max's visit at u of penn

mapquest directions there, okay.

lit a candle at the 7:00 a.m. mass for traveling mercies which is why, i believe, i did not get broad-sided when i failed to yield to that nice tractor which was on about a 75-mph course when i was attempting to merge onto the I-76. i don't know how many peace signs i flashed at him, but he knew i was sorry. i think.

after a pretty lengthy wait in the office itself, we had the pleasure of meeting dr. ming. he explained the letter from the head dermopathologist, dr. elder, who received most of his schooling at harvard and is really one of the leaders in his field in the entire world. looking over his letter at lunchtime, with all the poly-syllabic words he uses, i would believe that to be true.

but first, the reason the pathology was sent to johns-hopkins in the first place was the pathologist at the atlantic city medical center found "atypical features" and wanted a second opinion. the first comment made in the johns-hopkins report was "this is a very difficult case," and the final one, "this case was discussed at our dermatopathology conference." the sentence that was the most disconcerting (after we complimented max on his rareness) was "while an atypical compound nevus is favored, a melanoma cannot be entirely excluded...presence of epithelioid components which exhibits mitotic activity is of concern."

okay, that means: deep cell division, consistent in precancerous conditions.

dr. u of penn cream of the crop concluded his long sentences by saying that in the largest series reported today (cases where the lesions removed were like max's), there were no instances of metastasis or recurrence after complete excision (first surgery). in this case, there is a somewhat greater degree of cytologic atypia (deep cell division) than is often seen in these lesions, and there is occasional mitosis (more cell division, cancer).

which means re-excision.

when it comes to your children, you don't want to see *rare* or *difficult case* when it is coming from doctors like university of penn or johns-hopkins. you want to see words like *benign* and *tell mom to relax, it's all good*

i will be calling his surgeon from this last time around and telling him of our office visit and seeing what we can do about scheduling.

continued prayers most appreciated.