Superficial spreading melanoma
BMJ 2012; 344 doi: https://doi.org/10.1136/bmj.e2319 (Published 11 April 2012) Cite this as: BMJ 2012;344:e2319
- Penny D’Ath, patient1,
- Penny Thomson, associate specialist in dermatology2
- 1Department of Optometry and Visual Science, City University London, London EC1V 0HB, UK
- 2Barnet and Chase Farm Hospitals NHS Trust, Barnet Hospital, Barnet EN5 3DJ (penny.thomson@.nhs.net)
- Correspondence to: P D’Ath p.j.d’ath{at}city.ac.uk
- Accepted 25 November 2011
“You do understand this is cancer?” asked the dermatologist. It would be another few months before I fully understood the significance of this sentence and its implications. At that precise moment, it was just a mole: asymmetric, with irregular borders, of different colours, bigger than the diameter of a pencil, and elevated. In fact, everything the ABC rules of dermatology said it shouldn’t be. My GP had said it would probably be fine, and I could leave it alone. Only it hadn’t been fine, and it was lucky I hadn’t left it alone. Except that it had been left alone long enough to march unrepentantly to my lymphatics, where it had settled comfortably into my sentinel node.
The dermatologist had just confirmed Google’s tentative diagnosis of a superficial spreading melanoma. She mentioned survival rates. What? Along with the rest of the population, I thought that if it was malignant they would cut it out and that would be the end of it. Survival rate? This was a new concept, and one that I hadn’t entertained.
My mole had a low mitotic rate (good), minimal inflammation (good), and no ulceration (good). On the other hand, it had a Breslow thickness of 1.8 mm and was Clark level IV, meaning that it was neither early nor thin. It was a mole with a mission. I found it incredible that something so thin—1.8 mm for goodness sake—could kill.
I returned one week after the wide excision and sentinel node biopsy to receive my results. The odds were heavily in my favour, as 80% of patients have no sentinel node involvement. …