|
12 September 2009
Historic Melanoma
|
An unknown GP had suggested whilst I was at church, that a mole on my right calf be looked at. Following a visit to my GP I was referred to a dermatologist, who recommended that a suspect Melanoma be removed from my calf. This was undertaken at Wythenshawe hospital on 12 September 2009 by Mr Kanitkar.
|
|
15 October 2009
|
The removed suspect mole tested as a malignant melanoma, 0.3mm deep, Stage 1 cancer. On 15 October 2009 I therefore had further surgery where Mr Siddiqui undertook a Wide Local Excision (WLE) to remove additional skin around the original mole area. This was to be followed by regular follow up reviews over many years.
|
|
17 November 2021
|
The last dermatologist review by Dr O’Connor (having had many over the years since 2009.)
|
|
1 February 2024
|
Having recently noticed a new ‘bump’ on the skin of the right temple on my face, I requested a GP appointment via the ASKMYGP online service. Mid afternoon my GP, Dr Brand phoned and recommended I see Dr Barber, who was more specialised in Dermatology; I agreed to this suggestion. From ASKMYGP notes, Dr Brand requested Dr Barber to call me on 7 February. (The photo below is what was sent to the GP prior to my appointment.)
|
|
15 February 2024
|
Dr Barber appointment. He examined the ‘bump’ but stated that this was just skin ageing and nothing to be concerned about. He took the opportunity to review my back and expressed concern relating to a new mole on the upper left of my back. He stated that I would be referred to a Dermatology consultant.
|
|
21 February 2024
|
Withington Hospital examination by Gaurav Krishan Dhawan, Consultant Dermatologist.
Examination concluded: Lesion 1 is a 9x9 mm erythematous and light brown macule to the left upper back. On dermoscopy this had some angulated white lines homogenous patch of light brown and some patchy erythma. This is not present on historic clinical photographs. As such, I sugested we excise this as it looks atypical.
Patient information: I have explained to you today that this is an atypical/abnormal naevus, however I cannot rule out a cancer. We will initially proceed by performing a excisional biopsy to remove the lesion and confirm the diagnosis. Once we have the histology report I will contact you with the results to discuss further management. I have advised that if the lesion significantly changes between now and at your next to please contact our secretaries and I will bring you back sooner to review the lesion.
|
|
4 March 2024
|
Skin surgery appointment at Trafford General Hospital. Surgery undertaken by Mr Dhawan.
|
|
14 March 2024
|
Photo of surgery wound after 10 days, following removal of dressings.
Click here to open a separate window displaying the photograph.
|
|
21 March 2024
|
Phone call from Mr Dhawan, followed by a letter stating: Just writing to you further to our telephone consultation today to confirm the solid reports of the lesion excised from your upper left back is now available. The lesion has proven to be a superficial spreading malignant melanoma with the Breslow thickness of 1.3mm. I have referred you to the Christie Hospital for further investigation and management of this.
|
|
26 March 2024
|
Letter from Christies, advising an appointment for 10:10 on 22/4/2024 at the Kosutic Mon AM clinic.
|
|
28 March 2024
|
Excerpt from Pathology report summary.
Conclusion
A) Left upper back: superficial spreading malignant melanoma, pT2a, excised (please see margins below).
Microscopic Description
A)The skin contains an atypical melanocytic lesion with features amounting to invasive melanoma, superficial spreading type (Dr S Al-Habba agrees). The in situ tumour consists of a lentiginous and focally nested proliferation of atypical melanocytes with hyperchromatic nuclei.There is architectural atypia and pagetoid ascent of single cells, There are junctional mitotic figures. Ulceration is not seen. The invasive component is formed of variably sized, closely packed nests of cells with hyperchromatic, round nuclei. Scattered single cells are also seen. The tumour extends into the reticular dermis and has a Breslow thickness of 1.3mm (pT2a). Dermal mitotic figures are not seen. There is fibroplasia and features of regression are seen in the surrounding dermis (amounting to less than 75% of the tumour area). Scanty tumour infiltrating lymphocytes are seen. The malignant cells are admixed with dermal population of bland melanocytes which show maturation with depth, consistent with background naevus. The Tumour appears excised with the nearest peripheral margin 2.6mm away from the invasive component and 1.9mm from the in situ component. The deep margin is 7mm away from invasive tumour.
Size of specimen: 33mm x 14mm x 10mm.
Max diameter of lesion: 7mm
Mitotic index: 0 per square mm
Growth phase: vertical
Clark level 4/5: Yes
pTNM (UICC TNM 8): pT2a
Staging: Pre-Treatment Staging: Stage 1B (cT2a, cN0, cM0) - Unsigned
Treatment Recommendation: Already referred to the Christie for WLE (Wide local excision), Vitamin D check and 5 year follow up.
David Rutkowski
|
|
22 April 2024
|
Christie’s hospital appointment to discuss followup treatment for diagnosed Melanoma.
Long discussion with Mr Bista with regard to recommended treatment of Wide Local Excision (WLE) and Sentinel Lymph Node Biopsy (SLNB). I intend to proceed with the WLE, but have spent some time considering whether to undertake the SLNB. The advice states that it assists with cancer ‘staging’ but ‘has no proven survival benefit’. Given any surgery involves risk, it is unclear as to why I should have the SLNB. At the time of writing I am still considering whether to have this.
|
|
27 April 2024
|
I watched a video for GPs on SLNB by Myles Smith via the Royal Marsden Hospital in London. He did not cover the outcome benefits of the SLNB, only the procedure. I emailed him via his PA email address (given in the presentation) asking why undertake the SLNB if, as I am advised, it has no survival benefit.
|
|
1 May 2024
|
Sent the above email to Mr Kosutic’s PA, Linda Stewart, for the attention of Mr Kosutic or Dr Bista.
|
|
3 May 2024
|
Pre-op appointment, Christies.
Conversation with Pre-op nurse, where I explained I had still not decided to undergo SLNB and was awaiting a response from Dr Bista. She stated that she had emailed a further request to Dr Bista to respond.
|
|
7 May 2024
|
Telephone call from Dr Bista. Didn’t clarify why SLNB was proposed. I suggested undertaking only the ‘NM Sentinel Node Loc and Imaging’ procedure, but not the SLNB, as this would indicate where the potential for spread would be and allow future focus, personal and professional in this area. Dr Bista said this was not normal and he would discuss this with his senior consultant when he saw him on Thursday 9 May.
|
|
10 May 2024
|
Call from the Christies to confirm arrangements for my attendance, 16 & 17 May. I explained I was still awaiting a response from Dr Bista as to what procedures I would undertake. She said she would make enquiries.
|
|
13 May 2024
|
Having not heard from Dr Bista, I called the secretarial number provided by the pre-op nurse. The secretary advised that she would seek to contact Dr Bista and get him to call me. This he did, a short time after. He stated that they would not undertake the ‘NM Sentinel Node Loc and Imaging’ procedure if I was not having the SLNB. He agreed to alter the schedule for Friday and do the WLE only. He also advised that they would initiate the Ultrasound scan of the under arm lymph nodes at a separate appointment following the WLE procedure.
|
|
16 May 2024
|
To see a pre-op photo of the healing initial excision wound, click here to view a photograph in a separate window.
|
|
17 May 2024
|
WLE Surgery appointment. Dr Bista performed WLE. Two samples removed, the excision and a cyst; the cyst was viewed as being benign but will be sent as a separate sample to pathology. A telephone followup in 6 weeks is to be arranged following the pathology report. Also an Ultrasound scan of the lymph nodes is to be undertaken to provide a baseline measure for future monitoring.
|
|
24 May 2024
|
District nurse review of wound. Appears to be healing well with no apparent infection.
Click here to open a separate window displaying a photograph.
|
|
29 May 2024
|
District nurse review of wound. Again appears to be healing well. Nurse advised that it was no longer necessary to have a dressing over the wound.
Click here to open a separate window displaying a photograph.
|
|
25 June 2024
|
Scheduled call from nurse, checking on status of WLE wound. I advised that it seemed to be healing well with no sign of infection. I mentioned that I had anticipated that the call would be providing the pathology results from the WLE. She advised that she had sight of the results and advised me that these were clear and that I should receive written confirmation soon. She advised that the next stage would be to arrange an ultrasound scan of the lymph nodes. I also asked for the vitamin D blood test results which she was unaware of, and she advised me that she will ask a doctor to investigate and let me know.
|
|
27 June 2024
|
Letter (received 8 July) from Dr Kosutic’s department, signed by Dr Totorean with feedback from the WLE.
“You had a WLE of a melanoma scar on your left upper back. The histology report revealed that there was no evidence of residual disease within the tissue which was excised. This is indeed reassuring.”
|
|
12 July 2024
|
Lymph node ultrasound scan appointment. Scan undertaken by a consultant, no anomolies found.
|
|
31 July 2024
|
Received letter dated 17 July 2024 electronically signed by Dr H. de. Berker stating “I am writing to you with the results of your ultrasound scan of your left axilla that you had performed at the Christie on the 12th July 2024. I am pleased to tell you that this has been reported as being normal.”
|
|
19 August 2024
|
Consultant clinic appointment. Kosutic Mon AM in Integrated Procedure Unit (Dept 2) at 9:35
Straight forward consultation and physical check of lymph nodes. Nothing unusual identified. Next appointment will be for a periodic ultrasound scan.
|
|
14 October 2024
|
Christie’s hospital Ultrasound appointment to scan both arm pit lymph nodes. No anomolies identified.
|
|
6 November 2024
|
Received letter dated 29 October 2024 electronically signed by Dr R Totorean stating “ I am writing to you with the results of your ultrasound scan of your right axilla that you had performed at the Christie on the 14th October 2024. I am pleased to tell you that this has been reported as showing no suspicious or enlarged nodes seen. This is good news and we shall see you in clinic as planned.”
Paul’s notes: They in fact scanned both armpits (axilla) for lymph node observation.
|
|
10 March 2025
|
Appointment to attend The Christie, Kosutic clinic, in IPU at 9:20am (rearranged from 17/2/24)
Straight forward appointment. Doctor reviewed status, stated that he had requested the next regular ultrasound scan of the arm pit lymph nodes, noting that, as above, the previous scan had shown no anomalies. He physically checked under arm lymph nodes and the status of the scar which he found no problems with. He advised me to request 6 monthly appointments from the Dermatologist who undertook the initial melanoma removal, and stated he would be writing to them also to request this.
Spoke with Withington Dermatology appointments and have been booked in for 1/4/25
Summary content of post review letter dated 10/3/25 from Dr A Tantawy, Clincial Fellow Plastic Surgery
“On examination today the scar on his back has healed quite nicely with no suspicious lymphadenopathy within both axilia lymph node basins. His recent ultrasound scan did not show any supicious lymphadenopathy.”
|
|
1 April 2025
|
Withington Community Hospital Dermatology appointment, 15:00 1/4/25 with Joan O’Connor
Summary of Assessment contained in letter dated 1/4/25 post appointment, from J O’Connor
“Full skin check with dermoscopy was undertaken. Scar from the wide local excission of the left upper back has healed well. When compared with the baseline photographs from 2013, there were no obvious changes identified in any of the moles. He should continue to monitor his skin and has been listed for dermatology review here in 6 months time.”
|
|
10 April 2025
|
Christie’s hospital Ultrasound appointment to scan both arm pit lymph nodes. 9am Radiology 2 Department (Dep. 34)
Extract from letter dated 16/4/25 post Ultrasound appointment, signed by Dr Arash Rafie, Plastic Surgery Registrar.
“I am pleased to tell you that this (the ultrasound scan) has been reported as showing no abnormality and this is reassuring.”
|
|
4 August 2025
|
Not Melanoma related. 10:45 GP appointment to investigate growing lump on upper middle back.GP referred the issue to Dermatology.
13 August 2025, had a ‘Skin Analytics’ photo/AI session at Altrincham Hospital.
24 August 2025, a follow up appointment at Withington Hospital with a Nurse Practitioner, Nichola Miller, who recommended excision of a suspect Basal cancer.
14 September 2025, Trafford General Hospital appointment. Excision of suspect growth undertaken by Adrian Caramida.
26 September 2025, District Nurse removal of stitches, wound healing progressing well, no issues.
7 October 2015, Pathology results “Conclusion. Excision biopsy, mid back: irritated (benign) seborrhoeic keratosis, clear margins.”
|
|
29 September 2025
|
Consultant clinic appointment. Kosutic Mon AM Integrated Procedure Unit (Dept 2) 10:25am (Originally had been diaried for 8/9/25.)
Review undertaken by Dr A Khalaf. Reported: “There are no signs of local recurrence and no palpable lymphadenopathy in both axilae (armpits), groins and the neck.” Note: he didn’t physically check the neck.
|
|
1 October 2025
|
My nephew sent me a link to www.theconversation.com relating to the debate on Lymph node removal.
Click here.
|
|
22 October 2025
|
Scheduled Dermatologist review with J O’Connor, Withington Hospital.
|
|
29 October 2025
|
Scheduled Ultrasound scan IPU at Christie’s hospital.
|
|
16 March 2026
|
Scheduled appointment to attend The Christie, Kosutic clinic, in IPU at 9:25am
|
