Paitent Stories

Michelle Graham

Malignant Amelanotic Melanoma: More than Just a Mole

Malignant Melanoma. “It’s just a mole. Just a mole,” they said, nodding their heads. This one was different. It didn’t fit the ABCDE criteria for suspicious moles. I have hundreds of moles thanks to my Irish genetics, fair skin that burns before it tans, green eyes and blonde hair.  But this mole wasn’t dark and flat like in the ABCDE posters.  It was dark pink (amelanotic) and raised (nodular). Atypical.  

In my childhood, in the 1970’s and 1980’s, I played outside all day in a bikini, wearing “suntan lotion” with SPF 4.  I was a typical Gen Xer. In 1989, I suffered a second-degree burn in Mexico, blistering on my face and ears. For years afterward, I would break out in hives from sun exposure.  In the late 1980s, I used a tanning bed to get a “base tan” to avoid burning on vacation. From 1990 onward, I was advised by doctors to “go to the gym” to manage my depression, which led me to take a step class. One of the instructors used a tanning bed 5 minutes per week to keep her depression at bay, so I did the same.   

I eventually got wiser, I have a family history of various types of skin cancers (not melanoma), so I tried to keep on top of getting my skin checked by dermatologists over the years.   

On November 20, 2019, Dr. Burbidge found a small, dark irregular mole in the middle of my back and biopsied it just before I left for Germany to celebrate my 50th birthday. I tried not to think about it while waiting for results.   

It came back as melanoma in situ. On January 14th, 2020, Dr. Shoimer cut a circle around it and removed it along with a chunk (wide local excision). Then, he sewed it up in a procedure called a Wide Local Excision (WLE) that left a big, ugly purple scar where the stitches looked like train tracks. 

Over a year before, I had flagged another small pink mole on my right earlobe that multiple doctors had dismissed.  In the past year, it tripled in size and became itchy. After my first melanoma, I insisted on another check. This was all in early 2020, just as the pandemic lockdown was beginning. I saw Dr. Hawkins at the Dermatology Clinic, Derm.ca in Calgary (now at Peak Medical in Okotoks) on February 28th, who did a skin check and a shave biopsy of a mole on my ear and sent it along for biopsy to rule out cancer. On March 20th, the biopsy came back positive for  melanoma. The mole was deeper than the shave biopsy and growing deep into my ear like a carrot (nodular) instead of flat (superficial spreading) on the surface. My results indicated it was “at least stage 2b” melanoma.  

I underwent a flurry of pre-op questions, online interviews and consultations with multiple doctors, some over Zoom due to the pandemic. I thought of all of my friends and family who had cancer before me and of their strength and all they had been through. I asked them to send me a pin, ribbon, band, favourite quote or photo to think of them as I follow in their footsteps, and I put together a little treasure chest of all my heroes. I ordered a green sleeve. Hubby and I already had wills, power of attorney, and personal directives in place.  

On March 30th I had my first appointment at the Tom Baker Cancer Center, which was allowing “emergency” cases like melanoma despite lockdown and closures.  I had done a lot of research and came prepared with questions instead of shock.  I wasn’t given a date due to ongoing COVID-related surgery reschedules. Then, sentinel lymph node mapping and dissection (removal) was done with radioactive sugar and blue dye to see if it had spread to my lymph nodes behind my ear and in my neck. None  were detected in the three lymph nodes that were removed.  

On April 1st, I began attending patient support groups online with Melanoma Canada. On April 23rd, Dr. McKinnon and Dr. Sass removed 6 mm more depth of melanoma and 2 cm all around it out of my ear like a pizza slice during the main surgery. They used skin from my neck behind my ear to reconstruct my earlobe. They took skin from behind my ear to use as a skin graft for surgical reconstruction. Surgery went well, and I felt pretty good – a little tired, a little nauseous, and a little pain. We stopped on the way home to get some prescriptions filled and headed home to rest, knowing there would need to be a second surgery to fix my ear. I applied antibiotics three times a day where the skin from my neck was grafted onto my ear.  

In August, I was over the most time-consuming part of the cancer treatment and was told they “got it all” and “not to worry.” I would have skin checks every six months, then every year for five years. I know that at any time, I can have another recurrence anywhere in my body including places that have never seen the sun – like under a toenail (like Bob Marley), in my mouth, or under my bathing suit.  It’s not just the places where you got sunburnt – melanoma can develop anywhere on your body, inside or out. Anyone can get skin cancer. Skin colour, geography, and wealth don’t matter. It’s no longer a dirty word that equals a death sentence we have to whisper, “the big C.” Health is a precious gift and without it, nothing else matters.   

We must find the balance between personal enjoyment, freedom and liberty – having a few fun drinks on vacation in a sunny place versus taking care of ourselves, taking precautions, eating healthy and staying out of the sun.  Some people completely change their lifestyle, others not at all.  

I continued to get skin checks from my dermatologist at the Tom Baker Cancer Center every six months. In November 2023, I mentioned the sinus pain that has been going on since at least 2020, and was sent for an MRI, which revealed a lesion in my brain that was “highly concerning for metastasis based on the patient’s history of melanoma.” I immediately went on medical leave and began to get my legal, medical and financial affairs and belongings in order, planning for the worst and hoping for the best.  I attended numerous informational webinars, learned more about MAID (Medical Assistance In Dying), and read medical studies and journals of treatment protocols.   

As part of my mental health cancer treatment and support, I attended patient support groups and Cancer Coaching hosted by Melanoma Canada, and Wellspring Alberta’s online wellness classes and Money Matters program have been incredibly helpful and have kept me somewhat grounded. You have to “feel it to heal it,” and you have to see it, recognize it, and want to make changes in order to get better.   

I have been so grateful that my ability to read and learn has come back through therapy. The time off work allowed me to focus on my healing, establish boundaries, determine my priorities, and get on with the business of living my life. I chose to stop living under the rock of fear, obligation and guilt that was crushing my soul, and begin living my life as if I only had a short time left to live – and I don’t regret that. 

While the path ahead is uncertain, I stay hopeful, engaged in treatment, and committed to my mental and physical well-being. Every day is a new opportunity to live fully and make the most of the time I have.