Looking To The Past For Clues
The doctors at the Harkness Institute asked Mom many questions about her past to find out how far back symptoms may have gone. Once she started thinking about it, Mom realized how many times shed fainted as a teenager. She had lost consciousness several times after even just light hits on the head once after being hit with a snowball. She had also passed out at three high school dances, each time when strobe lights were turned on. Its possible that her tendency to faint was tied to the tumor pushing on her optic nerve.
The doctors deduced that she had always had a mole in the back of her eye, but some sort of trauma had likely triggered it to turn into a cancerous tumor. Thats when my mom remembered the sunlamp.
It was the 1960s, and she hated her pale legs then as much as I would in the 1990s. First, she tried lying out in the sun, on the roof of her parents house, for hours. Each time, she held out hope that the inevitable sunburn would turn into a tan. But it never did, so she bought a UV-emitting sunlamp from her local drugstore. She clipped the lamp to the desk in her bedroom and moved around so the light would hit her legs, arms, chest and face. She only used it two or three times and remembers burning herself badly enough that she decided it wasnt worth it. Though she kept the lamp for years, she never used it again.
How Serious Is Melanoma
Melanoma. The most serious type of skin cancer, melanoma affects the cells that give our skin its color. Although it can spread easily, it is curable when treated early. This cancer forms when the cells that make melanin grow abnormally or do not die when they should. These cells, called melanocytes ,
When Is A Mole A Problem
If a new or existing mole begins to change shape, color, size, or becomes flaky, crusty, or begins to bleed, it’s time to make an appointment with your dermatologist to get it checked out. A mole can turn into melanoma on rare occasions. In early melanoma, the shape of a mole becomes asymmetrical and uneven.
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Nodular basal cell carcinoma is a type of skin cancer that is most often found on the head. This type of cancer starts in basal cells, which are tasked with making new skin cells to push the old ones toward the surface of the skin. Nodular basal cell carcinoma is responsible for 60%-80% of all basal cell carcinomas. In the United States, its estimated that 4.3 million cases of basal cell carcinoma are diagnosed every year, with 2.5 to 3.4 million of those cases being nodular basal cell carcinoma.
This type of cancer appears as a pearl-like papule that is round and surrounded by threadlike red lines on the skin made up of tiny blood vessels. The risk of developing nodular basal cell carcinoma can be increased by spending a lot of time out in the sun, living in high-altitude and sunny locations, and radiation therapy.
Other risk factors include:
- Prolonged exposure to arsenic
- Certain rare genetic disorders such as basal cell nevus syndrome
Although this type of cancer is common, it is highly treatable, and the five-year relative survival rate is 100%.
How Long Does It Take For Melanoma To Spread
Melanoma can grow very quickly. It can become life-threatening in as little as 6 weeks and, if untreated, it can spread to other parts of the body. Melanoma can appear on skin not normally exposed to the sun. Nodular melanoma is a highly dangerous form of melanoma that looks different from common melanomas.
Staging And Grading Of Eye Cancer
The results of your tests helps your doctors find out more about the size and position of the cancer and whether it has spread. This is called staging.
A doctor decides the grade of the cancer by how the cancer cells look under the microscope. This gives an idea of how quickly the cancer might grow or spread.
Knowing the stage and grade helps your doctors plan the best treatment for you.
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Diagnosis And Staging What It Means For You
How is melanoma diagnosed?
To diagnose melanoma, a dermatologist biopsies the suspicious tissue and sends it to a lab, where a dermatopathologist determines whether cancer cells are present.
After the disease is diagnosed and the type of melanoma is identified, the next step is for your medical team to identify the stage of the disease. This may require additional tests including imaging such as PET scans, CT scans, MRIs and blood tests.
The stage of melanoma is determined by several factors, including how much the cancer has grown, whether the disease has spread and other considerations. Melanoma staging is complex, but crucial. Knowing the stage helps doctors decide how to best treat your disease and predict your chances of recovery.
How Quickly Should Melanoma Be Removed
Hypothesis-based, informal guidelines recommend treatment within 46 weeks. In this study, median surgical intervals varied significantly between clinics and departments, but nearly all were within a 6-week frame. Key words: melanoma, surgical interval, treatment time, melanoma survival, time factors.
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Infiltrative Basal Cell Carcinoma
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Infiltrative basal cell carcinoma occurs when a tumor makes its way into the dermis via thin strands between collagen fibers. This aggressive type of skin cancer is harder to diagnose and treat because of its location. Typically, infiltrative basal cell carcinoma appears as scar tissue or thickening of the skin and requires a biopsy to properly diagnose.
To remove this type of basal cell carcinoma, a specific form of surgery, called Mohs, is used. During a Mohs surgery, also called Mohs micrographic surgery, thin layers of skin are removed until there is no cancer tissue left.
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Superficial basal cell carcinoma, also known as in situ basal-cell carcinoma, tends to occur on the shoulders or the upper part of the torso, but it can also be found on the legs and arms. This type of cancer isnt generally invasive because it has a slow rate of growth and is fairly easy to spot and diagnose. It appears reddish or pinkish in color and may crust over or ooze. Superficial basal cell carcinoma accounts for roughly 15%-26% of all basal cell carcinoma cases.
What Are The Symptoms Of Intraocular Melanoma
A small growth may not cause any symptoms. As it grows larger, your symptoms may include:
- Blurry vision or sudden vision loss
- Soreness in an eye, or bulging of the eye
- Flashes or floaters in your vision
- Dark spot on your iris, the colored ring at the front of your eye
- Change in the shape of your pupil, the black circle in the center of your eye
- A change in the way your eye moves or looks
Many of these may be caused by other health problems. So its important to see a healthcare provider if you have these symptoms. Your healthcare provider will do an exam and testing to find out if you have cancer.
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What Are The Symptoms Of Skin Cancer Of The Head And Neck
Skin cancers usually present as an abnormal growth on the skin. The growth may have the appearance of a wart, crusty spot, ulcer, mole or sore. It may or may not bleed and can be painful. If you have a preexisting mole, any change in the characteristics of this spot such as a raised or an irregular border, irregular shape, change in color, increase in size, itching or bleeding are warning signs of melanoma. Sometimes the first sign of melanoma or squamous cell cancer is an enlarged lymph node.
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Squamous Cell Skin Cancers
Squamous cell skin cancers can vary in how they look. They usually occur on areas of skin exposed to the sun like the scalp or ear.
Thanks to Dr Charlotte Proby for her permission and the photography.
You should see your doctor if you have:
- a spot or sore that doesnt heal within 4 weeks
- a spot or sore that hurts, is itchy, crusty, scabs over, or bleeds for more than 4 weeks
- areas where the skin has broken down and doesnt heal within 4 weeks, and you cant think of a reason for this change
Your doctor can decide whether you need any tests.
Cancer and its management J Tobias and D HochhauserBlackwell, 2015
Cancer: Principles and Practice of Oncology VT De Vita, TS Lawrence and SA RosenbergWolters Kluwer, 2018
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How Aggressive Is Ocular Melanoma
This is an aggressive type of cancer that can potentially spread to other areas of the body, most often to the liver. Immediate treatment is often necessary. The approach depends on the size and placement of the tumor, and the stage at which it is found. The two most common treatments are radiation therapy and surgery.
Is It Possible To Get Melanoma In The Eye
Melanoma usually shows up on the skin, but it also can happen in your eyes. When it does, doctors call it ocular melanoma. Some ocular cancers form on the surface of the eye and the eyelid. Those are closely related to melanomas of the skin in other parts of your body. But ocular melanoma can also form inside the eye.
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Cancers Of The Eyeball
- sensation of something in the eye
- white painless growth on the surface of the eye
Treatment includes surgery to remove the cancer, freezing therapy or chemotherapy eye drops .
Conjunctival intraepithelial neoplasia
Sometimes cells on the surface of the conjunctiva can look abnormal. These cell changes are called conjunctival intraepithelial neoplasia and are usually diagnosed with a biopsy. You may have treatment with surgery or topical chemotherapy.
CIN is a pre-cancerous change. If left untreated, it may turn into invasive squamous cell cancer and may spread to other parts of the body.
The Risks The Causes What You Can Do
Skin cancers like melanoma have damaged DNA in skin cells that lead to uncontrolled growth of these cells. Ultraviolet rays from the sun or tanning beds damage DNA in your skin cells. Your immune system repairs some of this damage but not all. Over time, the remaining DNA damage can lead to mutations that cause skin cancer. Many other factors also play a role in increasing the risk for melanoma, including genetics , skin type or color, hair color, freckling and number of moles on the body.
Understanding what causes melanoma and whether youre at high risk of developing the disease can help you prevent it or detect it early when it is easiest to treat and cure.
These factors increase your melanoma risk:
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Signs And Symptoms Of Eye Cancer
Many people with eye melanoma dont have symptoms unless the cancer grows in certain parts of the eye or becomes more advanced. Other, less serious conditions can also cause many of these symptoms. For example, floaters can be a normal part of the aging process. Still, if you have any of these symptoms, its important to see a doctor right away so the cause can be found and treated, if needed.
Signs and symptoms of eye melanomas can include:
- Problems with vision
- Floaters or flashes of light
- Visual field loss
- A growing dark spot on the colored part of the eye
- Change in the size or shape of the pupil
- Change in position of the eyeball within its socket
- Bulging of the eye
- Change in the way the eye moves within the socket
Pain is rare unless the tumor has grown extensively outside the eye.
How Is Melanoma Diagnosed
If you have a mole or other spot that looks suspicious, your doctor may remove it and look at it under the microscope to see if it contains cancer cells. This is called a biopsy.
After your doctor receives the skin biopsy results showing evidence of melanoma cells, the next step is to determine if the melanoma has spread. This is called staging. Once diagnosed, melanoma will be categorized based on several factors, such as how deeply it has spread and its appearance under the microscope. Tumor thickness is the most important characteristic in predicting outcomes.
Melanomas are grouped into the following stages:
- Stage 0 : The melanoma is only in the top layer of skin .
- Stage I: Low-risk primary melanoma with no evidence of spread. This stage is generally curable with surgery.
- Stage II: Features are present that indicate higher risk of recurrence, but there is no evidence of spread.
- Stage III: The melanoma has spread to nearby lymph nodes or nearby skin.
- Stage IV: The melanoma has spread to more distant lymph nodes or skin or has spread to internal organs.
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Who Gets Ocular Melanoma
Both males and females appear to have equal incidence of ocular melanoma. The peak incidence of presentation is closest to 62 years of age.
Those most at risk of ocular melanoma are of Caucasian race and have fair skin and light iris colour. However, melanoma may also affect those with darker skin and eye colour.
Melanosis, congenital ocular melanocytosis and neurofibromatosis are also associated with increased risk.
Patients with conjunctival melanoma tend to have many melanocytic naevi . It is thought that about 20% arise from naevi and about 60-75% within conjunctival melanosis.
Treatment For Eye Cancer
A team of specialists will meet to discuss the best possible treatment for you. This is called a multidisciplinary team .
Your doctor or cancer specialist will explain the different treatments and their side effects. They will also talk to you about things to consider when making treatment decisions.
Treatment for eye melanoma may include:
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Possible Signs And Symptoms Of Melanoma
The most important warning sign of melanoma is a new spot on the skin or a spot that is changing in size, shape, or color.
Another important sign is a spot that looks different from all of the other spots on your skin .
If you have one of these warning signs, have your skin checked by a doctor.
The ABCDE rule is another guide to the usual signs of melanoma. Be on the lookout and tell your doctor about spots that have any of the following features:
- A is for Asymmetry: One half of a mole or birthmark does not match the other.
- B is for Border:The edges are irregular, ragged, notched, or blurred.
- C is for Color:The color is not the same all over and may include different shades of brown or black, or sometimes with patches of pink, red, white, or blue.
- D is for Diameter:The spot is larger than 6 millimeters across , although melanomas can sometimes be smaller than this.
- E is for Evolving: The mole is changing in size, shape, or color.
Some melanomas dont fit these rules. Its important to tell your doctor about any changes or new spots on the skin, or growths that look different from the rest of your moles.
Other warning signs are:
- A sore that doesnt heal
- Spread of pigment from the border of a spot into surrounding skin
- Redness or a new swelling beyond the border of the mole
- Change in sensation, such as itchiness, tenderness, or pain
- Change in the surface of a mole scaliness, oozing, bleeding, or the appearance of a lump or bump
Life With An Artificial Eye
Mom describes the space where her eye used to be as like the inside of your cheek. She removes the prosthetic eye to clean it occasionally and treats the area with natural tears when it gets dry . Every few years, usually when the prosthetic starts to get uncomfortable, she visits an ocularist someone who specializes in creating and fitting artificial eyes to have the eye refitted or replaced. Over the years, her lower lid has thickened, so the ocularist thins out the bottom of the prosthetic to make it fit better. She has also experienced some drooping of her top lid where the bone has receded. Its possible that cosmetic surgery might help, but Mom is reluctant to have a procedure when there are no guarantees it will work. These days the appearance of it annoys me, Mom says. But I know that I cant worry about that every day or Id go crazy.
Over the years Mom has found ways to adapt. She knows where to sit in a restaurant booth or around a conference table, so she can see everyone. She learned to tell new coworkers about her eye, so they knew she wasnt ignoring them if they happened to approach her from the left. I have a constant bruise on my left forearm from walking into doorknobs, she says, but things could be so much worse.
On March 17, 1978, almost exactly two years to the day after her surgery, she met my Dad. They were married a year later, on St. Patricks Day 1979. My brother, sister and I were born over the next six years.
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