Chapter 3:

The Longest Weeks

The weekend and Monday passed by, and Tuesday brought the results from the clinic as follows: NOT likely to be melanoma, rather it is “favored” to be a severely atypical dermal Spitz nevus.  What the hell is that? Answer is….. it’s a whole lot of craziness.  I ended up at a melanoma specialist at a local cancer center.  He had gone to school with my boss and they are still friends to this day.  Incidentally, I still see him occasionally. He is one of the greatest physicians I’ve ever met, and an even better person.  So, what is a Spitz nevus?  I was very confused when he first explained this to me. If you have a Spitz nevus at birth, or develop one as a child, they are totally harmless.  But, if you acquire one later in life as I did; it’s a totally different set of circumstances. My lesion developed over a span of about three months during my late thirties.  Its maximum size was about that of an eraser on the end of a pencil.  It had been there roughly 4 years at the time of removal.  Unlike a Spitz nevus that has developed early in life, one occurring in mid-life is at risk of converting into melanoma. A problem with Spitzoid tumors is that under microscopic observation the cells of a melanoma and Spitz are essentially identical.  The difference lies in their behavior.  Spitz nevus cells are benign; while melanoma cells are aggressive, metastatic, and deadly. My specialist at the cancer center said the only way to truly know if mine had converted to melanoma would be to do nothing and see if I was alive in five years.  He was that frank with me, and I appreciated it.  The protocol for treatment of this type of tumor involved a second forehead surgery to excise a larger football shaped piece of skin.  About 1.5” wide at its maximum point, and 1” from top to bottom at its largest.  In addition, I needed to have lymph nodes removed and checked for melanoma cells.  If melanoma cells were to show up in my lymph nodes then it was going to be a bad prognosis.  If my nodes proved negative for the cells; that was good.  It meant that either it had not yet changed into melanoma, or it had changed but not spread.  

     Surgery was scheduled for 6 weeks later.  Ugh.  That’s a long wait!  That was the tough part.  My first experience with this type of thing, and I must wait that long to find out what my future was to hold.  I recall the weekend before surgery being the toughest.  I was nervous. Not even just about what I was going to find out regarding the lymph nodes, but maybe even more about the cutting into my forehead and neck (lymph node location). The procedure involved a two-day event. Tuesday of that week was something called a lymphoscintigram, and the actual surgery was the next day.  A lymphoscintigram is done for finding to which lymph nodes my forehead “drains”.  Those would then need to be removed the next day. A lymphoscintigram is not an awful procedure by any means, but it’s not very pleasant either. The patient lies on a table; which is part of a scanning device.  A syringe is then filled with contrast dye. Contrast dye is a substance that shows up on radiological testing. Six injections of the dye go into the forehead.  Not just injected subcutaneously (just under the skin), but the needle firmly pushed against your skull.  A bit painful.  You are warned of this so you’re prepared.  There can’t be any sudden movements. The scanning device then tracks the dye to the lymph nodes which the forehead drains.   The sight of my forehead lesion happened to drain to lymph nodes on both sides of my neck. Located just about an inch forward of my ear lobes, and one inch below my jaw.  Therefore, I was facing three total incisions the next day.  I remember being mentally exhausted after the lymphoscintigram. This was all such a new disconcerting experience to me. One which I will soon begin to accept as a regular part of my life.

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