I guess my experience with acral lentiginous melanoma began in late 2005 when I noticed a thin line than ran straight down my right index finger nail from cuticle to tip. The line was very faint at first, almost as if someone had drawn it with a pencil. I assumed it was due to wearing acrylic nails or possibly a fungus from a manicure, ew. The next time I saw my dermatologist, I happened to show him my finger since the line seemed to have gotten thicker and darker. He recommended I see a specialist -- a plastic surgeon that specialized in hands and fingers. The dermatologist suspected that I had a mole growing inside my nail bed (under the finger nail itself) which was causing discoloration of the finger nail. I went to see the plastic surgeon and he agreed with the dermatologist, it was likely a new mole that would need to be biopsied. In April 2006, I had my finger nail removed along with a sliver of my nail bed. To ensure the shape of my nail bed remained intact, they inserted a piece of aluminum into my finger as a temporary finger nail. The nail was stitched down and stayed on for about 4 weeks until my finger nail began growing back. The biopsy results came back negative (benign), and at that time my doctor mentioned that if the mole or line came back, there was no cause for concern since it was already found to be non-malignant. Unfortunately I do not have any photos of my nail prior to the first biopsy or any during the healing phase. I do not remember the healing process being very difficult or painful and within about 6 months my nail had grown back and looked almost exactly the same as before!
Round 2. April 2011.Fast forward 4 years from the time of my first biopsy... In mid 2010 I began to notice discoloration in my right index finger nail again. It was different this time, however, because the line was spotted and grew very quickly. I remembered what my doctor had said, that it was nothing to worry about if the line came back. Since I had moved out of the area, making a follow up appointment with him was not very convenient so I just kept an eye on my nail assuming it was nothing to be concerned with. In August 2010, I noticed that the discoloration was getting significantly darker and my nail began to lift from my nail bed so I went to see my new dermatologist. I explained to him the history and had him take a look at the current state of my finger nail. He felt there was no cause for concern but took a photo for my medical records anyway.
After a random conversation with a co-worker one day about my finger nail debacle, he referred me to a local plastic surgeon that was a hand specialist. I set up a consultation and met with the doctor at the end of March 2011. He agreed with the previous doctors, there did not seem to be cause for concern, HOWEVER, he left the decision up to me and offered to perform the biopsy again if it was something I wanted. I can't say I had a "feeling" or any profound emotions... I think ultimately it came down to aesthetics. I like my hands to be manicured at all times and I did not like the appearance of my finger nail. BUT I also didn't understand how three doctors could find this "normal."
I had the biopsy done on April 11, 2011. While I don't remember many details from the previous biopsy, I think I would have remembered if it had been as painful as the second one. I was awake for the procedure, the finger nail was removed, a piece of the nail bed was excised and, like before, an aluminum nail was inserted into my nail bed. The procedure took approximately 45 minutes and I was sent home... without pain medication. That was the first complication of many!!
|1 hour post-op|
The lidocaine began wearing off around 2am and I woke up in terrible pain. I ended up calling the doctor and driving to the pharmacy at 3am for Vicodin. It turned out that the Vicodin was not offering much relief and I was only sleeping in 45 minute intervals and the pain and throbbing were outrageous. The following day I asked the doctor for something stronger and was prescribed Tylenol with Codeine. This had the same effect on the pain (none) as the Vicodin, but allowed me to sleep for longer periods of time. It wasn't until I was allowed to remove the bandage on day 4 that I finally had relief. In retrospect, I believe the bandage had been wrapped too tight, causing more pain than necessary.
|4 days post-op|
After the original bandage was removed, the swelling went down very quickly. I kept it wrapped and covered for the first week, but washed it with soap once a day. On Day 7, the aluminum nail popped out of place so I went back to the doctor. The stitches and nail were supposed to stay in for another week so I went in to the office with the idea that he would have to re-insert the aluminum otherwise my nail would not grow back properly. I was not prepared for what I was about to hear -- I had acral lentiginous melanoma in-situ. This is a very rare form of melanoma that is found in finger and toenails that does not correlate with sun exposure. It is a matter of having the right (or wrong) DNA. This type of melanoma is typically found in people with darker skin tones and later in life, which explains why my doctor and several pathologists were shocked to find this is a 25 year old Caucasian. In-situ meant that it did not appear that the melanoma had traveled beyond the finger tip, however, it was unclear how much of my finger would have to be excised to ensure all of the melanoma was removed. At this point, the aluminum nail was pointless so it was removed along with the sutures.
|7 days post-op|
|Infection, 10 days post-op|
I was told that I would have to wait a few weeks for my finger to heal before the next procedure would be performed. At first, I was told that my entire nail bed would be removed and a skin graft would be taken from my big toe and placed on my finger to ensure that I would still have a fingernail after the whole process was complete. I was referred to an oncologist to have blood work done and to rule out any other melanoma. The oncologist gave me a 50% percent chance of losing my entire fingertip at the joint, however, when he looked at my age, he lowered the chance to 30%. He also informed me that too much of my nail bed would have to be removed and therefore I would never have a fingernail again. This meant that my next procedure would not involve a skin graft - just the excision of my entire nail bed, in hopes that the melanoma had not traveled any further.
Round 3. May 2011.
|Pre-op, May 2011|
|1 hour post-op|
|My nail bed. Yum.|
|Day 3, hollowed out down to the bone.|
The swelling was much more significant this time, but the tissue grew back very quickly. I received the biopsy results one week later, and unfortunately, the margins still were not clear. The bad news was that I would need another procedure to remove the very tip of my finger including a piece of bone. The good news was that the margins were clear at the germinal matrix and therefore, the entire joint would NOT have to be amputated. Again, I would have to wait a few weeks to allow my finger to heal before they would be able to operate.
|1 week post-op|
|2 weeks post-op|