I found a map that I had not seen since the day of my very first melanoma surgery. It's a map of me.
Malignant melanoma often spreads from the original tumor site to regional lymph nodes. Knowing that there is cancer in your lymph nodes is scary because it means that the melanoma has the ability to spread wherever its little black heart decides to go. How does one find out if there is cancer in lymph nodes? Well, that's where Sentinel Lymph Node mapping comes into play.
Lymph nodes are important because they are part of the immune system; they help fight disease. Unfortunately, sometimes cancer cells spread from the original tumor sites into regional lymph nodes. With advanced melanoma, it is important to find out if the lymph nodes have been affected by the disease. melanoma.com describes SLN mapping well. They say, "The first lymph nodes that the fluid from the tumor flows into are called the "sentinel lymph nodes." A sentinel is someone who stands guard. You can think of the sentinel lymph node as the gatekeeper to the rest of the lymph nodes. If the sentinel lymph node has cancer cells in it, there is a chance that the cancer has spread. If the sentinel node does not have cancer cells, the other lymph nodes in that area are probably also cancer-free, and the cancer probably has not spread."
How do you determine if there is cancer in the SLN?
Again, melanoma.com says, "The surgeon will inject a blue dye and a radioactive tracer around the tumor site. The lymph fluid carries the blue dye and tracer away from the tumor, to the nearest lymph nodes. The surgeon looks for the lymph node that has blue dye in it (or uses a detector to find the lymph node that has the highest amount of tracer). This is the sentinel lymph node. The surgeon removes this node and a pathologist will test it to see whether it contains cancer cells."
I vividly remember being on the table after the dye was injected into my body (this is actually quite painful) and seeing the way the two technicians changed. There was one lady, around my mom's age, and one younger guy. He was new to the hospital and it was obvious I was one of his first patients. I remember when they informed me that I was "glowing" in 4 separate areas. I asked the new guy if that meant that Dr. Pink would cut me in in all four areas. He quietly responded, "You want him to, ma'am." Well, shit.
It is weird for me to look at this sheet of pictures and know that it is actually me. I imagine most people feel that way. As you know, the results of the SLN were less than pleasant: Definitely positive for melanoma under left arm, right neck, and "possibly positive" under right arm. Ew.
When I received these results, we immediately started looking for cancer centers who specialized in melanoma. Mom kept pushing for Memorial Sloan Kettering Cancer Center. After talking to the people in the scheduling department, and many hours of debate and frustration, I decided it was best.
MSK determined that there was not enough melanoma in the SLN under the right arm to say for sure that it was positive. They did agree on the other two reports though. This meant I was stuck with the decision of having the full lymph node dissection or "watching and waiting." (Have I mentioned that I hate that term, by the way? Must think of a more positive way to describe the observation treatment plan!)
After meeting with Dr. Glinda, my surgeon at MSK, I decided that having the full dissections were necessary. When she admitted that she would do the same if she were in my shoes, I knew it was what I needed to do. That way it would allow us to know exactly how far this cancer had spread and it would also give me a peace of mind.
I had the full dissections and before I even left NYC to heal, Dr. Glinda informed me that all of my lymph nodes were clear: No evidence of disease. (And yes, this news made me cry in the middle of the busy waiting room.)
People have asked me if I regret having gone through the full dissections. My answer is--and always will be--Absolutely not. Sure, I have some pretty intense nerve damage. And yes, my right neck/shoulder looks a lot different than my left side, and at times it makes me very self conscious, but because of these surgeries, I know that I am fighting melanoma just as hard as I can fight. If it spreads, I will know that I made the necessary decisions to try to prevent it from spreading. I could not sit home and night and wonder if there was more cancer in my "glowing" areas. That is just not who I am. I am a need to know girl. Some would argue--including my first oncologist--that the full dissections were unnecessary, but I would bet money that he would change his mind if he was the one with cancer...I rest easy at night because I know that I am taking all of the necessary steps to fight this thing called Melanoma.
Oh, the memories...
Oh, the memories...