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3 melanomas on one arm

Forums Cutaneous Melanoma Community 3 melanomas on one arm

  • Post
    kareylou
    Participant
      I have been newly diagnosed with melanoma. I had a spot check in May where the nurse practitioner took a biopsy of a suspicious mole. It was found to be melanoma (1.2mm). Surgery and sentinel node biopsy was scheduled for next week. Since they hadn’t done a full body scan, the dermatologist scheduled me for that . At that appointment, they found 2 other spots on the same arm that turned out to be melanoma as well (.3mm & .7mm). I haven’t found any information from anyone who has had this occur. The two sites are quite close to one another and the third is about 6 inches from them. The surgeon (who hasn’t seen the location of the two additional spots) has agreed to at least remove the one closer to the original one and do another sentinel node biopsy. I am hoping she will also agree to do the wide excision surgery on the third (due to a snafu, she thought the third was on my back).

      Has anyone had more than one wide excision surgery at once? I know the surgeon cannot remove the original one as planned since the newly diagnosed (.7mm) one falls right outside the 2 cm margin she was going to make. Do I assume she will probably take both with large margin that may require a skin graft?? I am praying hard they won’t find cancer in the nodes as I am terrified of removing all my lymph nodes. Trying not to get ahead of myself. Thanks for any information anyone may have.

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        Debbiem
        Participant
          Hi Karen

          I’m sorry about your melanoma diagnosis. Hearing it for the first time is the hardest.

          Over the past 11 months I’ve had over 40 surgeries for many melanomas – on my arms, legs, face, etc.

          My dermatologist gives me the option to remove more than 1 at a time which I always do. I’ve had to have skin grafts and she did 2 of them at the same time. It can be a lot but I prefer to just do it. Also since I’ve had so many, she sometimes “stages” them and doesn’t close the excisions (since I’ve had several re-excisions due to positive margins). It helps preserve healthy skin and sometimes we just let them heal this way instead of stitching.

          I would recommend a dermatologist who specializes in melanoma if possible. They will take the minimal margins to see if they are clear. Regarding a skin graft it really depends on location and if they can close the excision.

          I just started Immunotherapy this week so there are great systemic treatments for melanoma now. It’s encouraging to see how much progress is being made in treating melanoma.

          I pray your surgeries go well,
          Debbie

            kareylou
            Participant
              Thank you for your response. I am not thrilled about one day of surgery–I can’t imagine 40 in 11 months. My surgeon is in a melanoma group but the dermatologist is a general one. Do you think it would be advantageous to find a dermatologist that specializes in it as well? Have you had sentinel node biopsies with any of your surgeries? You must be weary. I will be praying for you as well.

              Thanks again.

              Karen

              kst
              Participant
                I am not sure a SNLB is still needed after recurrence. You should be stage 3A already unless I am missing something. That means other treatment options are available such as targeted therapy or PD-1. I would assume at this point that only nodes that light up on scans or ultrasound would be removed.
                Susanne
                kareylou
                Participant
                  I have not had my surgery yet so have not been staged. All of my melanomas that will be excised tomorrow are primary. By pathology reports, they are 2- pT1a moles and 1- pT2a mole. The margins were not clear on the biopsy so my surgeon suspects we will be moving 2 of them to the next level (thus pT2a & pT3a). What I have seen online stated that if there is cancer in the node they remove, the standard is to take all the lymph nodes in the area. That is what I was referring to. Sorry if I wasn’t clear.
                  Debbiem
                  Participant
                    Hi Karen

                    I think as long as there’s someone on your medical team with melanoma expertise that’s great. I am blessed with a great team who have been thorough and advocate for me.

                    On another note, they thought all of my melanomas could be primary tumors but it’s unusual to experience multiple primaries. So they looked at epidermitropic Metastatic melanoma which is extremely rare. This is likely my case due to the number of melanomas and that they spread to other areas of my skin.

                    Thank you for praying. It’s good that we don’t have to be on the journey alone.

                    Praying and cheering for you!
                    Debbie

                    kareylou
                    Participant
                      Update: had my surgery a week ago Tuesday. They took out all three primaries and three lymph nodes. The node incision and the upper arm incision were closed by dermabond but the lower two that were right near each other was closed with a very rough incision (my son commented “bride of frankenstein”) because the surgeon assumed they may not have had clear margins. Fast forward to yesterday when she called with the pathology. Lymph nodes are clear! That was a huge answer to prayer. My margins, however, on all tissue taken out, were not clear. I have a large patch of freckles on my arm that they believe could all be premelanoma or melanoma in situ since this is what they found in the tissue they removed. So, my surgeon will be reviewing my case on Monday with a team of docs to figure out where to go from here. But all in all, I am thankful for the clear nodes!!!
                      Debbiem
                      Participant
                        Awesome news about the clear nodes! I’ve had a few that had to be re-excised several times but eventually came back clear. I pray your surgeon gets it all on the next go around.
                        Cheering for you and your healing!
                        kareylou
                        Participant
                          Thanks for your encouragement! I had 6 punch biopsies on Thursday to help them determine how far into my freckled areas they may need to remove. Worst case scenario is that they will “skin” me–taking all the skin that is freckled off my arm. I am hoping that won’t be the case, but now, as I look at my arm, I keep seeing suspicious markings… Best case is that the doctor will do mohs to remove the affected areas around my incisions. I’ll keep you posted. I can’t seem to find anyone else who has experienced this kind of melanoma dx… Thanks again for cheering for me!!
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