By Vallerie A. Malkin
Once people get tapped on the shoulder by cancer, they always worry the disease will darken their doorstep in the future. For AnnMarie Cangelosi, who was diagnosed with melanoma in 2015 at age 36, the anxiety is pronounced, because she knows that melanoma is a cancer that likes to recur.
AnnMarie, the mother of two young girls, knows she was lucky to have received an early-stage diagnosis: melanoma Stage IIA, which means the tumor had grown into the dermis, the second layer of skin, but remained “local” in terms of not having spread to the lymph nodes or other organs.
Now 41, AnnMarie has not had a recurrence of melanoma, but she will have to be closely watched for the rest of her life, something that gives this upbeat but sensitive mom a lot of anxiety. One thing she has learned through her diagnosis and treatment though, is that it’s the contrast between light and dark moments that deepen your appreciation of life.
Getting that call
AnneMarie, of Tinton Falls, New Jersey, is Italian, but has “light, freckly skin.” Like many women her age, she used tanning beds before special occasions: “My wedding picture shows this tan, blonde person!” she says, laughing.
She also recalls having “a million terrible sunburns” when she was younger: “I love the sun, I liked to lay out … and I never got skin checks or anything.”
She may not have noticed the mole on her back at all – it did not itch or hurt – if she hadn’t discovered blood on her towel one day. “I thought nothing of it,” says AnnMarie, “just that maybe I had a mole and it got snagged by my bra strap.”
A few days later she noticed blood on the towel again. She asked her husband to take a look.
He saw a raised mole that was black and continued to bleed. According to AnnMarie, his reply was: “That doesn’t look good.”
Worried it might be skin cancer, she asked a local dermatologist to take a look at it.
“The dermatologist said, ‘Let’s rule out melanoma,’ and took a biopsy,” says AnnMarie. “I agreed: ‘Yes, let’s rule that out.’”
The tumor measured 1.6 millimeters, with ulceration. In order to be diagnosed with Stage IIA melanoma, the tumor must be more than 1 millimeter and less than 2 millimeters thick with ulceration, or more than 2 millimeters and less than 4 millimeters without ulceration.
A call came in from the doctor’s mobile phone on his day off, according to AnnMarie, who knew it must be serious. “He said the diagnosis was melanoma, but he was reassuring that as long as I got the right treatment, I could be OK.”
AnnMarie called her husband, Joe, first. Her girls were just seven and three years old. His approach then and now is that “Everything will be fine.” They were proactive: They wasted no time in contacting one of the best cancer hospitals in the country, Memorial Sloan Kettering Cancer Center in New York City. Sloan got AnnMarie in right away and scheduled surgery on her 37th birthday. She was impressed with the care: “They even offered to move the date,” she explains, “but I said no because it wasn’t like I was going to enjoy my birthday!’” AnnMarie remembers feeling like she was in the best hands.
“From the day of the surgery to the time I got the final phone call I don’t think I took a breath,” says AnnMarie. “I was crazy worried.” The surgeon performed a wide excision and sentinel lymph node biopsy. All of the margins were clear for the primary tumor, according to AnnMarie, which meant the dermatologist had gotten it all in the initial biopsy. And even better was the news that there was no cancer in the lymph nodes.
“I was very, very clear – and lucky,” she explains.
If she knew then what she knows now
AnnMarie staves off anxiety about melanoma returning by being busy: She works 30 hours a week as a home sales manager/quality assurance specialist for the Newton Group. She devotes every remaining second to her two children Maddie and Kristen: “My kids are my hobby,” she laughs. She and her husband try to make a plan to spend time together, though it’s a challenge. Any time left over after that she draws on her support system of girlfriends with whom she will have breakfast or a drink, or take a long walk.
She wonders why more people don’t know how dangerous sun exposure can be and she wants to take part in educating people so that they don’t take the risks she took.
“My advice to people who are newly diagnosed with melanoma is find the best possible care within your area – for me, that means finding the best doctors on the East Coast,” says AnnMarie. Sloan had a satellite in her home state of New Jersey (Basking Ridge), which made follow-ups easy.
“Educate yourself enough so when you go to an appointment you can ask a million questions of your doctor and make a plan,” she notes.
While she didn’t feel like she needed to seek a second opinion, she stresses feeling comfortable with and confident in your doctor and getting a second opinion if you aren’t sure about the diagnosis.
Ann Marie, like most cancer survivors, is committed to her continued wellness. “Just do everything they tell you to do. I will never blow off a follow-up visit,” advises AnnMarie, who is seen every three months for a skin check and evaluation. Sometimes she sees the doctor sooner than that if she has a concern – she has had 10 concerning spots removed so far, but all have been benign.
Recently, AnnMarie was told by her physician that she could wait four months in between visits, and eventually she’ll get to wait six months. Her visits might include blood work, a physical exam in which she is questioned about headaches, weight loss, and other potential symptoms; and once a year she gets a lung X-ray when she visits her surgeon in New York City. She has also had two full-body PET scans since her first diagnosis.
She laughs at the uncomfortable exercise of getting a full-body exam with pictures. But now that she’s used to it, she is just thankful they have the technology to track her condition so closely. She also sees her surgeon once a year.
She checks her skin regularly, and when she sees something “weird” she takes a picture and sends it to her doctor.
AnnMarie cannot praise her doctors enough – not because they are incredible at the work they do, but because they understand the psychology of being diagnosed with a life-threatening disease.
Her surgeon is a mother of twins who is slightly older than AnnMarie, so she understands. “She’s a brilliant doctor, and she gets me, she gets my anxiety, and she gets how I feel about my kids.” Her dermatologist is a year younger than AnnMarie, with two young daughters: “She’s awesome, too!” says AnnMarie.
What will be, will be
AnnMarie has been fine for almost five years and that statistical milestone will feel good to hit. She feels lucky. She remembers walking through the corridors of Sloan, seeing people in much more dire straits. “There were people there who were very, very sick,” says AnnMarie.
She is learning to turn down the volume on the anxiety but admits it’s challenging. “I try to remind myself that anything can happen at any time,” says Ann Marie, “There’s too much to worry about and worrying doesn’t actually accomplish anything.”
She admits prayer helps a lot and when she can find the time, walks help, too. One experience that adjusted AnnMarie’s outlook was taking a vacation down to Florida with her family shortly after her diagnosis. I was crazy with worry about my diagnosis and we’re on the plane and it started to shake – I thought, ‘Why am I wasting all my time thinking about melanoma – there’s no point worrying – whatever’s going to happen will happen!’”
Something good this way comes
Some good things have come from AnnMarie’s melanoma diagnosis. The first is that it deepened her relationships.
“I felt a shift in my relationship with my husband,” says AnnMarie. “We definitely fight less about smaller things and are less likely to hold onto things. At any time you can get that phone call that can change your whole life.”
AnnMarie also feels that developing melanoma raised her awareness in a way that will protect her daughters in the future and the rest of her family. Her brother has grown diligent about skin checks.
If she knew then what she knew now, AnnMarie says, she would never have touched a tanning bed, she would never have sunbathed, and she would never have smoked. In fact, that is yet another boon to getting sick – after her diagnosis, she quit being a “closet smoker” and has not picked up a cigarette since.
“When I was 20 nobody could tell me anything,” says AnnMarie, “I thought I had to be tan – that was the most important thing. Now that I have children, I would take better care. I would tell people not to do a lot of the stupid things I did. Now, my family might not develop melanoma because of me.”
Peer support and optimism
AnnMarie is working with AIM at Melanoma’s PeerConnect program after finding out about it on Facebook. In preparation for that role, she has gotten her own PeerConnect mentor, an inspiring Stage IV survivor who is teaching her the ropes and counseling her on her own feelings around her melanoma.
“I would love to be paired with somebody who is newly diagnosed so I could comfort and support them,” says AnnMarie, who brims with kindness and has a cheerful, uplifting presence. “But I’m far from calm, I’m a ball of nerves, so I’m working on that!”
One thing that keeps her buoyed in addition to her family and friends is hope and the good news happening exponentially every year in melanoma research.
Says AnnMarie: “When I was diagnosed, my doctor said, ‘There’s no better time to have melanoma than now. They have come so far.”
Until there is a cure, AnneMarie says she has total faith that if she finds something on her skin, between her and her doctor, they will catch it early. But she may never have to face that. For now, she will stay committed to sun protection and following her doctors’ orders, particular the one that advises never to miss a skin check.
“I think I always feel hopeful that the future will hold good things in general,” she adds.