Other science bloggers have discussed their medical procedures on their blogs, occasionally even in real time. I have not yet been this personal in my posts, but what the heck. Here goes.
I had some minor surgery yesterday. It was more of a procedure really, but it still hurt and I am still cranky. I am at high risk for melanoma, you see, a rare but very deadly form of skin cancer that can be easily treated surgically, but if allowed to metastasize… well, that’s about it for you. The fact that there was an incidence of melanoma in my immediate family, combined with my being fair-skinned, has led to constant screenings and continuous vigilance on the part of my doctors searching for signs of melanoma, which show up as abnormal and scary-looking moles (or nevi).
Objects in mirror (or phone camera) may be closer (or bigger) than they appear.
Yesterday’s procedure was my fourth suspicious mole (or nevus) biopsy/excision in as many years. I have now decided that it will be my last for a while. Every time I have had this procedure, a doctor has found the mole mildly abnormal, and recommended that I have it excised and biopsied, “just to be on the safe side.” I appreciate that. I am a big fan of the safe side. What I am not a fan of is the fact that I have yet another three stitches to heal and am quickly running out of moles. At this rate, I will soon be completely mole-less.
What I am saying is that the safe side in this case is complicated. On the one hand, the doctors want to make sure they are not implicated in any negligence by leaving a potentially cancerous mole untouched. They are of course, also concerned for my well-being. My well-being, however, is severely compromised by repeated excisions of moles, a few of which I am rather attached to (pun intended).
So what do I do if and when this happens again, when my doctor identifies another suspicious nevus? Do I play it safe and suffer through (was that dramatic?) another unpleasant procedure and earn another scar, or do I just wait until things progress to a potentially risky point at which a doctor says firmly, “this mole needs to come off”? I need to figure out how to balance my fear of uncertainty and the promise of almost certain discomfort following the procedure. I just wish that my doctor(s) would figure it out too.
P.S. All three biopsies have been negative, thankfully. I will find out about this latest one next week.
Last updated:
Wednesday, 23 Jul
2008 - 20:22 UTC
I had my first mole excision last year and found it quite traumatic. I’d shown the mole to my regular doctor, who said she couldn’t really see what was going on due to inflammation and that I should really have a specialist look at it. I went to the dermatologist expecting a visual examination and maybe the setting up of a further appointment, but instead he had a quick look, pronounced himself unsure, and whipped out a needle and scalpel! I was completely unprepared for this, especially as he decided to ask me for my opinion on cancer stem cells while he sliced and diced.
It came back as “starting to change”, and I also found out that I have a relatively rare form of melanin and should have annual check-ups. I’m going to let him remove whatever he thinks should be removed in future (my safe side is quite large), but at least next time I’ll be prepared for the scalpel!
Aaargh! That happened to me as well! One one occasion, I went in entirely unprepared for any sort of cutting or needles, but there they were… along with a creepy-ish doctor asking me questions about herpes he really should have known the answer to. [Shudder]. I went home in tears, and not from the pain. It makes a difference when one is emotionally unprepared for a procedure.
I am so happy to hear that you caught your mole in good time. A large safe side in this case seems more than prudent.
It makes a difference when one is emotionally unprepared for a procedure.
Absolutely. Having all four wisdom teeth out was a horrible horrible experience, but going back with persistent pain a week later and unexpectedly being put back on the chair to be treated for two dry sockets was somehow worse. (I found out afterwards that two other friends have had complications after treatment at this particular practice. I have not been back since).
I just went home and slept after the actual extraction, but after the unexpected dry socket treatment I was a crying, shaking mess!
I don’t think there is really any contest, given that the choice is
1) some mildly uncomfortable procedures and the occasional scar
2) death.
I suffer from psoriasis and a few years back underwent phototherapy in which my entire body was bathed in UV for short periods twice a week. After that a couple of moles appeared close to each other on my
beer gutabdomen. These moles were getting quite friendly with each other and liked to chat noisily at unsocial hours, so my doctor recommended I have them removed. My local hospital did this within a very short number of weeks (they takle such things seriously) and the moles were biopsied. Nothing to worry about – but I am very glad I had that done.Someday I’ll tell you about my vasectomy…
I will pay you not to.
I’ll show you mine, Richard, if you show me yours.
Cath – Oh I had dry socket too. This is bringing back all sorts of unpleasant memories.
Henry – You’re right, perhaps I am just being whiny. In my own defense, it does hurt, and I do think the process messes with my head. I also think there is a line to be drawn between being on the safe side and causing unnecessary distress to the patient. I suppose the line has to be drawn on a case by case basis though.
Richard – Y’know, it’s not so bad! I read Abel Pharmboy’s account of it (links at top of my post), and it was fascinating! Then again, I am a geek, and a girl. That last part probably helps :)
A gentlemen does not discuss such matters in front of ladies.
gentlemAn, of course,
I’ve had a mole excised on the spot (as it were) before too. At the time I was quite pleased that I didn’t have to wait to see a specialist or anything, though, as I had convinced myself that it was definitely skin cancer and that I was probably done for.
On that note I agree with Henry. Hopefully it’ll get less uncomfortable as time goes on (having moles removed, not agreeing with Henry) and you get used to it, though.
Hopefully it’ll get less uncomfortable as time goes on (having moles removed, not agreeing with Henry) and you get used to it, though.
After a while, the relative discomfort of having moles removed and agreeing with Henry becomes almost indistinguishable.
Over ten years ago, my primary care physician referred me to a dermatologist, who promptly removed six shifty-eyed moles from my torso and upper arms. She also wanted to discuss melanocytes and neural crest cells while wielding the scalpel. I was grumpy about it briefly, because I had to miss a cross-country skiing trip I’d been looking forward to. I can definitely sympathize, Anna.
Now I see a dermatologist annually, and he suspects that I have “multiple nevus syndrome”, though I haven’t had any genetic tests to confirm. He told me that “blue-eyed white girls have no business living in South Texas”. I think I’m meant to live in Scandinavia, but since I don’t, I have to have all the little melanocyte parties checked frequently. Also, because I’m a biologist (and work on a disease that the dermatologist treats frequently), he spent some time describing the specific gross pathological changes I should look for – it might be worth asking your physician if he or she will do the same for you. Gives you a little more feeling of control, and less of the surprise element.
If I were a horse, I’d be a Leopard Appaloosa.
I am also of the fair skinned, frequently burned variety and have had my fair share of moles removed. All turned out to be just moles, and that made me cranky. Especially since my 1st Dr. had very little bedside manner and told me how thick my back skin was as she was hacking through it. But that’s another story. Then, the last mole I had removed (by a very kind Dr.) was basal cell carcinoma. Could have been worse, but still a little scary. Then my uncle was diagnosed with stage 4 melanoma (he had not been regularly screened). I’d rather they take off each and evey one of my moles and bitty freckles at this point, thick skin or not. But, you should at least keep an eye out for the ones that are changing. That’s the only one that turned out to be slightly scary for me so far.
Hi Anna, thanks for the link – I’d love to hear Henry’s story.
What’s truly amazing is that I’ve worked so hard on about 750 posts detailing natural products pharmacology, herbal medicines, pseudoscience, etc. but whenever anyone meets me in real-life I hear, “So you’re the dude who liveblogged his vasectomy!” I guess as long as they come over to Terra Sigillata I should be pleased.
I also share Henry’s view on the risk/benefit of having nevi removed. Dying of malignant melanoma is a horrible, horrible way to go and, sadly, it happens surprisingly often to people as young as you (with the trend moving even younger.). Reminds me that I’d better go have some of my moles examined.
Sorry to bring up painful memories, Anna! At least there’s a finite limit on the number of wisdom tooth extractions you can undergo in a lifetime…
Kristi – Oy. Six in one go. That had to have been seriously traumatic. That’s the thing about my nevi – they are all very normal looking. I know what melanoma looks like (I have had 50 of those little handouts given to me over the years) and luckily, I don’t have that. I only have a family history of it, which prompts my doctors to be overly cautious. Is there a strong genetic component to melanoma? I am unsure. I am being treated as though I am in imminent danger.
Malen! Hi! Yea, I am getting the feeling that I should just be quiet and get the moles taken off. What’s weird is that I went in specifically for one I was nervous about. The Dr said I didn’t need to worry about it, but another one, that hadn’t changed at all, needed to come off. Weird. I don’t get it. Apparently, there are a million different kinds of moles and some are more prone to melanoma than others. Eek. I am so glad that your carcinoma was caught good and early. How scary.
Abel – You have to admit, you were a pioneer. Your post did a lot of people a lot of good! What do you think is responsible for younger people being diagnosed with melanoma? Increased sun exposure? More surveillance?
Cath – Amen to that. I had all mine out in one go. It was an effective weight loss plan, but I can’t say I would do it again :)
Right! That’s it! Great! I am now so completely freaking out I am off to the doctor tomorrow morning for
a vasectomymole-inspection.Bugger. I was going to patch-clamp too…
Me too. My husband made me two kinds of soup the day before the procedure, and as yummy as they were (cauliflower/potato/blue cheese and butternut squash/ginger/orange), I was heartily sick of them by the end of the first week. Luckily he then made me mashed potatoes with melted cheese, which I think may have actually saved my life. All the weight I lost seemed to transfer to my hamster cheeks though – the bottom two teeth were impacted and the dentist had to really struggle to get those ones out! She said afterwards that the general anesthetic I’d requested and been denied would probably have been a good idea…
Ian – Good! Get checked. Pasty UK people (I haven’t met you and am working off a stereotype here) who live in the South need to get checked. Not vasectomized, necessarily, but checked for moles. Little known fact – Bob Marley died of melanoma. It was on his big toe. Make sure your doctor checks your feet – toes and bottom of your foot and all. Melanoma likes feet.
Cath – Sweet lord, you were conscious throughout the extraction? That sounds like medieval torture! I was out cold and happy as a clam. Coming out of anesthesia was markedly unfun, but I’ll take that over being conscious throughout. You’re brave.
Unfortunately, yes. I had called the local dental regulatory people looking for a place that would do the extraction under general anesthetic, and they referred me to a place that’s just a few blocks from my workplace. But when I went to see them, they said that no-one does that any more… instead they gave me a couple of atavan or whatever it’s called (mild sedative) that left me woozy and wobbly but awake. It was quite possibly the worst experience of my life, waaaaay worse than the mole removal. In fact if I had to do the wisdom tooth extraction again, or the two weeks of traction for a childhood broken arm again, I would choose the traction.
Cath- I had two wisdom teeth extracted without any complications (neither was impacted), and it was still very unpleasant. The nociceptors might be anesthetized, but the proprioceptors and mechanoreceptors still seem to send all sorts of SOS signals to the brain. Having the dentist torque my head around to get better purchase on the tooth and to brace his hand on my jaw didn’t help either – I once watched the equine vet pull the wolf teeth from one of my horses, and was distinctly reminded of that process the whole time I was having my teeth extracted. The horse got a sedative, whereas I did not.
Anna- No one in my family has ever had melanoma, nor as many moles as I have. There are germline mutations in the CDKN2 (p16) gene associated with a familial multiple mole and pancreatic/melanoma predisposition syndrome, but I think it’s quite rare. According to the dermatologist, about 2/3 of my moles are atypical in appearance (very dark, notched borders, etc.), but so far none has ever looked like the early stage melanomas that you see in the brochures, and all are pretty small and flat. I worked as a lifeguard at an outdoor pool for several summers, and I’ve always spent loads of time outdoors, but I’ve never had a bad sunburn, never peeled or blistered.
Okay, this is an easy question. My thesis is about melanin synthesis and distribution, and I have in front of me this book (from the library, of course – it’s expensive!) because it has a nice summary of the molecular stuff I need to know, but there is also a chapter full of Scary Pictures. There’s a picture of a foot with a giant oozing melanoma under it, and a picture of a boy who had several skin cancers (including melanoma) and his eyes are all weird and half-gone, and an otherwise non-scary picture (just some pale skin with a small melanoma) for which the figure legend says “A fair skinned man with a nodular melanoma on the back. The dark spots surrounding the tumor are satellite tumors. The patient died from the melanoma.” Died! It’s just a little thing in the picture!
So I don’t care if it hurts, I don’t want the next edition of this book to have a picture of you in it.
I think this wanting to ‘be on the safe side’ is an important issue in medicine and will become more so as we move towards more genetic screening and so-called ‘personalized medicine’. It’s one thing to have a suspect mole removed but what about, for example, women who find out through genetic tests that they are at high risk for a hereditary form of breast cancer? Some decide to have ‘preventive’ masectomies, to be on the safe side.
When you’re talking about a small mole, it’s easy to be on the safe side since the relative cost (to the patient and the health care system) of the procedure is pretty small. It’s not so easy when the cost and the invasiveness of ‘being on the safe side’ starts to go up. These sorts of decisions, when the stakes are really high, must be one of the hardest one must make in life, especially considering how scary cancer is to all of us.
Yes, there is a genetic component to melanoma. There is a familial melanoma which increases your risk of melanoma 100-fold, one of the highest odds ratios in the entire field of epidemiology.
I think Corie did a much better job than I, highlighting the problems with preventative care. I think there are many situations where the prevention could be more harmful than taking the chance and doing nothing at all.
CN H – Ouch. That pretty much swayed me. I really didn’t know that. Ok, lesson learned. I will submit to all future suggestions of mole excisions.
Well, the sutures are out and the biopsy results are in! And the verdict is…. drumroll please… it’s a good thing I had the procedure. This is the pathology report on the mole:
Melanocytic nevus, compound type with architectural disorder and moderate cytologic atypia, completely excised.
In other words, the mole had the potential to turn bad and was beginning to show signs of anomaly. The borders on the biopsy were clean, suggesting all weird cells were removed. I should be in the clear. Whew.
This is the closest I have come to having anything actually wrong with me, on a grand scale. It’s a bit of an eye-opener, to be sure. Thank you all for your comments! I will be vigilant from now on.
I am curious on the data for the genetic component to melanoma, CN H. 100 fold seems really high. Any ideas on where I can look?
Anna> Happy you removed it considering the outcome! Now, I just hope you don’t have to make more of them in a while!
And as someone earlier said, I feel an urge to go to the doctor and check my spots out. Never had had one either… exam that is. And the fair skin and freckles I am covered in might be an indication. It sounds scary indeed but I had never heard of “annual screens” before I moved to the States.
huh, maybe give a little look through the yellow pages and see if there is a dermatologist near by.
I should be in the clear. Whew.
Excellent news Anna.
Been there, done it, but in my case, have an “unsightly” scar to prove it.
Circa 20 years ago, my Mum was concerned about the size of a mole on one of my
manyknees.It was “gigantic” (mole, not the knee) so it was surgically assassinated by an ably equipped knife wielding member of staff at the hozzy.
—
No probs. Most probably however, I was told to “take it easy/rest at home, have a cup of tea.” etc.
Later that day, during my recovery and my day off work related to this ‘do or die’ event (spot on remarks from Corie earlier), I remembered that I was due to attend a night out for a member of staff from work (Louise Selby I do recall) who was heading off to what is now known to some as Richard P Grant’s Big Country – Remix aka Australia.
Off I went, partied away, got bladdered, took the correct bus home, but fell asleep.
Nothing new there but upon my return home, noted a rather bloodied knee. Yep, dem sutures had gone “ping”.
Parents on holiday – so I drove my injured body back to the hozzy the next morning.
From memory, paper based (akin to ‘post-it notes’) sutures this time and as a result of my over indulgences, now have this
One is therefore literally ‘scarred for life’ not due to the medical profession, but as a result of what we proudly call a DRI i.e., a Drinking Related Injury at least here in Scotland.
Asa – Yes! Everyone should get checked! Especially if you have a history of melanoma in the family (just looked that bit up). The exams are really quick. If the doctor is thorough, he/she will make a photo library of all your moles, complete with a little ruler, so you can track them. If a mole grows, changes in color, or itches, off it goes. I have never had to photos done, just visual exams. Think I might request it next time.
Graham – Ouch ouch ouch. Turned my stomach just thinking about popping my sutures! I am amazed you were able to motivate yourself to go out and party so soon after the surgery! I sat on my couch and whimpered for three days, and my incision was way smaller! I am such a scaredy cat – I didn’t do anything at all even remotely physical while the sutures were in. So you’re ok now? No more mole scares? You have a pretty rockin’ scar to show for all your trouble though. That’s always a plus :)
You have a pretty rockin’ scar to show for all your trouble though.
Shucks.
Nothing more to report on the mole front here, and yes, I continue to self check.
One was however re-elevated by this track by some chaps from Ireland who know a bit about a mole, a hole, and elevation.
They are called U2. VIDEO
Digression? Yes, but a fab video none the less.
Anna, I’m glad you had it removed, that sounds like the report I got back on mine last year.
Graham, when I lived in Glasgow we talked about UDIs – unidentified drinking injuries, or mystery bruises. At least you know what caused yours!
Anna> I guess I have to look it up then. I know my grandmother had some skin issues but I have always thought they were the result of being very old and in time we all get cancer… then again, it would probably not hurt to go to the doctor just once and check it.
It seems like a good coincidence that we’re having cancer awerness day tomorrow at work with different doctors giving talks and all. Looks like it will be hard to avoid ;)
Okay, I can’t hold back on this.
My daughter has a congenital giant nevus and also has somewhere upwards of 200 satellite nevi to monitor for transformation. I know more about both deadly consequences of nevi and arcana of reconstructive surgery than I would ever have wanted to know. Plus I already was working on neural crest cell development when she was born. Strange world.
I won’t show you her scars (she may not forgive me later) but as a result, I have become incidentally interested in skin development and fibrosis as well.
Popping sutures happens often when sites are under stress. You can read more about it here if you want to know all the gruesome details, but it’s actually not the end of the world if the site stays clean. It usually all closes up.
Your pathology report sounds fairly reassuring. That is, good you had it removed, but not unduly worrisome. Precancerous is not cancerous. I definitely recommend everyone see a dermatologist at one point or another – absolutely everybody ends up developing nevi during their lifetime, and the doctor has more experience than most of us in spotting those that could be problematic later on.
Mutations in components of the Ras signaling cascade are associated with heritable risk of developing melanoma, although they are probably not sufficient as they can be found in many other types of cancer, too. Possibly overactivation of the Kit receptor pathway is what tips the balance. If that is pure jargon and you so wish, I can expand on that and/or provide references for further reading.
Sorry I missed coming by! things just got too busy at the end, this week.
Thank you so much for your comment, Heather, and the links. Sorry to have been whining about my silly scar. It’s really not a big deal. The mental stress of repeated biopsies was more troublesome, in comparison. I feel for your daughter. She must be a strong girl!
I am starting to realize just how little I know about melanoma and the potential for nevi to transform. I did read that Ras may be involved in melanoma, but that’s not saying a whole lot, as you mentioned. I am going to look into the research more in depth. I don’t know if I will find reassurance or worry, but not knowing anything at all seems disturbing to me.
PUBLIC SERVICE ANNOUNCEMENT: Get your moles checked. That is all.
I was very sorry to miss you in the office this week. Will have to wait to meet you in a month.
The scar remark was more aimed at Graham. My girl once opened one of her sutures on the playground slide, which is probably the seven-year-old equivalent of getting bladdered. With similar consequences. Sigh.
I remember sobbing (after waking up) over what appeared to be butchery on my stomach when I had to be opened up real fast after a bout of peritonitis. It’s not the size that counts, it’s the shock factor. So I sympathize greatly with your whole ordeal.
I do have some follow-up here but since I’m the lonely sod on the early shift tomorrow at work, zzzz’s here.
I remember the time-line of events a bit more clearly now.
The sutures didn’t pop. The wound did !
They were kept in for about 7 days or so. They were removed locally at my GP’s surgery.
The wound had healed well but given its location, as a result of falling asleep on the bus leading to a lengthy walk home, all of that movement clearly resulted in the reopening of it.
Unfortunately, as you have seen from the scar, the paper sutures didn’t do a grand job.
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Thanks for that link Heather to the Humans in Science blog.
The section that interested me the most was:-
Proliferation–Beginning on the second or third day after the injury, and lasting for two to four weeks, structure forming cells called fibroblasts proliferate into the wound, and produce structural proteins such as glycosaminoglycans, collagen, and elastin. New capillaries form at this time, and epithelial cells migrate across the top of the wound. Areas where this is occurring are known as “granulation tissue.”
Since glycosaminoglycans is/are a personal area of great interest and I knew a bit about this in relation to wound repair, it was nice to be reminded of this.
I am starting to question whether 7 days is enough time for sutures do their job. I stupidly went to the gym the day my sutures came out (7 days post-procedure). That evening, I noticed that my excision was markedly less happy than it was in the morning. There was no bleeding or anything dramatic, but it had opened/widened a little bit. I am thinking the scar will now be a little wider than I had anticipated.
While I was happy to have the stitches out (they were really uncomfortable) I am now wondering if I would have been better off leaving them in for another couple of days. What’s the consensus in the field on the optimal number of days for sutures to stay in? Does it depend on the wound site/location on the body?
Thanks for posting the links on congenital giant nevus, Heather; I’ve been working on neural crest cells, in some form or another, since grad school, and I was completely unaware of the syndrome. Only about a dozen of my moles were congenital-they are the larger ones, but none was bigger than about a centimeter. Three of the larger ones were removed by the dermatologist, leaving scars much smaller than the one Graham has on his knee. I think my moles have appeared in a manner consistent with a germline tumor suppressor mutation, followed by accumulating somatic mutation “second hits” as I age…but that’s probably just the paranoid scientist in me talking.
Regarding the scars, I would assume that dermatologists try to make incisions parallel to Langer’s lines in the dermis, when they remove moles, but perhaps it’s not always possible.
And I vehemently deny any knowledge of ever removing sutures from myself, my friends, or my horses, using (sterilized) iridectomy scissors and watchmakers forceps from the lab. ;-)
I’m currently seeking the opinion from one of my friends who is well experienced in performing surgical procedures.
In the meantime, whilst it’s a tad more under the skin but still related, just found this public access Manu from someone I know.
The fact that I know her is not relevant but I’m rather thrilled to read about her pioneering work which she rarely talks about out of the operating theatre.
You can see her at work here
Fibroblasts proliferate in skin but also in the cornea or the lung, in wounds under tension. (Why they do so is a fascinating area of study, and definitely has to do with the changing matrix in which they develop, as you noted, Graham.) My experience is that a sutured wound needs a good month to get knit pretty solid and a good six months to be completely restored to as before the operation. But that’s for thin-skinned souls like me; your experience(s) will certainly vary. More about scarring in this open access review.
@Anna – don’t worry, that doesn’t mean that it will pop open! But subtle remodeling continues for some time. You can help remove some of the tension to which a deep wound is subjected by placing a strip or two of those “paper sutures” across, in the direction of the tension, even if everything is all healed up. That only works well if you tolerate the adhesive, of course. And it kind of rubs your epidermis raw after a while, so you may want to restrict this to when you go to the gym.
@Graham, makes me glad it’s not my lungs in those impressive photos!
@Kersti: I’m personally convinced that there is a continuum in the incidence of congenital nevi, ranging from the common small ones (1% of babies are born with one) to the uncommon “giant” ones where in one or more locations they can occupy 80-90% of the skin surface. So, you’d be somewhere in the middle.
Hey Anna, this is your blogging buddy JC. I haven’t checked out this site in a while, but I did today and I’m glad to hear that your biopsy results indicate that they got all of that funky mole.
I need to get checked myself. I’m fair-skinned with a lot of moles, I burn very easily, and I live in a sunny location. My mom had a pre-cancerous whatchamacallit removed a couple of years ago. I chalked it up to the fact that she lives in Arizona (where the sun is _insane_), but maybe that’s not all there was to it.
It sounds like you’ve been convinced to remain vigilant, which is good. Having moles removed must suck, but it beats the alternative!