Getting 3rd excision for Melanoma T1a on scalp, 0.4 depth

@kbo I want to welcome you to Connect. I realize how daunting it can be to have a dangerous skin cancer diagnosis, and multiple excisions. Melanoma is very hard to cure unless you get it early before it has spread to the rest of the body, so vigilance in making sure they remove every bit of it is normal treatment for this stage. If even one cell was left behind, that could multiply and cause a reoccurance. The pathologist needs to look at a prepared slice of the removed tissue with a microscope to identify the margins on the tumor and to know that they have removed enough tissue around it to create a safety margin. There is a very specific protocol developed over the years for this that recommends how wide a margin they need for the specific lesion size and stage. The tumor lesion can also have roots.

My husband had a stage 2a melanoma on his hand that wasn't recognized as cancer until the first dermatology biopsy came back. They had not gotten all of it, and because it had ulcerated through the skin and was close to 4 mm in depth, he was sent immediately to a cancer surgeon. It was the size of an eraser on a pencil and looked like one being the same pinkish brown color. It had not started from a mole, but just came up as a dome shaped bump under the skin. Just prior to the surgery, they injected a blue dye near the tumor which was transported to the closest lymph node in his arm pit. During surgery, they could identify the "sentinal" lymph nodes because of the dye and removed a couple to check them to see if they had cancer. The cancer was removed from his hand, again with a defined safety margin, and all tissue removed down to the bone of skin, fat and muscle. That leaves a hole, so a plastic surgeon did a skin graft removing a quarter sized piece of skin from the groin. Nerves were also lost in the surgery, so he has permanent numbness and pain sensitivity and it healed like a concave dent because there is not enough tissue thickness under the skin.

His Castle test gave him a high cancer risk which means that for the first 2 years, he sees the dermatologist every 3 months, the surgeon every 6 months, and yearly body scanning for other cancer. Going forward past year 2, he sees the surgeon annually with screening. The dermatologist has removed numerous moles with many of them being moderately or severely abnormal. We have to be vigilant in checkups.

So you can see, catching it when it is very small is the best thing, and kudos to you for getting checked by a dermatologist. Something like that is very easy to miss and dismiss, but can be deadly. We were lucky; it had not spread. There still could be another independent new cancer because of his risk factors. You are lucky there too with a low risk on a Castle test, but don't let your guard down. Just be grateful that you did the right thing and advocated for yourself. Thanks for asking the question because a conversation and awareness like this can save a life. In sharing your story, you will help other patients.

Have you been given a recommended schedule for followups and screenings since the melanoma diagnosis?

@jenniferhunter thank you for your insight, shared experiences and words of encouragement.
I talked to my doctor today and I have slow mohs surgery scheduled now-first surgery is next Friday and the following Wednesday is the second (4th surgery total since the beginning of January).
I’ll have another full body scan before surgery because a different doctor did my initial scan. This is to insure that everything has been found.
Our plan after this is to have a full body scan every three months.
My husband and I started having yearly dermatology body scans two years ago and in December my melanoma was found during my appointment.
There is so much to be thankful for.

@kbo Thank you for your reply. When you talk about a full body scan, did you mean a dermatology check? I think I should have been more specific. I was talking about scans with imaging with x-rays and MRI with contrast looking for cancer. The surgeon asked for brain and lung imaging because those are common places that melanoma can metastasize. He also recommended an opthalmology eye exam because melanoma can affect the eye and my husband has eye exams every 6 months. That has been fine so far. Dermatology checks every 3 months is a good idea after having skin cancer. The Ken Burns documentary about Mayo had a story about a patient who recovered from melanoma in her eye. It is excellent and I would recommend it if you have not seen it. https://www.mayoclinic.org/about-mayo-clinic/documentary

I benefited too from what I learned about what an abnormal mole looks like when my husband had them. The key was the irregular shaped border and variation in the darkness of the color. The borders were lighter and kind of scalloped looking. I had a similar mole between my toes and got it checked out. It was moderately abnormal and was removed. On my next annual skin check, it was all good. My husband has had maybe a dozen things removed by the dermatologist and will be running out of stuff for them to find... and that's good too! He thought that bump on his hand was a wart and ignored it for about a year and it was growing. It is best to get an expert to decide if it's dangerous because patients shouldn't try to diagnose themselves and that is a big costly mistake if you get it wrong. We were very lucky, and my life would be very different now if his cancer had spread. We had been given an 80% chance that all would turn out OK, and it did. That left 20% of uncertainty of what our future would be together. I am so grateful. He had been covering it with a bandaid and when I saw it had grown, I found a doctor and scheduled his appointment. Lesson learned.

What tips do you have for sun protection that you would like to share? Do you spend a lot of time outside? I'm so glad you have it all scheduled to get the cancer out for good! That must feel so good and give you a lot of mental relief. Will you check back in when you're in the clear and share your insights? I hope you will also stick around and give hope to others by sharing your experiences. I'll be cheering for you all the way!

Hi @kbo,
I added your discussion to the Cancer group and the Skin Health group, so you can continue to connect with @jenniferhunter and other members living with melanoma like, @lk3xs @donnaohm @dave62 @susu2 @mermaid7272 @grandmar. @herbert1 @birdman518 also had melanoma on the scalp. You can read more of their stories here:
- Stage 1a Melanoma https://connect.mayoclinic.org/discussion/stage-1a-melanoma/

If I calculated your timeline correctly, you just had surgery on Friday and are preparing for another surgery on Wednesday. How are you doing?

@kbo
Hello,
I am so happy that your doctor was thorough and found the melanoma on your scalp.
I've been to several dermatologists who weren't.
I actually found a melanoma on my big toe during a pedicure.
I went for my annual check-up.
My brother had stage 3 melanoma, so I am very careful, especially since I have been burned many times and I live in Florida.
Anyway, I showed it to my doc when she was 'finished' with her exam.
It was a flat, even pin dot size on the inside of my toe, which she DID NOT pick up.
She took a biopsy and it came back positive for melanoma.
The surgeon made about a 1-inch long incision and about 1/2" deep.
I now go every 6 months for a check up.
Coincidentally, I go tomorrow.
Anything that concerns me or the doctor is removed.
I've had a couple of pre-cancerous spots.
Since my diagnosis, I have transferred my care to a dermatologist at a cancer hospital, where I was treated for lung cancer (there is no connection).
I hope you are feeling well and healing nicely.
Best of luck!
Ronnie (GRANDMAr)

I lost the love of my life to melanoma - so wish I had brought him to Mayo. But after reading your post, I think I’ll transfer my skin care to cancer specialists too.

WHEN Mom had melanoma on face - GP operated - Cut 2 xs. I took her to a GOOD DERMO - HE KEPT CUTTTING and checking - Had to go in for more repeatedly one day.
Careful who you allow to remove.
Experienced Dermo - if they can study skin they remove right then.
U don't want to keep WAITING and going Back . Get it ALL OUT AT ONCE.

Yes, I had a dermatology full body check and that’s how they discovered the melanoma on my scalp.
I had a third surgery two weeks ago because the second surgery margins showed additional cancer.
There was a fourth surgery scheduled and an hour before the procedure I received a call from the dermatologist telling me the margins were clear and the surgery was canceled.
My dr didn’t recommend any MRI’s or imaging.

Hi Colleen,
I’m doing good-3rd surgery margins were clear so the 4th surgery was canceled.
I have a dermatology check every 3 months now.