"You will now have to see me every six months for, well, many many years to come"


Three months ago I went to see my dermatologist for a check up and he removed a mole from the left side of my back. One week later he called and told me that the lab reports showed my mole was melanoma. My dermatologist, Dr. Roth, described my melanoma as "1st category, level 2, with very early downward growth, 0.27 mm deep". I keep data points like this written down on various Microsoft Word documents because I know that my father, a retired cardiologist, might grill me on every detail. Further, I fully expect my sister, Claire, will demand to know every modicum of information so she can spend hours looking it up online. I'm never sure if Claire's diligent research on such matters is inspired by her genuine desire to learn, or by her slight obsession with all things medical and macabre, but her help is always greatly appreciated.

During the phone call from my dermatologist, Dr. Roth informed me that I'd have to come back for surgery during which he would cut a circular area 3cm in diameter around where the mole had been. He explained that because it is difficult to stitch together a circular area of removed skin, the procedure would result in a 4 inch long scar. Dr. Roth recommended that I come in soon, within the week. He later told me, to my relief, that there would be a 99.2% chance that I would have no further problems from this melanoma. I furiously jotted down this statistic, 99.2, and later typed it into my "Dr Roth" Word document.

The procedure itself was easy, although it took longer than I expected. The toughest part by far was a series of novocaine injections. Dr. Roth started by giving me about 8 to 10 novocaine shots in a circular area around where the mole had formerly been. Each injection was fairly uncomfortable, but again this was the only hard part of the otherwise painless procedure. Dr. Roth was very kind to explain each of the next three steps of the procedure, which I found very helpful. When a doctor or surgeon is working on my body, it can be nerve-wracking enough. But not knowing exactly what they are doing increases my nerves 10 fold. Once I know what is being done to me (even if the answer is horrendous ñ for instance, "I'm now burning the flesh on your back with a cauterizing tool") it is still probably less scary than whatever my imagination might have cooked up. First, Dr. Roth cut a circular area with a scalpel. Second he scraped the skin away. These first two steps were easy, seamless, and only took about 5 minutes each. The only notable occurrence was that as I was lying there on my stomach, I at one point felt a stream of blood drip down my side. It was an eerie feeling, because although I felt no pain, it was a reminder that someone was in fact doing damage to my body that would eventually, hours later, hurt a lot. The third step, patching up the area of removed skin, was more complicated and lasted over 20 minutes. It involved a combination of repeated stitching and burning. The burning part involves a cauterizing tool, which I understand is used commonly during medical procedures. I actually had one previous experience with a cauterizing tool. While recovering from a lung surgery in 2005, my lung surgeon Dr. Houck noticed I had a bandage covering a freshly scabbed burn mark under my armpit. He told me that during the surgery on my lung, they use a cauterizing tool to burn the lung and slow down bleeding. Dr. Houck said that somebody had probably accidentally burned me while I was asleep during surgery. It wasn't a big deal though; the burn scar was fairly small and superficial, and I had more important things on my mind at the time.

During the melanoma procedure, however, my experience with the cauterizing tool was a bit different. During the final step of the procedure, I got the sense that Dr. Roth was working pretty hard to patch me up. The cauterization / burning was pretty constant. He would burn a little, then stitch a little, then repeat. This went on for quite some time. On two occasions, stitches snapped in half while Dr. Roth tried to sow up the circle he had cut in my back. Since I was awake during the melanoma procedure, I quickly became aware of the aroma of burning flesh. Now I'm not squeamish and to be honest the scent didn't bother me at all, but I know some people (Claire) would frown upon me greatly for excluding such an important detail. After the procedure was over, the nurse told me to avoid physical activity for at least two weeks. Other than that, I was free to go.

When Dr. Roth initially explained the procedure to me over the phone, I don't think it registered that I would have a somewhat scary-looking wound. I heard "remove small circular area of skin" and didn't think much of it. I was surprised though by the result. Although the scar looks completely normal now, it was quite nasty looking for the first two weeks. The day after the procedure, I of course made my sister Claire come over to change the bandages. I know this might appear to be an unenviable chore, but I imagine that Claire's curiosity to see a freshly carved scar outweighed any potential reluctance. I even convinced myself that she would be grateful that I had chosen her for the task. When Claire removed the bandages, she let out a curious yelp. The "tiny circular area" of removed skin had transformed into a 5 inch by 3 inch dark purple bruise, swollen an inch in height, with a nasty looking four inch scar through the middle. I was pretty surprised when I looked in the mirror, straining my neck to see the wound. Claire instantly ran home to get a camera. Not one to ever shy away from attention, especially not the kind that shocks, frightens, or grosses out my friends, I immediately posted a picture of my swollen back on facebook, to the amusement of some (my cousin Dena "chicks dig scars") and to the chagrin of others (my student Gabe "dude, you really need to take that picture down!").

I just got home from my three month follow up appointment with Dr. Roth. He removed another suspicious looking mole today and I'll probably be nervous for a few days, but hopefully he'll call soon and tell me it was nothing to worry about. Dr. Roth's parting words brought a wry smile to my face: "You will now have to see me every six months for, well, for many many years to come" While not exactly the words you want to hear from your doctor, I for some reason couldn't help but laugh.