The moles on both toes came back as Melanoma In Situ, aka Stage 0. That means it was all contained to the surface level of the epidermis and I need no further treatment. This does make me super paranoid about every other mole on my body, and genetics have “blessed” me with a lot of moles. My skin check appointment over Christmas break says it will take 20 minutes. All I can say is that she will be very busy for 20 minutes.
Let me backtrack for a minute. Tumor board recommended that both moles be removed (excised) and checked for clear margins. They did what’s called a Slow Mohs procedure. With a regular Mohs procedure, they can check the pathology on site and you know before you leave if you need to have more removed. With melanoma, the biopsies need to be sent off site, so you don’t know until the next day whether or not you need to return. I’m going to break down what happened as best I can.
- Thursday, October 21st
- Taught in the AM
- Appointment #1 in the PM - Slow Mohs done on both toes. Tissue was sent to Indianapolis that night. Get home and try to keep my feet elevated for 48 hours.
- Friday, October 22nd
- I got a call saying that margins were not clear and I needed to come back Monday.
- Monday, October 25th
- Teach Monday AM
- Appointment #2 in the PM - Not only were the moles in identical locations on both toes, but the area in which he had to remove more was identical on both toes. He had to cut farther into my toenail on both toes. Removing more of my toenail was pretty easy due to the Hand Foot Syndrome I had been dealing with all summer from the chemo pills. It had basically made my toenails lose. Not only have I been the topic of a couple Tumor Boards at Parkview, but I have now gained a reputation with the pathologist in Indy also. Not really the kind of attention I want. Time to start my 48 hours of foot elevation all over.
- Tuesday, October 26th
- Get the phone call that I need to go back in.
- Appointment #3 - Clear margins on the left side, so we’re good on that side. The right is a whole nother story. They don’t know if the margins on the right are clear, because there wasn’t an epidermis (top layer of skin) on the tissue that was sent. It’s suspected that when the nail was lifted from the skin, that the epidermis stuck to the nail due to the trauma caused by the Hand Foot Syndrome. So this time he checks things out, makes sure that nothing sticks to the nail, and ends up removing pretty much the whole toenail on the right side. He left part of it attached so that the nail could lay on top and protect it while healing. I’m basically supposed to clip it off as it starts to annoy me. Restart the 48 hour elevation clock for my right foot.
- Wednesday, October 27th
- Eventually I check MyChart results when I haven’t heard anything by lunch. Once again, there was no epidermis to check. Now I sit and wait for a phone call or something.
- The doctor called me a few hours later. Remember the Hand Foot Syndrome I mentioned 60 seconds ago? Well, guess what? This is about to get more bizarre and complicated. Our best guess is that I don’t have any epidermis left under that toenail due to the Hand Foot Syndrome. All summer, off and on, I would have puss seeping out from the side of my toenail. That puss was probably the rather unpleasant remains of my epidermis leaching out from under the toenails. He said I had two options.
- Option #1 - We keep cutting on the toe. But the chances we would find any epidermis is pretty slim. He would end up cutting into the nail bed, which would start causing other issues. It was not the route he recommended.
- Option #2 - We keep an eye on it. Chances are pretty high that he got it all. He and the other dermatologist would go this route. This is the option I chose.
Through this whole process, watching them work on my toe while it was numb was fascinating. I know most people wouldn’t want to watch, but I was all for it. It’s kind of like an out-of-body experience. You know it’s your foot, but you can’t feel a thing. After he finished cutting, the nurse would cauterize it. It’s one thing not to feel the knife hacking away, but to not feel the cauterization either? It was crazy. I figured for sure that the pain would be pretty intense later. They recommended tylenol for pain. Really? That’s it? Turns out, I only needed tylenol for part of a day after one or two of the procedures. I didn’t think about the fact that all of the nerves would have been cut out when the tissue was removed. So the only pain I ever really felt was sometimes around the edges of the incisions.
In case you're interested in seeing some pictures, here is a link to the toe healing process. I have to keep the wounds covered during my shower. Afterwards I hop up on the kitchen counter, put my feet in the sink, and let the water run over them for a few. Then I let them dry while I play around on my tablet before putting ointment on them and wrapping them up again.
So now I wait a little longer to take a breath and relax. I’ll wait until after the skin check at Christmas. But then I’ll wait until after the toe follow-up in February. And then I’ll wait until after the next follow-up with the next doctor. There may never really be a point where I feel like I can breathe and relax. It will probably be something that comes slowly over time. Without a doubt, fear and anxiety will always pop-up, triggered by so many different and random things. #CancerSucks
