Not every melanoma is black
1 September 2016
West Australian nurse Amanda Whittle never imagined a small pink mark on her upper arm was anything to be concerned about. The spot didn't resemble anything she knew about skin cancers. It wasn't black or raised, hadn't grown from a mole or freckle and she couldn't remember it changing shape, size or colour.
When her dermatologist noticed the mark at her annual skin check and insisted on a biopsy, Amanda, aged 51, was surprised and shocked.
"I had previously noticed the spot six months prior, but there was nothing about it that raised my suspicions at all because it was pink. It was hardly even raised. I thought my dermatologist would simply burn it off next time I saw her," Amanda explains.
"When the biopsy report came back two days later and my dermatologist said it was an amelanotic melanoma, you could have knocked me over with a feather. I hadn’t heard that name before. Here I was a nurse, looking after my skin, and I'd never even heard of this type of skin cancer."
An amelanotic melanoma is a rare type of melanoma containing less brown melanin or pigment. These types of malignant melanomas are often harder to detect or recognise because they aren't discoloured like more common melanomas. They can be normal skin colour, or pink, red or purple. They can also have an asymmetrical shape and an irregular faintly pigmented border. Because amelanotic melanomas don't resemble a typical melanoma or skin cancer, many are diagnosed in the later stages resulting in poorer outcomes for patients.
Thankfully for Amanda however, regular skin checks meant the skin cancer was picked up and treated early with surgery.
"Although it was a very small lesion, the surgeon removed quite a lot of tissue as it was a level 3 melanoma. I have ended up with a very long 15-16 centimetre excision, but my surgeon is confident it is all clear," Amanda says.
"Now I have regular 3 monthly check-ups. I've had a PET scan and I've had more lumps and bumps taken off, including a squamous cell carcinoma which, again, I didn't even know I had."
Knowing that amelanotic melanomas are often associated with poorer outcomes, Amanda feels very lucky that her condition was caught early. Although she is worried that the melanoma may metastasise, Amanda wants to raise awareness about this rare and nasty type of skin cancer to help other people.
"Part of my reaction has been to spread the word about amelanotic melanomas. If I didn't know they existed, a lot of other people wouldn't know they existed either," she says.
"The take home message is: if you see anything irregular, regardless of what colour it is, you need to be checked out. For me, this one was a pink spot. I knew there was something there but thought it was a solar keratosis - I didn't know the severity of it. If I had gone to my dermatologist earlier, I might not have needed as extensive surgery. You just need to pay particular attention to any irregular marks that you see on your body," she urges.
Nine months on since diagnosis and treatment, Amanda says her journey has been harder to overcome that she first realised.
"I thought I would have bounced back more than I have. I am actually struggling a little bit because I'm now living with the fear of the unknown. Will I get another one, will that one have metastasised?" she says.
"I have a good prognosis but there is always that lingering doubt that spurs you on to make sure you are really super sun smart, that you go for your regular checks and that you are proactive in your health. I'm now practicing a lot more yoga and meditation. My diet is better and my lifestyle is better," she says.
"My focus now is on me and getting my head around what I've been through. I'm trying to move on and do everything I can to be healthy."
If you notice something different on your skin, don't ignore it. Visit a skin specialist or your GP for an examination.