From initial diagnosis through treatment and, ultimately, the feeling of rain on my scalp
One of the major problems we have encountered in the fire service is the reluctance of firefighters to share their knowledge or experiences with others, whether an operational or tactical experience, even a life experience. With this in mind, I would like to share my story of dealing with a type of cancer called melanoma. It has been a year since my original diagnosis, and at this point, I feel comfortable discussing my journey through diagnosis, surgery and treatment. I am doing so in the hope that it will educate and inform you about the dangers of melanoma and that it will encourage you to become more aggressive in your approach to your physical and mental health.
In October 2021, I discovered a small black bump on my scalp under my hair. I live in a very rural area inhabited by a large wildlife population. My biggest fear was that I had been bitten by a tick and might have Lyme disease. I debated calling my primary care physician. I had my annual visit to the dermatologist scheduled in six weeks so I decided that I would just monitor it until then. Everything would be fine.
I went to my dermatologist appointment as planned. The physician assistant asked me if there was anything that I wanted her to examine. I showed her the black spot on my scalp, and she said, “I think we better take some samples of that area and send them to pathology.” She took two samples, placed them in a small round vessel and told me that she would be in touch with me in about a week.
Seven days later, the PA called and told me that I had cancer. The small black bump was melanoma.
My first question: “Are you sure because I don’t feel sick?”
She was sure. She wanted to refer me to Dr. Seungwon Kim at UPMC in Pittsburgh. He would be my surgical oncologist.
When I met with Dr. Kim two weeks later, he examined my scalp and scheduled me for a PET scan. The scan would encompass my entire body and show if the cancer had spread to any other areas.
The PET scan technician did everything he could to make my scan less stressful and me more comfortable. He was able to fulfill my request of some good old 60s rock music. If you have never had a scan, they are noisy, uncomfortable and seem to take an eternity.
A day later, Dr. Kim called with the good news: My cancer had stayed localized to my scalp. He said that he was making an appointment with Dr. Diwakar Davar at UPMC Hillman Cancer Center who would serve as my medical oncologist.
I still couldn’t believe that I had cancer.
It was a cold winter day when my wife and I went to meet Dr. Davar.
Like other appointments, there were forms to complete … and more forms to complete. Finally, we were taken to an exam room.
Upon our meeting, Dr. Davar’s first question was, “Are you a firefighter?” as he pointed to the department patch on my job shirt. “Yes, I am,” I answered.
He went on to say that I was in relatively good health for my age, and he wanted to offer me a spot on a new clinical trial he was undertaking. He explained that melanoma has a high reoccurrence rate of 30% within 5 years and 50% within 10 years. The trial he was conducting might be able to reduce those rates to 5%.
The trial would consist of two drugs being administered intravenously and repeated in six weeks. The area affected by melanoma would then be surgically removed. He told us we had a few days to think about the offer. I asked what the success rate of the trial treatment had been thus far, but they were still in the process of recruiting patients.
For several days, my wife and I debated the options, and ultimately decided for a few reasons to not participate in the trial. The first reason was I had no real idea when the melanoma surfaced on my scalp, and we felt that delaying the removal for 12 weeks could lead to a further spread of my cancer. The second reason was because the treatment might not work, giving time for the cancer to progress. Because the clinical trial was in its infancy, we felt that there just wasn’t enough reliable information.
I informed Dr. Davar of our decision, and surgery was scheduled for 10 a.m. on Feb. 15, 2022.
I arrived at UPMC for my surgery with plenty of time to spare and went through all the pre-op tasks.
At one point, I heard one of the nurses say, “He’s here for a wide-area surgery.”
Wide area? They must be mistaken, I thought. I was just having a small black bump on my head removed.
Before surgery, they took me for a scan to determine what lymph node drained that area of my scalp. Once they determined that, they would also remove it and test for cancer. The problem: My body wouldn’t cooperate. I was in that metal tube for 71 minutes, and the dye they injected into my melanoma wouldn’t move. They tried hot towels and more hot towels, and the dye just wouldn’t budge. Turns out this happens to only about 5% of patients.
Dr. Kim decided to move forward only with removal of my melanoma because the scan had not successfully identified the lymph node.
The anesthesiologist said she was going to give me something to keep me calm, and the next thing I knew, I was waking up in the recovery room.
Everything appeared to go well. They gave me a drink, moved me back to my room, and informed me that I could head home that day.
Once we arrived home, I looked in a mirror and discovered that I had what looked like a pancake-sized bandage on my head. My wife measured. They had removed a 2-inch by 4-inch piece of my scalp.
Nine days later, I was back at UPMC for my skin graft. The graft would come from my left thigh and would be 1/12,000-inch thick. I still think about that and wonder how something that thin would become my new scalp.
The surgery was a success.
They sent me home with a new pancake bandage covering the top of my head. I had a few restrictions, like no lifting and no bending.
I soon found out that while I was in surgery, Russia had invaded Ukraine. Like several others in the fire service, I decided to launch a turnout gear drive for our brothers and sisters in the Ukraine. In a short period, we were able to collect 80 complete sets of turnout gear along with SCBA and several individual items of turnout gear that we could ship to a collection point in New Jersey. This focus helped keep my mind off my health issues.
In mid-March, I had an appointment with Dr. Mario Solari, my plastic surgeon. What happened at this appointment completely surprised me. The bandages from both my thigh and scalp were removed. A bandage that looked like a piece of gauze was placed over the spot of my donor skin. I was told that as the bandage became loose, I could cut it away and eventually, the bandage would be gone. As far as my scalp, I would receive no new bandage. I was to keep the area moist with Vaseline or Aquaphor. Both sites were healing correctly.
My first post-op scan
My medical oncologist laid out my treatment plan at my next visit:
The scan was negative, and I started my immunotherapy the next day. The goal of immunotherapy was to cut the chance of a melanoma reoccurrence by 50%.
One item that continued to weigh on my mind was my skin graft. In six areas of my scalp, the surgeon had to go deeper than other places. There was concern that the graft might not take, and I would have to go through the surgery again.
Then one day in early May, I hung some clothes outside to air out. Shortly thereafter, it started to rain, so I ran outside to retrieve my clothes. I stopped for a short period to savor the moment. I could feel the light rain landing on my scalp. My scalp actually had feeling again. The skin graft had taken.
December marked one year since my original cancer diagnosis. There have been ups and downs along the way. All my scans have been negative. However, in September, I had a severe negative reaction to the Keytruda. As a result, my medical oncologist has decided to suspend my immunotherapy.
As I continue down this road, I ask of you, my fellow brother and sister firefighters, please do three things for me:
Hopefully my story has encouraged you to take these steps.
If you have questions or comments, please do not hesitate to contact me. I will be back with my regular monthly column on grants soon!
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