Hi. On Mar. 11th, I had surgery on the bottom of my foot. I was told it was a sweat gland that was clogged up. The Dr removed it 3 times in the office with tweezers. I went back to get the stitches out to hear that it came back as malignant melanoma. I was and still am in total shock. I can't find anyone that has heard of this or even find anything about it on the internet. I'm still waiting for the surgery proceedure to cut out part of the ball of my foot and have skin grafting done. I'm just nervous and scared. I know lots of people are praying for me, including myself. Has anyone else had this happen to them on the bottom of the foot? So confused.
It would be good if you can get a copy of your pathology report, then you can compare it with the pdf document to get a better feel for where you are.
Like other cancers, mel requires you to be staged. Some things are already known about your mel, some are not.
If you do a search for Hoaleboy, you will see many posts. He also had mel on the bottom of his foot.
I have had the procedure you are heading for, (at least a variation of it). It is called a WLE, wide local excision. Basically they are going to remove enough tissue to try and ensure they have removed all the mel. Based on your pathology report you may also be a candidate for a SNB, sentinel node biopsy. That is where they will check the nearby lymph nodes for signs of the cancer spreading.
Twister, use us as a resource to elevate your confusion, (ask questions). Also, you can use us as a "shoulder" to lean on. We have been there, through the process.
I can tell you the medical procedures, (surgery) will be a nuisance. The waiting for test results to be staged can often be gut-wrenching!
We are here for you. I wish you the best outcome possible!
Wow, thank you all so very much. I can tell there is a lot to learn. I know the secret to anything medical, is education. I am overwhelmed by all the terms, numbers, etc. I don't know anything except the doctor said it is incapsulated. I know that is a good thing. He said that when the surgry comes up, they will take out skin down to the fat layer. But, I saw him again on Thursday, and he said he's sending me to another doctor that does a different type of procedure. It's called skin rotation flapping. Does that sound familiar to anyone? I'll know more in the morning. Do I get the copy of the pathology report from the doctor or hospital medical records?
Twister, they will still cut down to the muscle fascia when they do the wide local excision..... the conversation on a skin rotation flap (versus a skin graft) is all about how they plan to close the wound after they do the Wide Local Excision to remove any remaining melanoma cancer cells.....be advised that the wound on your foot will heal somewhat slowly because the foot is pretty far away from the heart, so be a "patient" patient .....
You should be able to get a copy of the pathology report from your doctor (in fact, it is your right to get a copy -- they can't say no, so just ask them).... would strongly recommend that you keep a personal copy of all pathology reports, the analysis reports of all imaging tests, blood work, etc., in a dedicated "Twister's Melanoma Folder" .... It will come in handy as doctors do move/relocate their practice, retire, get shot by jealous husbands and wives, etc.....
Thank you HaoleBoy. You are a tremendous help to me. I saw the "new" doctor on the 18th. He is a plastic surgeon and I was told he is the one that invented, or discovered, the skin flap rotation method. He is Dr Pradeep Mohan. He was extremely helpful. The first doctor did NOT mark anything when he performed the original surgery. So when the report came back from pathology, it stated that the cells were "on the edge". As Dr Mohan explained, the entire piece that was taken out was an EDGE. So, he will have to start from scratch. He will remove 1/4 inch all the way around the origanal incision. He will "hog tie" the wound and send me home. The area will be marked this time and be sent off. It will take 3-5 days to get the report back to see where the cells are located. IF the edge is clean, we are finished. IF NOT, we go back to surgery to remove more in the area that needs removing. At that point, he will use the skin flap rotation method. The process will be repeated. IF we have to go in for a third time, then he will do skin grafts. With the angle of the incision, IF it is at the top (meaning under the smallest toe), he said he MIGHT have to take the smallest toe and maybe the second toe. He does NOT think that will be the case, but can't say till he knows where the cells are located. IF it goes the opposite direction, it will go down into the arch. It is located on the weight bearing area of my foot, so like you said, it will take longer to heal before I will be able to walk on it. He said it is 1A and I will get the report when I go pick it up. It is Melanoma in Situ.............which I have been told mean "in capsule". He said if one has to have melanoma, this is the one to have. Not that it makes it any easier on me. But, I have seen that there are so many on here that are so much worse than myself. My surgery is set up for May 3. I will definitely start the folder and thank you for suggesting it. Let's hope that my doctor does NOT get shot by a jealous wife. (That got my attention, LOL). Thank you again and I'll be back.
twister- I hope your surgery went well today, I am sure you are sleeping - but I am thinking about you!
March 2011- mole removed- Stage II Melanoma
April 2011- 1cm margin excision + 3 axillary lymph nodes removed
pathology showed no mets, but I have plenty more moles and enough
sun exposure history to keep me paranoid about a new melanoma
Well, surgery went well and the Dr said they would call me with the results from pathology on Fri or Mon. I didn't hear from the Dr. do I called and found out that the Dr was gone to a convention and would not be able to give my results till Fri 13. So, I went to the hospital and picked up my report. Now, I have no idea what it means. It does NOT look like it's over, as I had hoped. Where my last report showed 1A.....this one shows 1A - 1C. I need help understanding this. FINAL DIAGNOSIS...."Skin lesion designated "melanoma in right foot", excision: residual melanoam in situ extending very close to 12 to 3 o'clock margin of resection (less than 0.5mm. from 12 to 3 o'clock margin) and close to 9 to 12 o'clock margin (approxiamately 1.5mm. from 9 to 12 o'clock margin
Focal dermal fibrosis, chronic inflammation, and foreign body giant cell. Reaction consistent with previous excision site". "The specimen is serially sectioned from tip to tip and entirely submitted in "1A - 1C". I know that many of you have so much more experiecne and know how to read this stuff, but if anyone can help me, I'd really appreciate it.
Don't confuse Stage 1A with "the specimen is serially sectioned from tip-to-tip and entirely submitted in "1A 0 1C"..... This refers basically to how they "bagged and tagged" the body tissue from the WLE... IT IS NOT STAGE .....
Given that you posted that the original biopsy specimen "was Stage IA" (in one of your earlier posts)... and I suspect the doctor meant to say that the biopsy was T1a (meaning under 1.00 mm and NOT ulcerated).... and it appears that they found another 1.50mm (Breslow depth) of tumor in your WLE, I would guess that the total Breslow depth of the tumor (biopsy + WLE) is NO MORE than 2.50mm thick AND COULD BE LESS .... What was the depth on your initial biopsy report ?... Whatever it was, add it to 1.50mm and you'll get the total depth of the tumor -- which is what determines the "T" portion in TNM (which is what they use for staging)....Worse case is that your tumor would appear to be T3a (T3a is 2.01 - 4.00 mm thick and NOT ulcerated).... My primary was a T3a, which with a negative Sentinel Node Biopsy (SNB), puts you at Stage IIA ...... Best case is Stage IB (again, with a negative SNB) from what I've read (due to the 1.50 mm depth of the residual tumor) based on what you posted
Did they do a Sentinel Node Biopsy .....
Again, my primary was 2.40 on the bottom of my left foot's second toe.. It was T3a.... Stage IIA..... I'm still here going on three years (BIG KNOCK on wood)...
Thank you again, Haole Boy. You are a tremendous help to me, even though the "lingo" is still so hard for me to understand. I looked again and there are no "T"s on any of the pages. Maybe just a difference in Drs or pathologists. They have not done a Sentinel Node Biopsy. I did ask about it and the Dr said it is not that deep. I get these stitches out on Monday morning. The Dr told me that there is a clean edge, BUT, the cells are so close to the edge that I will have to have another surgery just to be on the safe side and make sure all the cells are out. This incision will be from the middle of the incision all the way to the top on both sides up to the crease of the little toe. He said I will probably loose the function of the little toe, but after reading your posts, I can handle that. I have developed a nodule on the tendon of the same foot right in the center of the arch. When I first noticed it, it was about the size of a pea. That was about 3 weeks ago. It now is about the size of a marble. It is visible now and it does hurt when I walk. I showed it to the Dr. but he said I will need to see another podiatrist to see what that is. I'm very worried about going to the same podiatrist because he is the one that did the first surgery. When I started seeing him, it was for a tiny little bump that felt like a splinter. NO mole, no discoloration, nothing. He scraped it and used the tweezers to take out a little "bump" and he threw it in the trash. I asked to see it and the nurse just told me it was just a little bump. It came back and 2 more visits the same procedure was performed. He NEVER sent anything to pathology. So, when he did the surgery, he DID NOT mark anything at all and when the report came back is when he told me about the melanoma. I feel that I have lost trust in him. I will always wonder if those 3 pieces that went in the trash might have shown the melanoma earlier. This report said that this place that taken out is a corn. That confused me even more. That a corn could be cancerous. But, this is where I am right now. A few more weeks before the next surgery.
Well, I'm back. My other computer crashed and I had to get a new one. All my information was backed up and put on the "home" computer, but that room is going through some problems and I don't get in there much. So, since my last visit in April, I had another surgery in May to remove the amount needed to get a clear margin. The path report came back and it did not have a clean margin. So, we waited for some healing to occur, and in July, the Dr felt it was necessary to do a biopsy on two different spots on the bottom of the same foot. Both biopsies came back CLEAN.......We were all estatic. In August, he did another surgery to hopefully get the magin we had hoped to get in all the other surgeres. The path report came back and we had gotten the clean margin, BUT as the Dr cut down in length, he cut out a totally different area of melanoma. The only way he knew that was because now, there is an area that has a very fine margin. My surgeon sent me to a dermatologist and he performed a Routine H&E. He sliced out a circle 1 in X 1 1/4 in. It was sent to Dallas, TX to get it checked. Both Drs were positive that we had to have gotten all of it so the surgeon called me in and said when the results come in, he will make sure it has a clean margin and do a skin graft. It's an open wound that I clean 2 times a day. The results were given to me on the phone this morning by the nurse. There are still residual cells. The nurse said the Dr needed time to study the path report and really concentrate on it before calling the surgeon. At that time, one of them will call me back and tell me what's going on and what the next couse of action is going to be. They still have not checked the lymph nodes. I talked to my Dr about going to MD Anderson, but I have no insurance, so they are not wanting to treat me. One consultation is $2500 and surgery starts at $40,000. I don't exactly have that kind of money sitting under the bed. So, I hope to know more tomorrow, but wanted to get back in touch. Thank you.