difference in whether I would consider having it done.

Positive Influences

       Successful treatment and continued care are not limited to purely medical factors. Ultimately, emotional well-being is the most important element for you to nurture. Having a good support system is essential to emotional health. This may include a network of close friends and family and/or a group that shares your religious beliefs.

       It is also important to reduce stress and negative feelings. Instead, focus on maintaining a positive mindset, seeking new challenges and exploring new pursuits. The patient who engages in activities that bring enjoyment and satisfaction benefits most in life. This is particularly true during times of great difficulty. Positive influences produce inner strength and optimism. This enables a patient to cope successfully with challenging situations. My positive mindset has been essential to my emotional and physical well-being.

       Humor is another emotion that plays a key role in your emotional health. There is real power in harnessing a sense of humor — laughter releases tension, enabling you to approach a challenging situation more calmly. It keeps us from taking ourselves too seriously. In the midst of a stressful situation, I have benefited greatly from sharing laughter with my physician and his staff. The healing power of laughter is well documented.

       All of these medical experiences have been positive because of several factors. First of all, communication with my physicians before, during and after each procedure has always been excellent. Also, I appreciated the respect shown to me as an individual, as shown by the willing exchange of information on a level appropriate for my previous experience and knowledge.

       My physicians, and their staff, showed interest in me as an individual with emphasis placed on maintaining the good quality of my general health. Procedures were explained thoroughly, and ahead of time. As I requested additional information, it was readily provided. Care was taken to avoid any unnecessary pain before and during each procedure. I was made comfortable, both physically and mentally, during all procedures. The nurses offered invaluable support and information whenever needed. Therefore, I have always approached an examination, surgery or other procedure with confidence.

Recommendations/Precautions

       Do not overlook your personal responsibilities to maintain good general health. These are easy preventive measures that you can enforce – the choice is yours.

Eat a healthy diet, including fresh fruits and vegetables known to be cancer-fighting.

Exercise on a regular basis. This can help reduce the possibility of all cancers by enhancing immune system function.

Avoid exposure to sun between the hours of 10:00 a.m. and 4:00 p.m. If exposure to sun during that time is unavoidable, wear protective clothing.

Examine your skin on a regular basis.

Be aware of all its unique characteristics – freckles, moles, unusual blemishes or growths. If changes occur, seek medical treatment as early as possible.

If you have a history of receiving intense sunburns, be especially diligent in skin protection and care.

Use sunscreen of at least SPF 15 daily on all exposed areas of skin.

Avoid tanning beds and sun lamps. These are very dangerous.

        I encourage you to take responsibility for your health and well-being. Skin problems can develop anywhere, anytime. Have an annual whole-body examination performed by a dermatologist. It is a simple, quick procedure that can help you avoid unnecessary medical problems by early detection of suspicious moles, growths or blemishes. You will not always be able to detect potential skin problem areas on your own. Take the initiative to address the health of your skin, before a serious condition develops. Be an active participant in your care, and do not hesitate to ask your dermatologist for information regarding your condition.

In my research, I came across a book that serves as an excellent reference for skin problems and diseases, particularly melanoma. It also offers general information and protection techniques for good skin care. It is easy to understand and supplies an impressive amount of information. The title is Saving Your Skin by Barney J. Kenet, MD and Patricia Lawler.

Written by E. C.