An unexpected melanoma diagnosis for husband and wife

Several months after noticing an unusual spot on the back of his arm Paul was diagnosed with melanoma, the least common but most serious form of skin cancer. Just six months later, after finding an unusual spot on her forearm, Paul’s wife Christine was also diagnosed with melanoma. Here, Paul and Christine speak about their experience at The Christie Private Care, part of HCA Healthcare UK, and highlight the importance of protecting your skin and acting quickly if you notice something new or unusual. 

Paul first noticed what appeared to be a small pimple on the back of his right arm prior to a routine checkup at his GP clinic. "I went for a routine checkup, the usual stuff, they checked my cholesterol which was fine, my blood pressure was a touch on the high side but I'm in my mid 50's so that wasn't too unexpected." Although he wasn't overly concerned, he mentioned the pimple to the nurse. He adds, "You hear the advice, if there's something on your skin that wasn't there before, or has changed, it's something to be mindful of. But it wasn't something that I was overly concerned about. It wasn't brown and just looked like a regular pimple, but I mentioned it to the nurse", Paul says.

The nurse examined Paul's arm and thought it was unlikely to be of any concern but, if when he returned in 8 weeks' time to have his blood pressure checked it hadn't cleared up, then she would refer him to the minor operations clinic at the surgery for removal.

Paul had his follow-up appointment a few weeks later. His blood pressure had improved but the lesion on his arm, as far as Paul could tell, had stayed the same. The nurse referred Paul to see his GP and have it removed. Paul comments, "I saw my GP in the minor operations clinic. He examined my arm and suggested I have it removed, although he wasn't concerned and thought it was simply a cosmetic issue, as did I. The pimple was shaved, cauterized, and sent for testing - just as a routine check. I was told it would heal within the next couple of weeks and that would be that."

Two weeks after the lesion had been removed Paul received the unexpected news from his GP, the biopsy results revealed that he had a malignant melanoma, and he would need to be referred to a specialist. Paul says, "They sent me a copy of the referral along with the results of the biopsy and I see this word 'melanoma'. I suppose I'm like a lot of people, I know the stats around cancer, that one in two people will be diagnosed. But if I'm honest, I always thought 'it’s not going to happen to me'. It was a complete shock."

At this point Paul decided to see a consultant dermatologist privately who, on examination of the lesion and review of the biopsy results, recommended Paul be immediately referred to Mr David Mowatt, plastic and reconstructive surgeon and specialist in malignant melanoma at The Christie Private Care, part of HCA healthcare UK. Paul added, “That was another watershed moment. A visit to The Christie, that’s where you go for cancer, that’s when it really sunk in. I’m not the sort of person that goes to The Christie. I sank back into my chair and thought right, OK, this is getting real now.” 

Shortly after Paul had his first appointment at The Christie Private Care with Mr David Mowatt. Given Paul's diagnosis, Mr Mowatt wanted to act quickly and performed a first excision of Paul's cancer at his first appointment. He advised Paul that he would need a wider excision of the cancer as well as lymph node removal later to make sure there was no potential spread, which in Paul’s case was a strong possibility. Paul said, "When I went to the first appointment, I wasn’t expecting him to do the initial excision of the cancer, but it was very reassuring it was done so quickly. And he was very clear on the next steps which was, again, very reassuring."

The biopsy from Paul's first excision at The Christie Private Care revealed that he had a stage 2, 9mm deep, rare form of melanoma called Amelanotic melanoma. This is an aggressive and fast-growing type of skin cancer that doesn't produce the pigment melanin, which gives most melanomas their signature dark appearance and could have contributed to Paul's cancer being mistaken for a pimple. Following the biopsy results Paul had CT and MRI scans to check for any spread of the cancer, these tests were clear.

In an unusual turn of events, Christine - Paul's wife - had spotted a red dot on her arm some weeks earlier. An increased awareness of her own skin following Paul's diagnosis had encouraged Christine to get the dot checked by her GP who suggested she have it removed.

When Christine's GP appointment to have her skin lesion removed was cancelled, she decided to see a dermatologist privately. He was unable to diagnose the lesion by sight, but did not believe it to be cancerous, however he arranged for it to be removed and biopsied to be sure.

Christine remembers it had changed in appearance by this time, "At that time it had changed from the week previous and had a bright red pin prick in the middle. The dermatologist thought it could be a reaction to an insect bite and I thought that was quite feasible."

To both Christine and Paul's surprise, Christine's biopsy revealed she had malignant melanoma with a high mitotic rate, which means it was more likely to spread and quickly, leading the couple to, once again, seek the expertise of Mr Mowatt.

On that same day Paul received a call from his CNS to share some very good news, the margins from his wider excision and his lymph nodes were clear. Christine reflected, "So we received that good news for Paul, and that very same day I was diagnosed with the same cancer he had, so it was a funny old day that one. It was just before Christmas too, so that was an interesting Christmas."

Given Christine's diagnosis she would need to have a wider excision. Christine says, "Paul's experience with Mr Mowatt and the team had been excellent so, whilst I was anxious about my diagnosis, I knew that I was in the right place and in very good hands."

Mr Mowatt performed the wider excision of Christine's cancer and the removal of her centinal lymph node, she adds "My results showed that my tumour was only 0.9mm as opposed to Paul's 9mm. Thankfully, the margins and lymph node were both clear. My risk of recurrence is low, so I don’t need any further treatment, I just need to attend regular follow ups to check my skin over."

Because Paul's cancer has a high risk of recurrence Mr Mowatt referred Paul to his colleague, medical oncologist Professor Paul Lorigan at The Christie Private Care, to discuss a type of immunotherapy treatment which can reduce the risk of Paul's cancer coming back.

Professor Lorigan explained to Paul and Christine the benefits and risks associated with this type of treatment, ensuring they had all the information, and he had answered any questions they had, so that Paul could make an informed decision about whether to go ahead with the immunotherapy or not.

Paul said, "Anything which can reduce your risk of the cancer coming back seems like a good idea, but at the same time you've got to weigh it up because immunotherapy can cause problems in the future. But on balance, for us, we talked about it, and it was kind of a no brainer - if it's reducing the risk of the cancer coming back then it must be done. I have had my first cycle of immunotherapy. This is the first of 9 cycles which will finish around this time next year."

Reflecting on the care he has received so far Paul has found the continuity of care within the team particularly reassuring, "When Mr Mowatt referred me to Professor Lorigan – another brilliant guy, I was pleased because Sarah - my fantastic CNS - works with him, so that's been great in terms of having that continuity of care. It's really reassuring", he said.

Regarding his care overall, Paul added, "The care that I have received through all the team, and I should mention Sarah in particular, has been just fabulous. One of the good things has been the level of contact. Sarah will keep in touch over WhatsApp, which is what I prefer, to send updates or answer questions. Unfortunately, last year we had postal strikes as well, so I said to Sarah, do me a favour, drop me an email instead. So yes, one of the best things has been just the level of reassurance with contact, it makes a huge difference to your sense of wellbeing and of being looked after."

Paul went on to say, "The whole team are just lovely, it's kind of a strange thing to say but I quite enjoy going for my immunotherapy. The atmosphere in the area on that ward is just lovely. It's a relaxed but very professional environment. They're exceptionally good at putting you at ease. I wouldn't have anything adverse to say about the whole experience of my care and the treatment I have received at The Christie Private Care, everything has happened when it should, when they said it was going to and it's been first class throughout. It really has."

Christine's search engine warning

When Christine first noticed the dot on her forearm, she did what many people do, she went online. But, looking back, both she and Paul would warn against this. Christine said, "Search engines are fantastic in so many ways, but they can also, in my opinion, cost lives. If you are worried about something on your skin do not rely on the internet to diagnose you. When looking for pictures like the lesions we had, we couldn't find anything online, neither of us. Our lesions were very different than anything that was coming up on any of the skin cancer pages and websites we looked at. If you've got a lesion or a spot that's suddenly appeared, or it's changing, you must see a doctor."

A welcome shift in sun safety awareness

The more times somebody experiences sunburn, particularly if they were sunburnt as a child or the sunburn blistered, the higher their risk of skin cancer. 

Paul recalls his initial meeting with Mr Mowatt, "I remember Mr Mowatt taking down my history in that first appointment. He asked, 'have you ever sunburnt', yes, I replied, 'did you ever get sunburnt as a child', yes again. It makes you cringe; you start to disappear into your own neck. Mr Mowatt continued 'have you ever peeled, gone red, used a sunbed', yes, yes, yes! We know the damage was likely done when we were children. Our parents didn’t use sunscreen, in that kind of era nobody knew." Christine adds, "It was the opposite to sun safety back then, do you remember your grandad, he used to put margarine on his head. Any type of grease or butter to help get a tan." "Exactly", says Paul, "Times have changed and that's positive but there needs to be even more awareness of the damage that we’re doing to ourselves. Wear hats, cover up, use sunscreen. There are so many ways you can prevent that damage happening in the first place."

Paul and Christine are sharing their experience in the hope that it will encourage others to act if they notice a change to their skin. Christine says "That's why we are sharing our story. Even if just one person takes something from what we have gone through, whether it's taking better precautions with their skin or paying more attention to any changes."

Paul adds, "It’s been a very enlightening experience to be fair. Anybody that notices anything on their skin, and they aren't certain what it is, just go and get it checked out, it's so easy. It’s all about time, you need to get it as quickly as you possibly can. We learned a hard lesson."

Christine continues, "As a result of what's happened to us, people we know are being more vigilant. I have a friend who's had something removed just this morning, so it's heightened everybody's awareness for sure."

Paul and Christine are prioritising sun safety. "We're going to Spain in August with our son, daughter in law and granddaughter. I think I will look like a trans-channel swimmer I would imagine by the time I've finished applying all my sunscreen", says Paul, "You and me both", adds Christine. "It starts at factor 30 and only goes up from there now. In fact, I might just wear a wetsuit" Paul concludes.

To learn more about different types of skin cancer, the signs and symptoms to look out for, and how to access specialist care at HCA Healthcare UK visit our dedicated skin cancer hub.