The First Surgery – Wide Excision for Melanoma

melanoma stages

This article is my second post regarding my journey with cancer.

After learning of my diagnosis, I think a lot of things went through my head.  It was a busy time at work.  My daughter had just miscarried what would have been my first grandchild.  You don’t really know what to think!  And all the other parts of life don’t stop – you just keep on going.

Surgery was scheduled and even more anticipation and anxiety arose.  In my lifetime, I had not been sick very often, much less seriously ill.  The closest that I had previously come was in Nebraska went I got very sick with a virus that led to a hospital stay.  I had developed encephalitis that thankfully did not last long.  I probably had come down with the West Nile Virus before they knew what it was – my diagnosis was a vague “viral encephalitis”.   Even though I recovered from that illness fairly quickly, it left me weak for several weeks.  That had been 22 years earlier and since then the worst I had faced was hypertension and recurrent sinus infections.  Also, I didn’t feel bad.  I had the lesion on my upper leg, but I really didn’t feel sick.

The day for surgery came.  Since I worked at the hospital, I knew everyone involved, some very well.  Checked in early that morning, was prepped and went through the informed consent one more time.  I was to have a “wide excision” of the melanoma with a sentinel node biopsy.  That last part meant that before surgery I would make a side trip to Nuclear Medicine for a procedure to determine which lymph node or nodes were the sentinel lymph nodes.  Simply speaking that means the lymph nodes that would first receive lymph draining from the site of the melanoma.   It would turn out that they would identify two nodes as the sentinel nodes.

From there I returned to Surgery where I went to the holding area for final prep.  I was seen by the Anesthesiologist and then given the sedative (happy juice) to prepare me for anesthesia.  Very shortly, it was my turn and I remember being moved to the OR.  I was transferred to the operating table, greeted by the CRNA and from then on I remember nothing more.

The next thing I knew was hearing my name called in recovery (post anesthesia care).  I awakened without much difficulty.  At first I did not feel any pain whatsoever.   It was a little difficult to move my leg but it really didn’t hurt very much.  After I was stable the required amount of time, I was moved to another part of the prep area where you are prepared for discharge.

By this time, I started to feel some pain.  I was able to look at the wound dressing.  Boy, was it large!  I guess that’s what’s meant by “wide excision”.  The pain was getting worse and I was given some pain medication which primarily made me sleepy.   My wife came to be with me and after a couple of hours, it was time to go home.  We were given a prescription for some pain medication and given instructions on wound care.  I would return to the surgeon in about a week unless some problem developed.

When we got home, I was tired so I went ahead and tested out climbing stairs to go upstairs to my bedroom.  It was a tough climb.  I learned the lesson quickly that you start upstairs with your good leg and start downstairs with your bad leg.  That way your good leg is always doing most of the work.

After a couple of days rest, I went back to work.  Post surgery is really a waiting game.  The surgeon has told you that he removed the melanoma and a lot of surrounding tissue to try to ensure that nothing bad remained.  He also said that he took out the sentinel nodes and that they along with the tissue had gone to Pathology for their report.  The big question was:  Had the cancer already spread to the lymph nodes?

As soon as I could, I asked for and received a copy of the medical record for my surgery.  The lab report was still pending.  It was now time to go back to the surgeon.  During the visit, he looked at the wound, which was healing nicely, and told me to come back in a month.  I asked about the pathology report and he looked and said it was still pending.  He said he would call when it was back.

The next day I decided to give the chief pathologist a call to ask why the delay.  He said he needed to check and would get right back with me.  Instead of a telephone call, he showed up at my office a few minutes later.  He told me that both lymph nodes had tested positive but that he had sent them to an expert in Boston for a second opinion.  He had wanted to wait until he got that report before giving me and my doctor the results.  So, bad news with a small glimmer of hope that the expert in Boston would have a different opinion.

I have to truthfully say that I was devastated.  I had read enough about melanoma to know that it was a very nasty type of cancer and that survival rates were low – especially if the cancer had spread beyond the primary site.  For the next week, it was pretty much all I could think about.

When the results came back, the chief pathologist brought them to my office, handed the report to me, waited for me to read it and then asked if I had any questions.  The report was pretty simple to read.  It said that after examination, the two samples tested positive for microscopic evidence of metastatic malignant melanoma.  At that point, I didn’t have any questions.  It just had to set in.  I pretty much sat back in my chair and spent much of the rest of the day contemplating what it all meant.  My surgeon called and also gave me the news and asked what he could do for me.  We talked a little while and I told him that I would be more prepared to talk about it when I came to my next appointment.  He told me that he would need to do another surgery to remove all of the lymph nodes in that area of my body.

When I got home, I had made up my mind that I would learn everything I could about melanoma so that when I went to see the surgeon, I could have an intelligent discussion.  I searched the internet for everything I could find.  I looked at websites, scholarly journal articles, and anything else that discussed melanoma, treatment options and, of course, chances for survival.  I wanted to know my opponent well because I expected it to be a tough fight.  From the initial results, I had Stage III melanoma – a serious diagnosis but survivable.

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About mcreyscope

Retired / disabled survivor of Stage IV melanoma and paraneoplastic syndrome.
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