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Results of the MRI are back- the lump does not appear to be a metastasis, though apparently can never be 100% certain with an MRI, it’s not a plantar fibroma (good news) and it’s probably a ganglion. Now comes a difficult decision- my consultant says that the only way to make sure the lump is benign is to have it surgically removed but this involves a general anaesthetic, 10 days bandaged up, and 2 weeks unable to drive. So both the consultant dermatologist and orthopaedic surgeon both think it is nothing nasty but neither can give a 100% assurance- for peace of mind (hopefully) I’ve decided to go with the operation next week as I can’t cope with not knowing even though I know that I’ll continue to live with uncertainty with everything else about the melanoma. Am I being stupid putting myself through this- I get the opinion that the surgeon and dermatologist think I am! Had appointment with the foot specialist today. He thinks it is a plantar fibroma but sent me for an MRI scan to try and rule out metastasis for my peace of mind. Had the MRI this afternoon and should get the report before the weekend but specialist said that probably the only way they can be 100% sure will be to take the lump out. This means a general anaesthetic, possible infection, possible nerve damage etc etc so I think I will be faced with a tough decision depending on exactly how reassuring (hopefully) the results of the MRI are. Thank you once again for all your reassuring words and advice. Thank you everyone for your reassuring words. Time is dragging very slowly until my Wednesday appointment, just had x-rays taken of my foot so a step closer… Just a quick update. Went to see my consultant dermatologist at hospital who said it was extremely unlikely to be anything to do with my melanoma. It is a subcutaneous lump, however, and as he has no idea what has caused it he has referred me to a foot specialist who I am seeing next Wednesday. Still worrying non-stop, do not get any scans with stage 1a in the UK nor are you able to have an SLNB so for all I know it has spread. Five more days of worry and probably more after that if it has to be cut out and biopsied, which is probable if the foot specialist cannot identify it straight away. Thanks Catherine and everyone else for the words of reassurance. I’ve calmed down a bit but every now and then feel totally overwhelmed with the worry of it all. I’ve always been a very anxious person and the more I learn about the unpredictability of melanoma, the more I live my life in a constant state of waiting for the axe to fall. I just can’t see me ever getting to a day when I don’t constantly think about melanoma.
Anyway, the lump is very real which doesn’t help matters and I’ll let you know how I got on after tomorrow’s appointment.
Seven months ago. This is an extract from a website I found and also the skin is one of the most common sites for distant metastasis:
Metastases appeared as small, discrete rounded densities in the subcutaneous fat; lesions were occasionally subtle because of their small size and peripheral location. The location of subcutaneous nodules could not be predicted consistently on the basis of the site of the primary malignancy. We conclude that subcutaneous metastases are common with melanoma in patients with Clark level IV or V lesions.
It looks like a mosquito bite/ bee sting (although it’s neither) and is painless. Regarding it being on the other side of my body, yes, it’s not a local recurrence but I have read that you can get distant recurrences anywhere on your body regardless of where the primary site was. This is why I am so worried that it’s a recurrence.
Continue to be very wary with any diagnosis of dermatofibroma. I also had a small red mark (not even raised) on my leg which was diagnosed as such in January 2011. As these are totally benign and never change into cancer, although can continue to grow and change in colour, I did not really keep an eye on it. 12 months later and only 5mm across I thought it didn’t look quite right and it was then diagnosed as melanoma with a Breslow depth of 0.72mm.
If I was ever diagnosed with dermatofibroma in the future, I would have it removed.
Cohanja, I got the 95% survival rate from my consultant dermatologist and this also agrees with the rate shown on the American Cancer Society website. The Royal Marsden Hospital, the major cancer centre in the UK, gives a 93% rate on their prognostic model and I got a figure of 96% on the AJCC based prognostic tool. My consultant has been practising for 9 years in his current role at a fairly large UK hospital and he said that, personally, he has not yet had any stage 1a patients that have progressed. Hope I’m not the first!
Goldengirl, in my view the status of NED can only be applied to invasive melanomas where there can never be any guarantee that surgery has given a cure. In the case of in situ, surgery cures the melanoma 100% so there will always be no evidence of disease in later years.
Congratulations! Just wondered though was there any particular reason your excision went so deep? My melanoma was 0.72mm and “superficial” Clark 4 and this was excised to a depth of only 1cm compared to your 4cm. Perhaps it all depends on the depth of skin/ fat in the area of the melanoma site… I note this quote from the Irish guidelines:
“Shave and punch biopsies are not
recommended (because pathological staging of
lesions on these biopsies is impossible).”
I would contradict the assertion about punch biopsies. My biopsy was a punch, taken only four months ago. I had a punch biopsy as my dermatologist was 99% certain there was no malignancy. It turned out there was (stage 1a) but the biopsy showed both clear lateral and deep margins (confirmed by subsequent wle) and my pathological staging was not compromised in any way.
My melanoma was only 5mm wide and I do agree that an excisional biopsy is best, particularly if the lesion is too big to be fully removed by the punch.
Sorry, I cut and pasted the link but it doesn’t come out correctly. So I’ve typed this out and hopefully it will work Jamesluke, the Irish guidelines from your link are dated 2006 and have therefore been superseded by the 2010 guidelines. The following link from the British Association of Dermatologists has been very helpful for me as it contains a lot of useful detail: Catherine, I had a 0.72mm Clark 4 superficial spreading melanoma removed 4 months ago from just above my knee which is very similar to your pathology. I must admit I’m now rather concerned about the 10% chance of recurrence as all my research/ prognostic models etc have shown my chance to be nearer 5%. My pathology did show a zero mitotic rate and showed an “invasive radial” growth stage as opposed to vertical (albeit the dermopathologist seems to have only reported this because of Royal Society of Pathology guidelines and not because he seems to believe in the distinction).