Thank you all for praying. It was a busy, long and confusing day. First of all, we learned much more about his diagnosis - but most of what we learned just led to a lot of confusion. In summary, let me give you a little information to help you follow all of this. There is a special kind of mole called a Spitz Nevus. By definition, a Spitz Nevus (also called Spitzoid tumor or Spitz Melanoma) is benign. However, there is a subset called an Atypical Spitz Nevus that pathologically (when they do a biopsy and study it's features) looks just like melanoma. So much so, that there is ongoing debate in the medical world as to what to do when pathology comes back as an "Atypical Spitz Nevus". Which is exactly what Gideon's pathology came back us.
However, since melanoma can be so serious, many doctors call an Atypical Spitz Nevus a melanoma. They give this diagnosis and treat it as such. This is what the dermatologist that originally gave us the diagnosis told us - it was melanoma, which is usually very rare in children and quite fast growing. It was based on this, that the oncologist and others gave us the recommendations to do a Wide Local Excision and Sentinel Node Biopsy (SNB), which would be very drastic - especially on his face. But when your dealing with cancer, drasitc is okay. That doctor and many others are on the side that says "It looks like melanoma, it is melanoma, treat it like melanoma."
But the other side of the coin says, there is a possibility that it is completely benign and since it's on his face, maybe we should start with a smaller more complete excision that would leave him with a smaller scar. Then we will biopsy that tissue. If it still comes back inconclusive or conclusively melanoma, then we will move forward with the larger excision and SNB. If it comes back clearly benign, we saved him from a bigger surgery. Obviously, as parents, we want to do everything we can to prevent any unnecessary surgery and cutting, so it sounds like good news. But this is where it gets confusing.
First, the dermatologist, while recommending the smaller surgery first, did say that if this were anywhere else on his body, she wouldn't hesitate to call it melanoma and treat it as such with the exact same pathology. If he were older, again, she wouldn't hesitate. And ultimately, she kind of expects us to end up needing to do the bigger surgery. So are we simply delaying the inevitable? Maybe, but right now it seems worth the risk and have the possibility of a much smaller scar and a benign finding.
Bottom line. Does he have cancer? Depends on who you ask. Some would say yes, some would say maybe. Nobody can say no. At least not yet. Maybe this is the answer we asked for. It's too soon to know.
Surgery is re-scheduled for the 17th at this point. But before then, Seattle will be reviewing the slides for a third opinion on the pathology. All of the doctors will "pow-wow" and determine with us just what margins they need to take. In the meantime, the chest x-ray did not show any nodules, which was definitely good. His bloodwork wasn't too exciting, but did show that his reactive Lymphocytes were relatively high. So a few more pieces to fill in the puzzle.
Again, thank you for your prayers. This is all very confusing for us and it isn't reassuring when the experts you seek out don't give you clear answers, but rather leave you with a lot more questions.
