Okay…you get over the age of 50 and all of a sudden all of these weird skin spots start coming up all over your body and particularly your face. The sun exposed places, the disease of farmers. Looming in the background is the “M” word…melanoma.
My wife posed an interesting question a few weeks ago, ” Why would something given by God and so necessary to life (the sun) be the very thing that causes cancer of people’s skin.”
Good question…maybe it’s a “too much of a good thing” thing.
Anyway I have had this little brown spot under my right eye for years. I see it every morning when I shave and have often thought about if it could be a melanoma. I have stopped several friends in the hospital over the years and asked, ” Does this look bad to you?”
To a person or should I say doctor the response is as they lean their respective head back and tighten the skin between the forefinger and thumb, ” No John. That looks okay to me.”
Apparently concern regarding a skin lesion in an “aged male” is most commonly an “age spot or actinic keratosis. It gets darker with exposure to sunlight and in turn is more prominent and more noticed in the summer. This spot on me never changed in size but did get dark in the summer. I was on the verge of having it removed for years but “life interceded” something else in my life taking priority over this “place.” Also I was told that if you can feel a skin spot that it is most probably not melanoma.
A pigmented spot with irregular edges, that you cannot feel a rough area if you run your finger over it, and in any way changes in character. That is the spot that is worrisome and should be checked out to rule out melanoma.
By the way melanoma is a strange bird. It can be very aggressive and all of us know of someone who was found to have one, maybe a very small one, and it turned out to be a very bad actor. It is a difficult disease to treat, detect and can progress very quickly and indolently and violently.
So last week I am looking in the mirror shaving and this spot below my right eye is now black. Not only that it is like a scab. It happened I guess in a day or so. Just like that.
“Are you kidding me?” I ask myself as I look at my face.
I call a friend of mine who is a plastic surgeon.
“Mike this is John. I have got this place under my right eye that has been there for years and was flat and brown and now is raised and black. What does that mean. Is this a problem?”
“John the most common presentation of melanoma is a skin spot that changes. The most common reason for what you described is an inflamed actinic keratosis. We need to remove. It needs to be a full thickness excision. When do you want me to do it?”
Well this was the Friday before Labor day.
“I am on call for Labor day and the office is closed. That would be a good day for me. How about you.”
“I’ll pick you up at 1 one Monday and take you to my office to do it,” I’ll see you then.
I really did not realize it but my plastic surgery friend (we roomed together in med school in 1978) and I have gravitated to the same place in terms of cars. He shows up at my house in a 1994 Buick that has 110,000 miles on it , but he got it from his 80-year-old mom with 46,000 miles. It has the original tires on it. As we pull out of the neighborhood I notice that the steering wheel is shaking.
“Mike it looks like to me that you car tires may be out of alignment. I know a guy that is good at that if you want his name.’
“No I think it is probably the tires. They are old.” We continue on to his office which was about 30 minutes away. All the while the steering wheel does its shuttering thing which got a bit better the faster the car went.
“The guy that does the alignment is a patient of mine. I took his prostate out a few years ago. His name is Homer London. He is old school. He has a shop off of Brown’s Bridge Road and it like something out of the fifties. He’s got an old van seat in the shop that friends will come over and have coffee, read the paper, and talk politics while he aligns cars. He’s good, ” I say.
I continued, ” He told me one time a guy comes into his shop and says that another shop aligned his car but now it pulls to the right real bad. When he took it back to correct the problem the guy told him that he had the car pull to the right on purpose.
“I fixed it to pull to the right so that if you fall asleep the car will pull you off to the side of the road to safety,” the other shop guy told him.
To reimburse Mike for doing my surgery I offer to buy lunch along the way at McDonald’s. We pull up and go in and Mike begins to very seriously look at the menu behind the attendant at the register.
“John, McDonald’s has the very best dollar menu.” As he is peering at the dollar menu the person behind us makes a gesture and we let her go in front of her. I had made tea before leaving my house and I made one for Mike so back in his car we had tea. Well I had tea because I had a bigger cup than Mike. He had finished his tea but by the time we ate the ice had melted giving him about a third of a cup of weakened ice tea. So enough not to have to order a drink from the dollar menu.
He gets a double cheeseburger and fries for a total of $2.oo.
I splurge and get the value meal with a hamburger that allowed for lettuce and tomatoes and fries. No drink.
The total was $6.oo or so.
We make it to his office and in his business office with a view of the hospital campus where his office is located we eat lunch. Delightful. We could watch people parking and then going into the hospital. They looked like little ants.
“When it’s slow John I like to sit here and watch the old people park in the handicapped parking area and then have to navigate the emergency parking that is between them and the hospital. That has never made sense to me. It is comical. You should come here sometime and watch all the activity because the way they have laid this out. Something bad is going to happen one day. You ready to get that thing off?”
Mike starts going around his office putting together the stuff he’ll need to do the procedure.
“Let’s see. A knife, pickups, and scissors. A drape. Betadine. Where are the needles and syringes? I usually have someone else do this for me. Oh, here it is. Okay come in here and lay down. I need to numb up the area.”
I lay down and he wipes some cool fluid on my face and slowly injects the lidocaine. Very little discomfort. We waited five minutes for the epinephrine portion of the solution to achieve venous constriction.
He puts more Betadine on and then a drape and in five minutes the lesion is removed and the 6-0 stitches placed. I was glad I had a friend who was a plastic surgeon.
I get up and inspect my stitches and like the look. Like a lop sided quarterback who but the black reflection stuff only on one side. I felt I looked rough….like cowboy or something.
“I like it Mike. When do they come out?”
“I’ll come over to your house on Saturday and remove them,” as he is cleaning up and throwing away the used supplies.
We turn off lights and go out into the hall. Mike locks his office and we begin to go to his car.
“John. Where is the thing I took off? Do you have it?”
We both simultaneously turn around and go back to the office. He unlocks the door, goes into the office and begins to rifle through the trash.
“Here it is,” he says. He puts it in a formalin container and hands it to me.
“Sorry about that. I usually have someone else who is putting the specimen in the container.”
We make it to the car and as we begin to back out there is a noise and very rough “bumpity bump.”
“I think we have a flat tire John,” he says as he moves the car back into the parking space.
To be continued.