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   Tuesday, September 12, 2006  

Malignant?!?!?!

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?

   [ posted  @ 2:56 PM ] [ Post a Comment ] [ View Comments (13) ]
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  Comments about my post, "Malignant?!?!?!":
Yikes! How scary. I would probably do the surgery now...I couldn't stand the 10 years of wondering and worrying, but of course that's easy to say since it's not actually me facing the decision.

Best of luck whatever you decide.
now, now now,no... now.
Could you maybe split the difference? Wait only a year or two so he isn't quite so tiny? Poor thing.
Well, I guess I'm in the minority, but I've had three of those basal cell suckers removed from me. And they're really not a big deal.

It's scary to hear the "m" word, but they don't spread. They grow slowly. Even if he were to hit puberty early and wind up with one, it wouldn't be the end of the world.

I find the thought of putting your poor little guy through general anesthesia more scary than the thought of waiting and risking a BCC.
oh, boy. haven't you beem through enough?? i guess i would wait. i like the "wait a year or two" idea that blue had!
Wow, that's a tough decision. I'm sorry that you and the mister are having to face this.

If it were my child, I think I'd opt to have it done sooner rather than later. Like you said, perhaps 10 years down the road from now, he'll have an overwhelming fear of needles and it'll end up being a traumatic experience (okay, it'll be a traumatic experience either way, but at a younger age, he's less apt to remember it). And you also raise a good point about will you still be living in your town 10 years from now--and if not, I imagine that necessitates finding a well-qualified surgeon, etc., which may be slightly inconvenient but doable.

Good luck with your decision.
I would have it removed now. I would not want to wait - he is little, he will forget - he will be asleep. You will feel better not letting it go for 10 years...I know I would.
As the mom of a 9.5 year old girl, I can tell you she would be totally freaked out if I told her I was taking her to the doctor, she was getting a shot in her head and he was going to cut something off and then stitch it. It would take 5 people holding her down while she screamed bloody murder.

I personally would do it now for that reason as well as just not having to think about it anymore.
My personal opinion, for what it's worth, is that it would drive me crazy to leave it there for 10 years - I would constantly be inspecting it and would probably cause a phobia in my son about it. I don't know much about them, but right or wrong the word 'malignant' screams at me to do it now.
I'd do it now. My older son had a procedure that required general anesthesia when he was a year old, and it was really nothing. Honestly, the worst part of it was managing the not eating for hours before surgery. And I'd just want it over with.
Yikes. This touches very close to home for me. I'm sorry you have to go through this. Our baby has been through various hospital procedures that have required him to either be completely sedated or have general anesthesia. All of it has been pretty traumatic for me, after the NICU experience (and I realize yours was worse than mine). I had visions of him being in the hospital for weeks rather than an afternoon, you know? But these procedures were necessary, and we got through it. I was really, really worried about general anesthesia, but it was not as big of a deal as I'd anticipated. I can't tell you what to do, but for my own part I know no matter how freaked out I would be about the prospect of my baby having surgery, the prospect of worrying for 10 years would probably be too much to handle. It is hard either way.
Email me if you want to know more about our experience with our 9 mo. old having surgery: jbhovis@hotmail.com.
My husband and I were just told that our 7 month son has a small(about the size of my pinky nail)nevus sebaceous on the back of his head in his scalp. Itis a pale orange color and has a small pimple in it right now. I was told by the head pediatric dermatologist at Baptist that it was not a huge concern right now and he recommend us what until his teenage years to have it removed. My husband and I want to remove it sooner than later like 18mos..Another concern we have after reading online is the association with nevus sebaceous and mental retardation and seizures...that scares us to death...Thank God our son seems to show no sign of this, and seems to better than average developmental skills, but we are still worried...about what ifs?? If the sebaceous nevus is removed, does it ever come back? does it bring the risk or cancer or seizures or mental retardation to 0? Is the association with mental retardation and seizures just linked to the syndrome or is it linked to individual nevus sebaceous..these are all questions I have as my mine just races about this... any help would be appreciated...thank you!!
my daughter was born with one everyone told us it was harmless and now all of a sudden that shes 4 they decieded to be concerned and had us go to a derm i want it off now


 
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