August 2003: I first notice lump on my wrist while I was camping near Skykomish. I thought it was just another mosquito bite.
October 2003: The lump is still there. It had grown a little. I figured it was just a ganglion cyst. It was so insignificant, I didn’t even mention it to my doctor at my routine diabetic exam.
February 2004: The lump has grown a little bit more, but nothing painful or too funny looking… just a soft, squishy lump. This time I show my doctor. He refers me to the hand surgeons upstairs (at Virginia Mason).
March 2004: One hand surgeon looks at it and isn’t certain what it is. A second figures it is some kind of “dermatoid cyst”, but orders some blood tests. The tests are negative. They schedule me to see a 3rd surgeon.
Later that same month: The 3rd surgeon rules out a cyst, and schedules me for surgery on March 18.
March 18, 2004: A simple 10-minute surgery, done with local anesthesia, removes small "fleshy mass" about the size of a small pea. He has it sent to pathology to see what kind of infection or fungus this might be.
March 24, 2004: I am informed that the pathologist found the mass to be a tumor caused by Merkel Cell carcinoma, a rare and aggressive type of skin cancer.
Some links to the web about Merkel Cell:
April 9, 2004: After 2 weeks of more tests, consternation, denial and discussions with doctors and friends, I agree to have surgery. The surgery involved four procedures:
The sentinel node biopsy required a radioactive isotope to be injected at the tumor site the afternoon before the surgery. Then during surgery, they use a Geiger counter to find the one segment of the lymph node which might have collected any migrating cancer cells.
The 3 cm wide excision is the removal of all skin and stuff from my wrist. All bones, tendons, nerves and blood vessels were left intact.
The radial flap involves taking a piece of tissue from my forearm. This tissue has a good network of blood vessels. That tissue is placed on my wrist and hooked up the radial artery, which is moved to supply the flap.
A skin graft from my thigh is used to cover up the hole in my forearm.
The surgery took nine hours, 8:30 to 6:30. I was in the hospital overnight and left on Saturday morning. There was no pain anywhere… except for a bed sore on my butt. It was like a Charlie Horse that took about a week to loosen up.
April 10, 2004: I have full feeling and mobility in all my fingers and thumb. The flap on my wrist is numb and should remain that way. There is a very slight chance that nerves might reconnect there, but it isn’t anticipated.
April 16, 2004: No cancer cells were found in the biopsy lymph node nor the tissue from my wrist. I have not yet seen the oncologist, but I am very reluctant to accept any radiation or chemo treatments.
Here are some pictures of me and my wrist the day after surgery. Click here for pictures taken during the surgery. (The pix on this link are very interesting, but some people don't like the blood and guts of it all.)