A couple sits back to back giving each other apprehensive looks. The woman has a shark biting her arm.

A Melanoma Called Wally: the Treatment

Previously I told the story of Wally, the melanoma that took up residence on my forearm. I focused mostly on the initial shock of the diagnosis then skipped to the happy all-clear ending, so in this post I will dive into the details of my treatment.

Wally, so christened by my husband, started as a small mole two inches above my wrist. Over time he’d grown taller and darker. After multiple visits to the primary physician trying to convince them it was worth investigating, I finally got Wally biopsied and sent off for testing. The results came back: malignant melanoma.

Learning about melanoma treatment

The first step in my treatment was a visit with the consultant dermatologist. He was a funny guy, combining directness with a calm, “let’s keep our heads here” manner that I found reassuring.

He examined my skin, checked the excision site then explained about Wally’s size. “1mm, we’d be concerned. So 5.3mm?” He shrugged. “That’s a pretty thick one”. Thus further surgery was recommended to make sure the melanoma was all gone.

My next stop was a consultation with the plastic surgeon, who explained the treatment options. He said they’d do a wide local excision, which meant taking about 3cm of tissue in each direction from the original site. This was to catch any melanoma cells left behind and to help prevent it from returning. I’d need a skin graft to cover the missing chunk on my arm.

A sentinel what??

Because of the melanoma’s depth, my family history of melanoma, and my relatively young age, it was decided to also do a sentinel lymph node biopsy. They’d take some lymph nodes from my armpit, the nearest nodes from Wally, and check for cancer cells.

A sentinel what?! My head was swimming from all this new jargon. I got the surgeon to write down those three words on a post-it note so I could look it up later.

I walked home from the hospital in a daze. So everything was probably going to be totally okay, but it might not be? And I needed to take time off for surgery and recovery? This was getting real. I remember thinking, Oh man, I need a slice of cake. But instead I called my sister in a slightly teary state and tried to explain a sentinel lymph node biopsy without getting my tongue tangled.

Pre-surgery worries

The next month passed in a blur of waiting for my surgery time and Googling “what to pack for hospital”. I hadn’t been a patient since my exit from the womb so I had no idea what to expect!

Once that was sorted, I was busy cramming in as much work as possible before my left arm would be out of typing action for a couple of weeks.

Finally, the day arrived and we drove 150 miles down the road to the hospital. My stomach churned with nerves as I watched the mountains whizz by the window. I keep thinking about the skin graft and having a piece of my thigh being welded to my forearm. I’d not always been the greatest fan of my thighs, and now I'd have to look at them, on my arm, every day?

Preparing for melanoma surgery

My treatment took place at two different hospitals over two days. All I had to do the first day was go to the Nuclear Medicine Department of Hospital 1 for a lymphoscintigraphy. This is a scan to find the lymph nodes for the operation. I was injected with a slightly radioactive (and totally safe) "tracer" around the original melanoma site. The tracer would show up on the scan, so the surgeon would be able to find the right spot for the lymph node biopsy. While the scanning machine was a bit noisy, the whole procedure was uneventful and painless.

So off we went to Hospital 2 where I checked in, ready for my surgery the next morning. I was on a plastic surgery ward with five other women. Listening to them talk about their upcoming surgeries was a great distraction for my nerves. One lady had accidentally stabbed her hand with a fish hook, while another had been bitten by her cat.

A successful surgery

I didn’t have much time for nerves as I was second on the surgery list the next morning. The surgeon popped around to the ward to explain what he was going to do, then a nurse came by with a stylish surgical gown and compression socks for me to change into, then it was go time.

I felt a little embarrassed, being slowly wheeled into the operating theatre on the gurney like a princess, with all these nice medical-looking people smiling down at me. I told them I was feeling nervous so the anesthetist started chatting away as he fiddled with all his anesthetist gear.

“So you’re Australian, eh? Why are you living in gloomy Scotland?”

“Because I’m hiding from the sun,” I said, “But that didn’t work very well, did it? Ha ha!”

I heard laughter and then I was told to count backwards from ten.

The next thing I woke up it was two and a half hours later.

“Is it over?” I asked the recovery nurse.

She said yes, and that they hadn’t needed to do a skin graft after all! They’d managed to close up the wide excision area without it. All credit to my chubby arms!

I burst into a delirious mix of tears and laughter. My forearm, without any bits of my thigh on it, was wrapped up in thick bandages.

After a restless night’s sleep and a hearty dose of painkillers, I was discharged from the hospital. My husband bundled me into the car with some carefully arranged pillows to keep my arm elevated. We made the 150 mile journey back home, ready to begin the recovery. I’ll save that for the next post!

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