Tuesday, September 12, 2006
When the lowercase was a wee tiny boy (January), he awoke one day with a bump on his forehead that hadn't been there the day before. And it never went away. So, after several weeks of seeing this bump, at his 3 month well-baby, I asked the ped. He wasn't quite sure and said that if we would like, he would refer us to a cranio-facial surgeon to have it examined. Of course, we took the referral. The lump was deemed harmless -- either an excess fat deposit in an odd location that would dissipate or a hemangioma beneath the skin which would also go away. We were instructed to come back in 6 months.
Today is six months later. We went and the bump on his forehead is all but gone. The doctor felt sure that all was fine and scheduled no more follow-ups...for that.
At his 9 month well-baby, I pointed out a spot on the back of my man's head to the ped. A tiny little spot, no bigger than the pad of my pinky. I had noticed it some time before but thought it was nothing, but, you know...just to be sure. And then the doctor said a lot of words and finished with "it has a higher than average likelihood of becoming malignant." To be quite honest, that's the only word that I remember in that conversation. Malignant. On my baby's head. MA. LIG. NANT. He suggested that I show it to the surgeon at our follow-up visit.
And the pediatrician was right. My son has a small sebaceous nevus. Right now it is just an orange-ish spot that feels kind of like suede as opposed to skin. And when he reaches puberty, it will grow as it's triggered by his hormones. It will grow and become lumpy and bumpy and gross. And there is, of course, the higher risk of malignancy. The risk of malignancy is only 5-10%, but if the nevus is removed, the risk drops to 0%.
The surgeon assured me that while it could be malignant, it would be a basal cell carcinoma and thus unable to spread throughout his body. In short, it will be cancerous but not deadly. Which, as cancers go, is probably the best you can hope for. Obviously, we're not going to take that risk. We have to have the spot removed. And we will.
The decision we are now faced with is when. There are two options.
1. We can remove it now. This will be done either in the pediatric OR of the university hospital where he was born or in a local surgery center. In either instance it would be done by our surgeon, who is an assistant professor at the university hospital. In order to remove it now, the lowercase will be given general anesthesia. The spot will be cut out and will be sutured with dissolvable stitches.
2. We can wait until he is 10. At that point, he will be given a shot of novacain in the back of his head, the spot will be cut off with him awake and will be sutured with dissolvable stitches.
There are some advantages and disadvantages to each.
There is the inherent risk of general anesthesia. I have had *many* surgeries and have no fear of this -- as the surgeon said, "It's more risky to strap him in his car seat and drive from the suburbs in to my office than to have him go to sleep."
There is the fact that he could be afraid of needles as a 10 year old and the procedure could be very traumatic.
We lived in our last town for 5 years...10 years from now, there is no guarantee we will live in this area. If we do, there is no guarantee that his current surgeon (a man I like and trust) will live here.
He could enter puberty early as my niece did. She had the hormonal changes beginning in first grade (requiring that she wear both deoderant and a bra. TO FIRST GRADE!). If that's the case, waiting to 10 could be too late. It could already be growing and becoming malignant.
Or, more likely, either way would be a viable and good option. The surgeon pointed out that there is no wrong answer. We will not be turned in to child protective services no matter which way we decide. It's simply a matter of what we can live with. Can we stand to live 1o years knowing that there is something on our son's head that could be cancerous? Or would we have worse problems seeing our son back in the hospital we spent so long in? It would likely only be for a day surgery...possibly one overnight stay...but could we handle that stress so quick on the heels of his NICU stay?
What would you do if it were your son? Do it now? Or wait?
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