Hello everyone. Thank you all for your efforts and support here. I apologize for the long post...
On 3/14/14 my GP noticed that I had a "dirty area" on my foot and didn't make much of a fuss about it. I had, on that day, a basal skin cell carcinoma that was on the back of my neck shaved off as well by the dermatology department. About three weeks later I got concerned about the discolored patch of skin on the sole of my foot because it didn't wash off and so I did a google search. I found similar pictures with those who were diagnosed as melanoma so I immediately contacted my doctor and they had another doctor look at it who was filling in for my doctor who was away on some continued educaton or training conferences. I do not know how long the patch of spotty brown/black areas have been on my foot. They are not raised or ulcerated.
My father died of metastatic melanoma in 1991 at the age of 61. I am now 54.
After the second visit and some photos they sent to the dermatology department, I received a call from the dermatologist the next day who wanted to see me immediately. I went in and she biopsied two spots on my foot with a 4mm hole punch. She punched and got most of the darkest spot, but left some behind because it was larger than 4mm, and another site nearby that had a different look to it, more like tar stains from the beach.
I received the biopsy results two weeks later and it came back as melanoma. I don't entirely understand the report. My BIL who is a doctor has told me that it's not in-situ, but it's about as good as it can get without being in-situ and that it looks like it's in my favor of being treated.
The dermatologist told me (and it's mentioned in the report along with a SLNB discussion) they would remove the area and graft some thigh skin off if it came back as melanoma (she's away right now too!) so I haven't spoken with her in a few days. She said I should be getting a call from the plastic surgeon to schedule the surgery, but I have yet to hear from that person. Do things normally take this long to get done? I'm going through Kaiser Permanente...and their seeming lack of aggressiveness is worrying me. They may be awaiting the results of a PET scan that I had done just two days ago to determine the timing for the surgery too. The Oncologist seemed to suggest that when I met with him.
I don't yet know what stage I'm in and am, obviously, worried given my family history and the large area on my foot that's discolored (about 2" x 2").
Here's what the pathology report says:
"The overal impression is that of a melanoma, which is Clark's level II, Breslow epth of 0.4mm, non-ulcerated with a tumor mitotic index of <1 per mm2. The in situ component and the invasive component are transected at side section epidermal and dermal margins. The diagnosis was rendered due to many atypical features seen in part B, and they include variation in nest sizes, confluence, adnexal involvement, diffuce pagetoid spread, and cytologic atypia. Part A is characterized by increased single units of atypical melanocytes with focal crowding/confluence. The proliferation is also transected at side section margins. Part A likely represents the edge of the melanoma.
In part A, there is an increased number of si ngle melanocytes along the junction. The meanocytes display hyperchromatic nuclie with irregular contour. Immunostains with Melan-A and MiTF highlight the slightly increased number of melanocytes along the junction with rare suprasal melanocytes. Nested forms are not seen.
In part B, there is an atypical meanocytic proiferation. There is a predominant junctional component wich is comprised of variably sized nests with bridging between the nests leading to confluence. The meanocytes are also involving acrosyringium. Pagetoid upward migration of single meanocyutes is seen across a broad front. The melanocytes display peomorphic nuclei with cherry red nucleoli and meanized cytoplasm. Similar atypical melanocytes are focally invading the dermis, and extend to the maximal depth of 0.4mm. Careful search reveal junctional mitotic activity; however fails to reveal conspicuous dermal mitoses. Melanin pigment is also seen difusely in teh conrified layer. Prominent pigment incontinence is also seen at the base."
Thank you for your help and support. I've not been able to go back to my day job because I'm just so depressed and can't focus. A 54 year old man should be such a cry baby!!!