The Register Citizen (Torrington, CT)
From birthmark to biopsy, and peace of mind
(Ad) Maureen Dewan has never spent much time in the sun. In her 75 years on the planet, she’s used sunscreen, hats, umbrellas and long sleeves whenever she was going to be outside for any period of time. So when she went to her dermatologist to get relief from hives, she didn’t expect to walk away with a cancer diagnosis.
“In the process of my doctor checking the hives, he saw an irregular birthmark on my back, so he biopsied it,” Dewan said.
She had Stage 1 melanoma, a small lesion on her mid-back that could be resolved with a simple outpatient surgery.
“That was the good news, but I’ll be honest, seeing malignant melanoma on your report is unnerving,” she said.
After the biopsy came back, Dewan immediately went to see Dr. Jill Rubinstein, a surgical oncologist at St. Vincent’s Medical Center.
“I talked to her on a Friday, and had an appointment on Monday,” Dewan said. “She went through the pathology report with me line by line and explained how she would excise the lesion. She drew a picture of how she would make the incision, estimated how deep it would be, and showed me how she would close it so it would not require external stitches. Twelve days later, I was scheduled for surgery.”
Rubinstein always walks her patients through all the possibilities that could happen during surgery so that they’re prepared.
“The features we learn from the biopsy help determine the first steps in treatment,” Rubinstein said. “[Dewan] had a wide local excision, meaning we took the lesion and the surrounding tissue. In melanoma, the depth is the main factor that determines how much of a margin you need to take. Since it’s the skin, the surgery itself is often straightforward. What can be difficult is dealing with tension when closing the wound, and optimizing the cosmetic outcome.”
Dewan’s wound had no trouble healing. It was in an area on her back that didn’t experience a lot of movement or stress that could cause tension to the skin.
“It was really much easier than I thought it was going to be,” Dewan said. “[Rubinstein] sent me home with pain pills, but I didn’t have to take a single one.”
Within a week, Dewan was back to normal activities, and this was because it was caught so early.
“Our primary goal is to catch them in their early local stage. It’s an outpatient procedure,” Rubinstein said. “The problem with melanoma is that they are cancers that can gain the ability to travel essentially anywhere in the body, which changes the way we have to treat them.”
She says melanoma can present in many different ways, and recommends the “ABCDE method” for periodic self-checks: Asymmetry in a mole or mark on your skin, borders of the mole that have changed, color changes, the diameter of the mole or marking, and its evolution over time. If your skin markings are changing in any of these ways, get them checked out.
Like Dewan, you don’t have to have a lot of sun exposure to develop melanoma, Rubinstein says. That’s just one of the risk factors.
“Anyone can generate a skin cancer, so everyone should be familiar with their skin and moles,” she said. “We generally think of it through cumulative exposure, but that doesn’t mean that younger people don’t get it because they absolutely do. We’ve actually seen increasing numbers in younger people.”
Those who don’t catch their melanoma as early as Dewan did may have to undergo targeted therapy or immunotherapy in addition to surgery. The landscape for treating melanoma, however, has changed greatly over the past 20 years, according to Rubinstein.
“It’s a whole new world in melanoma,” she said. “We have a couple categories of medication that can be incredibly effective, and there has been a massive success story in the last few decades.”
St. Vincent’s Medical Center employs oncologists and surgeons like Rubinstein who do more than treat the cancers — they study them.
“I study evolution of tumors under selective pressures,” Rubinstein said. “A lot of people understand these concepts of evolution from learning about Darwin in school. We can apply ideas from evolutionary biology to study tumors since they’re a population of cells, vying for survival. This is a newer way of thinking about cancer, and how the way we treat tumors can influence their evolution.”
They also truly listen to the patient.
“What I really liked was that she listened to me and talked to me,” Dewan said. “She wasn’t on the computer; she was totally focused on me, answering my questions. And my husband looks at my back and sees I’m barely going to have a scar. Her surgical skills were amazing, so I’m really done with it.”
“The real strength of St. Vincent’s is that it’s part of a health care institution,” Rubinstein said. “Having that excellence in multidisciplinary care is important in cancer care, but at the same time St. Vincent’s runs like the local hospital it has always been. You have a health system backing it, but you still have the feel of a personal touch.”
For Dewan, her hives lasted longer than her melanoma. She had her surgery on March 11 and is already back to her normal life.
“I never would have known about it,” Dewan said. “It was on a part of my back that I can’t see, and it was so minimal that my husband didn’t even notice it. I was incredibly lucky that I got the hives, in the end.”