I started running outside in the summer this year. After a few months, I noticed a mole on my arm had turned red. Looking closer, it was becoming heavily vascularized. Recently, it had become lightly pigmented.

My dermatologist biopsied it.

I received the results today.

Malignant melanoma 0.25 mm deep.

Deadly. But shallow.

So it’s probably OK. We will have the entire lesion–I think technically considered a tumor now–excised.

But if I hadn’t caught this early, I might have been in serious trouble.

Decades of data suggest a strong link between sun exposure and melanoma.

Moral: don’t believe what you read on the Internet about melanoma and sun exposure. Sun exposure is causally linked to melanoma risk.

If you have a genetic predisposition to melanoma (e.g., lots of moles), limit exposure to intense sunlight for long periods.

My own strategy: I now wear a long-sleeved rashguard whenever I run. A baseball cap when there is a lot of sun.

Melanoma is one of the deadliest and most difficult to treat cancers known. Take sunlight exposure seriously.

So after the shave biopsy, they decided to do a second surgery: a full excision of the region.

This is because melanoma cells “jump” laterally from the primary site, so even if you remove the complete primary lesion, a few asshole cells half a centimeter away from can regrow into a full melanoma.

So, they needed to take all of the area about 1 cm out from the shave biopsy area.

So what was a nickel-sized shave biopsy turned into an area the size of a golf ball.

Oh and then because a circular area cannot be readily stitched up, they had to expand the skin taken out to make it easy to sew up.

Think of an eye. Think of area needed to be excised as the pupil and iris. The additional area is the white of the eye.

Then you can sew it shut.

So they ended up taking like 3-4 square inches of skin off my arm.

Here is what it looks like:

My hope is that the scar tissue that replaces the area will be extremely tight, so that I become kind of like the Rookie of the Year (remember the movie where the kid gets a shoulder injury and can throw superfast fastballs?) of jiu-jitsu chokes.

Hey it could happen…

In other news

Considering dermatologic oncology as medical specialty?

Pros (in order):
Pleasant people in derm
I will have cancer Ph.D.
Time for science
No shift work
Short residency (I’m old)
Help avoid death from bad genes

Cons:
Nutrition & skin cancer- real research area?

Oh and I will provide the histopathology images and an analysis of them–melanoma looks cool as hell–but I am waiting for my derm to send them to me. She is really awesome but very busy…

UPDATE: THE IMAGES HAVE ARRIVED

The original mole:

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Now the histopathology. Here is how to read them.

Purple: Epidermis (top layer of the skin)
Dark blue cells beneath the epidermis: Lymphocytic infiltrate (immune cells)
Light purple/lavender inside the epidermis: Multinucleated melanoma cells
Breakdown of strict separation between pink (connective) and dark purple (epidermis) layers: a sign of pathology
Dark purple areas with blue cells inside the pink layer: blood vessels from which lymphocytes came
Brownish granules in the highest zoom: melanin produced by the atypical melanocytes

What about the scientific publication? That is a subject for part 2, where we use experimental treatments with the extensive scarring that resulted from the surgery. Yep, we used experimental treatments on me, a patient, and I co-wrote the case report with the doctors on myself. Is there a future for me in dermatology? Stay tuned for part 2.



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