I am a mother of 3 and a medical writer with 25 years of experience. This means that I worry about my children’s health like it is my job, and I have just enough medical knowledge to scare myself and others about potential diagnoses in several fields. My children are good sports about this, for the most part, and, fortunately, they have always been very healthy. My constant concern about their health is even a running joke in our family. That is, until my 20-year-old daughter was diagnosed with acral lentiginous melanoma earlier this year.
Mallory’s Story
My oldest daughter is beautiful, blonde, and fair-skinned. She does not tan, so we have been diligent throughout her childhood about using sunscreen. During her junior year of high school (2013), I noticed a new mole on the top of her right foot. It was small and did not look too concerning, but it was in a strange place and was a slightly different color from the rest of her moles. In 2014, Mallory graduated from high school, and I asked her primary care physician about this mole (and several others) during her pre-college check-up. I was assured during that visit and her next 2 yearly check-ups that it did not look concerning.
Mallory is a student at Washington and Lee University in Lexington, VA, and is a biochemistry and psychology double-major. During the summers, she only comes home for the month of August, because she has a job at college doing research. She works in a lab in the basement of the school’s science building and always wears closed-toed shoes to work. When she arrived home in August 2016, after her sophomore year, I noticed that the mole on her foot looked slightly shiny and sometimes had a pinkish hue.
Figure. Foot post-op.
We made an appointment for her yearly check-up, and I asked her to request a dermatology referral to have several suspicious moles evaluated. Her primary care physician provided a referral, but we have a shortage of dermatologists in our area, so it took 6 months to get an appointment.
I did not think much about the mole during those 6 months. I was concerned every time I saw it, but even I did not really believe that it would turn out to be anything. I just needed reassurance from a specialist, so I could move on to a new worry.
Mallory’s appointment with the dermatologist was in February of this year on a Monday during a school break. She was going to go alone to the appointment, but I was worried about her driving somewhere new and insisted on going with her. When we arrived at the dermatologist’s office, she was first seen by the hospital’s chief dermatology resident. I explained my concerns to him. He asked me which moles I was concerned about and examined them with a dermatoscope. He assured me that all of the moles he examined were not concerning. When I asked about the one on her foot, he said, “I’m 100% sure it’s nothing.”
Then, an older, attending physician examined the moles with a dermatoscope and seemed to hesitate when he got to the one on her foot. He said, “I’m also sure it’s nothing, but I’m not 100% sure. If you want us to, we can take it off right now with a shave biopsy just to make you feel better.”
I looked at Mallory, and then looked back at him. “What would you do if she was your daughter?” I asked.
“I’d take it off,” he said.
Both doctors reassured us that it was nothing and told us that they would see us in a year. A few days later, Mallory flew to Florida to visit her boyfriend who is in medical school there. On Friday morning, she called me at work and said, “I just got out of the shower, and there are 2 messages from the dermatologist. He says he will call back within 30 minutes and for me to be near the phone.”
{{pagebreak}}
My heart sank. Doctors do not call you personally to give you good news. I tried to reassure her and told her to call me right back as soon as he called. I was 900 miles away, and her boyfriend was in class. She was sitting alone in a strange city when she received that phone call, and that still saddens me. She was calm when she called me back; I was not. She said she had acral lentiginous melanoma and was being referred to a surgical oncologist in our small town for wide excision of the mole and a sentinel lymph node biopsy. She said that the dermatologist said I could call him if I had questions. I immediately started doing research on acral lentiginous melanoma and searching for melanoma experts. My search led me to a surgical oncologist at the University of Virginia (UVA), about 2 hours from my house.
Mallory received her diagnosis on a Friday and flew home from Florida on Saturday. On Sunday, she moved back to school. On Monday morning, we both started calling the dermatologist’s office to get copies of her records and a referral to UVA. The dermatologist did not respond. We each called multiples times on Tuesday, with no response from his office. On Wednesday morning, Mallory was feeling desperate and called UVA herself to ask about an appointment. The surgeon’s office said they could not do anything without her medical records. When she started crying on the phone, they said they would request her records from the dermatologist’s office. By Wednesday at lunchtime, we still did not get a response from the dermatologist. I decided to drive to his office and ask for her medical records. I knew it was a long shot because she is over 18, but moms do not stop being moms just because their children are adults. Fortunately, the woman behind the desk was a mom (I know because I asked her). After a tearful conversation and some back-and-forth on the phone with Mallory, she agreed to give me Mallory’s medical records.
The surgical oncologist at UVA agreed to see Mallory the next week, and we had a surgery date: April 5. We were finally on the road to recovery.
Little did I know how long that road would be. We were told that Mallory would be completely nonweight bearing for 1 week, and the stitches would be removed after 2 weeks. Unfortunately, because there is not a lot of skin on the top of the foot, there just was not enough for the surgeon to get the margins he needed. The skin was pulled tight, really tight.
Surgery week was also final exam week at Washington and Lee University. Mallory had asked for an extension, but she was adamant about finishing the semester on time.
For the first week after surgery, she laid in a recliner with her foot above her heart. She took several final exams and wrote a 25-page paper while lying in this position. She also received the news that her skin and lymph nodes were clear of melanoma. We were ecstatic.
After 2 weeks, the stitches were removed, but the skin could not hold, and it immediately opened up. Mallory was nonweight bearing for more than 11 weeks. On June 23, she was cleared to walk, and a few days later, she walked 9 miles while we were on vacation at the beach. She will continue to go to UVA every 3 months for the next 5 years for skin checks. We consider ourselves so fortunate that this was caught early enough that it had not spread. Mallory recently moved back to college for her senior year, and we are hopeful that she will remain cancer-free.
Lessons Learned
Our family has learned so much from this experience. We have some suggestions for dermatologists, as well:
1. Consider all potential diagnoses despite a patient’s age or lack of risk factors. Both of her dermatologists seemed reluctant to consider that a mole could be something serious because Mallory was so young and had never had a serious sunburn.
2. Take note of the patient’s age and situation before sharing a life-threatening diagnosis over the phone. So many times, I have wished that her dermatologist had asked her where she was and if she had a loved one close by before he gave her information about her condition.
3. If you give a young patient a cancer diagnosis, remember that he or she is likely to have additional questions after sharing the news with family members. A follow-up phone call later in the day or the next day to ask if there are additional questions would have been appreciated.
Ms Stephenson is a medical writer who lives in Roanoke, VA. Her work has appeared in more than 20 national trade and consumer publications.
I am a mother of 3 and a medical writer with 25 years of experience. This means that I worry about my children’s health like it is my job, and I have just enough medical knowledge to scare myself and others about potential diagnoses in several fields. My children are good sports about this, for the most part, and, fortunately, they have always been very healthy. My constant concern about their health is even a running joke in our family. That is, until my 20-year-old daughter was diagnosed with acral lentiginous melanoma earlier this year.
Mallory’s Story
My oldest daughter is beautiful, blonde, and fair-skinned. She does not tan, so we have been diligent throughout her childhood about using sunscreen. During her junior year of high school (2013), I noticed a new mole on the top of her right foot. It was small and did not look too concerning, but it was in a strange place and was a slightly different color from the rest of her moles. In 2014, Mallory graduated from high school, and I asked her primary care physician about this mole (and several others) during her pre-college check-up. I was assured during that visit and her next 2 yearly check-ups that it did not look concerning.
Mallory is a student at Washington and Lee University in Lexington, VA, and is a biochemistry and psychology double-major. During the summers, she only comes home for the month of August, because she has a job at college doing research. She works in a lab in the basement of the school’s science building and always wears closed-toed shoes to work. When she arrived home in August 2016, after her sophomore year, I noticed that the mole on her foot looked slightly shiny and sometimes had a pinkish hue.
Figure. Foot post-op.
We made an appointment for her yearly check-up, and I asked her to request a dermatology referral to have several suspicious moles evaluated. Her primary care physician provided a referral, but we have a shortage of dermatologists in our area, so it took 6 months to get an appointment.
I did not think much about the mole during those 6 months. I was concerned every time I saw it, but even I did not really believe that it would turn out to be anything. I just needed reassurance from a specialist, so I could move on to a new worry.
Mallory’s appointment with the dermatologist was in February of this year on a Monday during a school break. She was going to go alone to the appointment, but I was worried about her driving somewhere new and insisted on going with her. When we arrived at the dermatologist’s office, she was first seen by the hospital’s chief dermatology resident. I explained my concerns to him. He asked me which moles I was concerned about and examined them with a dermatoscope. He assured me that all of the moles he examined were not concerning. When I asked about the one on her foot, he said, “I’m 100% sure it’s nothing.”
Then, an older, attending physician examined the moles with a dermatoscope and seemed to hesitate when he got to the one on her foot. He said, “I’m also sure it’s nothing, but I’m not 100% sure. If you want us to, we can take it off right now with a shave biopsy just to make you feel better.”
I looked at Mallory, and then looked back at him. “What would you do if she was your daughter?” I asked.
“I’d take it off,” he said.
Both doctors reassured us that it was nothing and told us that they would see us in a year. A few days later, Mallory flew to Florida to visit her boyfriend who is in medical school there. On Friday morning, she called me at work and said, “I just got out of the shower, and there are 2 messages from the dermatologist. He says he will call back within 30 minutes and for me to be near the phone.”
{{pagebreak}}
My heart sank. Doctors do not call you personally to give you good news. I tried to reassure her and told her to call me right back as soon as he called. I was 900 miles away, and her boyfriend was in class. She was sitting alone in a strange city when she received that phone call, and that still saddens me. She was calm when she called me back; I was not. She said she had acral lentiginous melanoma and was being referred to a surgical oncologist in our small town for wide excision of the mole and a sentinel lymph node biopsy. She said that the dermatologist said I could call him if I had questions. I immediately started doing research on acral lentiginous melanoma and searching for melanoma experts. My search led me to a surgical oncologist at the University of Virginia (UVA), about 2 hours from my house.
Mallory received her diagnosis on a Friday and flew home from Florida on Saturday. On Sunday, she moved back to school. On Monday morning, we both started calling the dermatologist’s office to get copies of her records and a referral to UVA. The dermatologist did not respond. We each called multiples times on Tuesday, with no response from his office. On Wednesday morning, Mallory was feeling desperate and called UVA herself to ask about an appointment. The surgeon’s office said they could not do anything without her medical records. When she started crying on the phone, they said they would request her records from the dermatologist’s office. By Wednesday at lunchtime, we still did not get a response from the dermatologist. I decided to drive to his office and ask for her medical records. I knew it was a long shot because she is over 18, but moms do not stop being moms just because their children are adults. Fortunately, the woman behind the desk was a mom (I know because I asked her). After a tearful conversation and some back-and-forth on the phone with Mallory, she agreed to give me Mallory’s medical records.
The surgical oncologist at UVA agreed to see Mallory the next week, and we had a surgery date: April 5. We were finally on the road to recovery.
Little did I know how long that road would be. We were told that Mallory would be completely nonweight bearing for 1 week, and the stitches would be removed after 2 weeks. Unfortunately, because there is not a lot of skin on the top of the foot, there just was not enough for the surgeon to get the margins he needed. The skin was pulled tight, really tight.
Surgery week was also final exam week at Washington and Lee University. Mallory had asked for an extension, but she was adamant about finishing the semester on time.
For the first week after surgery, she laid in a recliner with her foot above her heart. She took several final exams and wrote a 25-page paper while lying in this position. She also received the news that her skin and lymph nodes were clear of melanoma. We were ecstatic.
After 2 weeks, the stitches were removed, but the skin could not hold, and it immediately opened up. Mallory was nonweight bearing for more than 11 weeks. On June 23, she was cleared to walk, and a few days later, she walked 9 miles while we were on vacation at the beach. She will continue to go to UVA every 3 months for the next 5 years for skin checks. We consider ourselves so fortunate that this was caught early enough that it had not spread. Mallory recently moved back to college for her senior year, and we are hopeful that she will remain cancer-free.
Lessons Learned
Our family has learned so much from this experience. We have some suggestions for dermatologists, as well:
1. Consider all potential diagnoses despite a patient’s age or lack of risk factors. Both of her dermatologists seemed reluctant to consider that a mole could be something serious because Mallory was so young and had never had a serious sunburn.
2. Take note of the patient’s age and situation before sharing a life-threatening diagnosis over the phone. So many times, I have wished that her dermatologist had asked her where she was and if she had a loved one close by before he gave her information about her condition.
3. If you give a young patient a cancer diagnosis, remember that he or she is likely to have additional questions after sharing the news with family members. A follow-up phone call later in the day or the next day to ask if there are additional questions would have been appreciated.
Ms Stephenson is a medical writer who lives in Roanoke, VA. Her work has appeared in more than 20 national trade and consumer publications.
I am a mother of 3 and a medical writer with 25 years of experience. This means that I worry about my children’s health like it is my job, and I have just enough medical knowledge to scare myself and others about potential diagnoses in several fields. My children are good sports about this, for the most part, and, fortunately, they have always been very healthy. My constant concern about their health is even a running joke in our family. That is, until my 20-year-old daughter was diagnosed with acral lentiginous melanoma earlier this year.
Mallory’s Story
My oldest daughter is beautiful, blonde, and fair-skinned. She does not tan, so we have been diligent throughout her childhood about using sunscreen. During her junior year of high school (2013), I noticed a new mole on the top of her right foot. It was small and did not look too concerning, but it was in a strange place and was a slightly different color from the rest of her moles. In 2014, Mallory graduated from high school, and I asked her primary care physician about this mole (and several others) during her pre-college check-up. I was assured during that visit and her next 2 yearly check-ups that it did not look concerning.
Mallory is a student at Washington and Lee University in Lexington, VA, and is a biochemistry and psychology double-major. During the summers, she only comes home for the month of August, because she has a job at college doing research. She works in a lab in the basement of the school’s science building and always wears closed-toed shoes to work. When she arrived home in August 2016, after her sophomore year, I noticed that the mole on her foot looked slightly shiny and sometimes had a pinkish hue.
Figure. Foot post-op.
We made an appointment for her yearly check-up, and I asked her to request a dermatology referral to have several suspicious moles evaluated. Her primary care physician provided a referral, but we have a shortage of dermatologists in our area, so it took 6 months to get an appointment.
I did not think much about the mole during those 6 months. I was concerned every time I saw it, but even I did not really believe that it would turn out to be anything. I just needed reassurance from a specialist, so I could move on to a new worry.
Mallory’s appointment with the dermatologist was in February of this year on a Monday during a school break. She was going to go alone to the appointment, but I was worried about her driving somewhere new and insisted on going with her. When we arrived at the dermatologist’s office, she was first seen by the hospital’s chief dermatology resident. I explained my concerns to him. He asked me which moles I was concerned about and examined them with a dermatoscope. He assured me that all of the moles he examined were not concerning. When I asked about the one on her foot, he said, “I’m 100% sure it’s nothing.”
Then, an older, attending physician examined the moles with a dermatoscope and seemed to hesitate when he got to the one on her foot. He said, “I’m also sure it’s nothing, but I’m not 100% sure. If you want us to, we can take it off right now with a shave biopsy just to make you feel better.”
I looked at Mallory, and then looked back at him. “What would you do if she was your daughter?” I asked.
“I’d take it off,” he said.
Both doctors reassured us that it was nothing and told us that they would see us in a year. A few days later, Mallory flew to Florida to visit her boyfriend who is in medical school there. On Friday morning, she called me at work and said, “I just got out of the shower, and there are 2 messages from the dermatologist. He says he will call back within 30 minutes and for me to be near the phone.”
{{pagebreak}}
My heart sank. Doctors do not call you personally to give you good news. I tried to reassure her and told her to call me right back as soon as he called. I was 900 miles away, and her boyfriend was in class. She was sitting alone in a strange city when she received that phone call, and that still saddens me. She was calm when she called me back; I was not. She said she had acral lentiginous melanoma and was being referred to a surgical oncologist in our small town for wide excision of the mole and a sentinel lymph node biopsy. She said that the dermatologist said I could call him if I had questions. I immediately started doing research on acral lentiginous melanoma and searching for melanoma experts. My search led me to a surgical oncologist at the University of Virginia (UVA), about 2 hours from my house.
Mallory received her diagnosis on a Friday and flew home from Florida on Saturday. On Sunday, she moved back to school. On Monday morning, we both started calling the dermatologist’s office to get copies of her records and a referral to UVA. The dermatologist did not respond. We each called multiples times on Tuesday, with no response from his office. On Wednesday morning, Mallory was feeling desperate and called UVA herself to ask about an appointment. The surgeon’s office said they could not do anything without her medical records. When she started crying on the phone, they said they would request her records from the dermatologist’s office. By Wednesday at lunchtime, we still did not get a response from the dermatologist. I decided to drive to his office and ask for her medical records. I knew it was a long shot because she is over 18, but moms do not stop being moms just because their children are adults. Fortunately, the woman behind the desk was a mom (I know because I asked her). After a tearful conversation and some back-and-forth on the phone with Mallory, she agreed to give me Mallory’s medical records.
The surgical oncologist at UVA agreed to see Mallory the next week, and we had a surgery date: April 5. We were finally on the road to recovery.
Little did I know how long that road would be. We were told that Mallory would be completely nonweight bearing for 1 week, and the stitches would be removed after 2 weeks. Unfortunately, because there is not a lot of skin on the top of the foot, there just was not enough for the surgeon to get the margins he needed. The skin was pulled tight, really tight.
Surgery week was also final exam week at Washington and Lee University. Mallory had asked for an extension, but she was adamant about finishing the semester on time.
For the first week after surgery, she laid in a recliner with her foot above her heart. She took several final exams and wrote a 25-page paper while lying in this position. She also received the news that her skin and lymph nodes were clear of melanoma. We were ecstatic.
After 2 weeks, the stitches were removed, but the skin could not hold, and it immediately opened up. Mallory was nonweight bearing for more than 11 weeks. On June 23, she was cleared to walk, and a few days later, she walked 9 miles while we were on vacation at the beach. She will continue to go to UVA every 3 months for the next 5 years for skin checks. We consider ourselves so fortunate that this was caught early enough that it had not spread. Mallory recently moved back to college for her senior year, and we are hopeful that she will remain cancer-free.
Lessons Learned
Our family has learned so much from this experience. We have some suggestions for dermatologists, as well:
1. Consider all potential diagnoses despite a patient’s age or lack of risk factors. Both of her dermatologists seemed reluctant to consider that a mole could be something serious because Mallory was so young and had never had a serious sunburn.
2. Take note of the patient’s age and situation before sharing a life-threatening diagnosis over the phone. So many times, I have wished that her dermatologist had asked her where she was and if she had a loved one close by before he gave her information about her condition.
3. If you give a young patient a cancer diagnosis, remember that he or she is likely to have additional questions after sharing the news with family members. A follow-up phone call later in the day or the next day to ask if there are additional questions would have been appreciated.
Ms Stephenson is a medical writer who lives in Roanoke, VA. Her work has appeared in more than 20 national trade and consumer publications.
My wife and I drove to the airport and left our car with the valet parking service for a week. We have an electric car, and the parking service charges it while we travel. At least they are supposed to.
My wife and I drove to the airport and left our car with the valet parking service for a week. We have an electric car, and the parking service charges it while we travel. At least they are supposed to.
This year, we are faced with new coding challenges. Decreasing fee schedules by Medicare have become our Christmas and Hanukkah presents year after year. However, many of us are still miscoding some procedures, and we could increase our...
This year, we are faced with new coding challenges. Decreasing fee schedules by Medicare have become our Christmas and Hanukkah presents year after year. However, many of us are still miscoding some procedures, and we could increase our...
A study revealed major progress in the treatment of atopic dermatitis and hand eczema. The innovative treatment, using upadacitinib, showed significant promise in providing much-needed alleviation of these skin conditions.
A study revealed major progress in the treatment of atopic dermatitis and hand eczema. The innovative treatment, using upadacitinib, showed significant promise in providing much-needed alleviation of these skin conditions.
A 37-year-old woman presented to our clinic with skin-colored papules, which had been present for more than a decade, on the medial aspects of her heels.
A 37-year-old woman presented to our clinic with skin-colored papules, which had been present for more than a decade, on the medial aspects of her heels.
1. What alternative therapies does Dr Swanson suggest for children who have difficulty adhering to topical treatment regimens?a) Antibioticsb) Injectable or oral medicationsc) UV light therapyd) Homeopathic remedies2. According to Dr Swanson,...
1. What alternative therapies does Dr Swanson suggest for children who have difficulty adhering to topical treatment regimens?a) Antibioticsb) Injectable or oral medicationsc) UV light therapyd) Homeopathic remedies2. According to Dr Swanson,...
1. According to Dr Linda Stein Gold, how do nonsteroidal topical therapies compare to traditional steroid-based treatments for managing psoriasis and AD?a) They are less effective but safer.b) They are as effective as mid-potency steroids and...
1. According to Dr Linda Stein Gold, how do nonsteroidal topical therapies compare to traditional steroid-based treatments for managing psoriasis and AD?a) They are less effective but safer.b) They are as effective as mid-potency steroids and...
According to a recent interview with Jessica Johnson, MPH, what is a significant barrier to seeking mental health support among patients with atopic dermatitis?
According to a recent interview with Jessica Johnson, MPH, what is a significant barrier to seeking mental health support among patients with atopic dermatitis?
Which class of medications received a "general thumbs up" in the latest guidelines for atopic dermatitis management due to their efficacy and low cancer risk?
Which class of medications received a "general thumbs up" in the latest guidelines for atopic dermatitis management due to their efficacy and low cancer risk?
Ms Stephenson is a medical writer who lives in Roanoke, VA. Her work has appeared in more than 20 national trade and consumer publications.
