Early Detection Assists in Fight Against Melanoma

From Siteman Cancer Center Cancer Matters

LuAnn Locks initially wasn’t concerned about the brown spot on the heel of her left foot.

“This spot was no bigger than the fingernail on my index finger,” says the 46-year-old from Advance, a small town in southeast Missouri. “It was smooth and it didn’t hurt.”

Her boyfriend insisted she have the spot checked out, though. To satisfy him, she drove the 35 miles from Advance to Cape Girardeau in June 2001 to see a podiatrist. He performed a biopsy and determined that LuAnn had a thin melanoma.

LuAnn’s former brother-in-law, a physician, recommended she consult Roberta D. Sengelmann, MD, assistant professor of medicine (dermatology), and director of the Center for Dermatologic and Cosmetic Surgery. Sengelmann performed an excisional biopsy of the silver-dollar sized lesion, only to discover that the melanoma was nearly 2 millimeters deep – much deeper than the original biopsy had suggested. The lesion extended into the second layer of skin, where blood vessels could transport cancer cells elsewhere in LuAnn’s body.

Sengelmann referred LuAnn to Jeffrey F. Moley, MD, professor of surgery, and Christopher J. Hussussian, MD, assistant professor of surgery. Within a few weeks, LuAnn drove three hours back to St. Louis to hear how they would remove the melanoma and perform reconstruction that would allow her to regain normal use of her foot.

LuAnn says she prepared for the surgery by drawing strength from friends, family and fellow church members at the Father’s Arms Fellowship in Scott City who prayed for her.

“I strongly believe in the power of prayer,” she says, noting that she turned the outcome of her surgery over to God.

She also put her faith in her physicians as she got to know them.

“I think that’s made all the difference,” LuAnn says. “Having confidence in them and knowing that they know what they are doing.”

Her sister from Oregon, mother and former sister-in-law joined her in a large hotel suite near the Siteman Cancer Center on the eve of the surgery.

“We just sat up and played cards and just made a party of it,” LuAnn says.

The surgery on July 11 took about six hours. First, Moley removed skin tissue covering most of LuAnn’s left heel to excise the tumor bed and a margin of tissue. He also performed sentinel node biopsies on two lymph nodes from the groin area that drained fluid from LuAnn’s left leg. One node contained cancer cells.

Then Hussussian took similar tissue from the bottom of that foot and rotated it onto the treated heel. He spent several hours making sure the new tissue retained nerve endings and a health blood supply. Skin from LuAnn’s upper thigh then was used to cover the instep area.

LuAnn followed Hussussian’s recommendations and began walking on the ball of her foot the week after surgery. The next week, she started putting some weight on her left heel.

The week after surgery, LuAnn had visited Hussussian and Moley on separate days. But they arranged for same-day appointments once they heard how far she traveled, one of many reasons LuAnn said she was glad they have overseen her care. For example, all the physicians have personally called LuAnn to check on her progress.

“It’s very comforting to know that, even though they’re pretty much done with the surgery, they still think about it and want to know what’s going on,” LuAnn said.

In mid-September, Moley removed the remaining lymph nodes in LuAnn’s left groin. None harbored any cancer cells. She has begun alpha interferon therapy to try to rid her body of any undetectable cancer cells that might remain.

LuAnn will soon return to work. Meanwhile, she continues to draw on the support of loved ones, and lets acquaintances know about the importance of seeing a dermatologist if they notice an unusual mole or pigmented spot.

“Early diagnosis is the most important thing,” LuAnn says. “If you see something on your skin that hasn’t always been there, don’t take for granted that it’s nothing.”