Thursday, November 02, 2006

Melanoma

I'm perpetually amazed at the resilience of patients.

Melanoma is one of those diseases that dermatologists dread. While some patients with thin melanomas do OK, patients with thicker melanomas can have a significant increase in mortality rates compared to their peers without melanoma. And the thing about it is, once you cut out the melanoma and do all you can do to try to get it out of your system, you then play the waiting game. As in, you sit and wait, and hope it never comes back. But it might. And you don't know where.

Or, if you've just been diagnosed with a melanoma, you need to schedule a surgery to get it all out. Which means you have to wait for the surgery date. Which means you know that the melanoma is still on you and shedding its cancerous cells into your body. Now, we know that cancer cells often start shedding way before they actually metastasize. And shedding does not necessarily increase the risk of metastasis. Specifically for melanoma, there have been studies that look at the several week delay between the biopsy and the surgery, and there have been no detectable difference in outcome between the two groups. So it's technically safe to wait. But put yourself in their shoes. How would you do if you knew you had cancer and you had to live with it for the next two weeks? Not a good place to be.

Melanomas are given a "stage" from I to IV. Each stage has a different prognosis, with stage I being the most benign to Stage IV being pretty dismal. At certain stages, because the risk of cancer recurrence is so high, even after you've had surgery to completely remove the melanoma, it's advisable to have adjuvant therapy. One of the adjuvant therapies is Interferon. Which you have to take for a year, gives you chronic fatigue, but may decrease your chance of recurrence from "pretty darn high" to "moderately high." Is it worth it? Maybe. Because if you don't do it, will you regret it when the melanoma comes back? How does one make such a hard decision?

And yet our patients do all these things. And most of the time, they do it calmly and gracefully, really serving as an inspiration to us all.

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Melanoma can have a horrible prognosis. I still remember the young mother of two who had metastatic melanoma. We never found the primary melanoma was. Her disease was diagnosed because acute abdominal pain led to a liver ultrasound, which showed metastatic lesions found to be melanoma on biopsy. A pan-CT after that showed mets everywhere - brain, lung, liver. It was heartbreaking.

Seeing cases like this make us tell everyone that the sun is NOT good for you. While UV rays are not the only cause, it's the only one that we can control. We see people with melanoma and people dying from melanoma. It's not a good death.

Nowadays the people with skin cancers (often older) talk about the lack of sunscreen back in the day, and about how no one ever told them that sun was bad. Well, here we are, fifty years after their youth, and we, as a society, are not doing much better with the information we've acquired.

How many people are still baking on the beaches? How many teenagers go to tanning salons to look "healthy?" You try to get the word out, but what fifteen year old is going to believe or care that she may get skin cancer? Even if you don't get cancer, is that temporary tan worth the wrinkly, sagging, damaged skin that will come about with time?

photo credit

13 Comments:

Anonymous Anonymous said...

I'm 24 years old and last week I had to have a mole cut out from my breast as it had changed shape, colour and size. Obviously my worst fear is melanoma. I have "researched" this on the internet although people think I am scaring myself by doing this, I would rather have the facts and face the reality of what could be. I was so naive about skin cancer although I am more sensible in the sun than a lot of people. It makes me want to scream at how stupid people can be by risking their lives for a tan! People are very misinformed on skin cancer and more should be done to raise awareness. The most worrying is the "it'll never happen to me" syndrome. Cancer is not prejudice. I am still waiting for my biopsy and obviously hoping all will be well. Whatever happens I know I'm going to be a lot more vigilant. One thing I have found puzzling is we are always told to get a mole checked out if it changes in appearance etc as it could be a sign of skin cancer however, we are not told what else makes a mole change if it is not cancer. I think my mind would be a little rested if I knew there could be another reason for this change! Thank you for your blog.

5:43 AM  
Blogger always learning said...

hi Anonymous,

thanks for your comment. There are definitely a lot of people out there who continue to bake and think that cancer is something that happens to only other people. And we're seeing more and more young people get diagnosed with melanoma, which is disheartening.

Moles can grow as children grow. They can sometimes disappear. Moles can change if they've been traumatized (ie scratched). There are lots of reasons why a mole can change, and while some of them may be benign, a changing mole in an adult should always be investigated - have your doctor look at it and see if it needs to be biopsied.

2:54 PM  
Anonymous Anonymous said...

My brother is 35 and has stage IIIB melanoma on his temple. He had it removed and underwent one year of alpha-interferon treatment. He has recently had an "all clear" scan and believes he is actually cured. The 10-year survival rate of IIIB patients is about 30-33%, and the chance of recurrence is high, but he is in denial and continuing an unhealthy lifestyle. Is there any way of convincing him to live a more healthful lifestyle without bringing in gloom and doom as proof?

1:50 PM  
Blogger always learning said...

Hi Anon,

Sorry to hear that your brother was diagnosed with melanoma.

Advanced stages of melanoma do have a higher risk of recurrence than that of lower stages. And unfortunately, at this time, there's no way of predicting who will have a recurrence.

Am not sure what you mean by unhealthy lifestyle. Besides sun exposure, there's not really a "lifestyle" factor that is known to increase the risk of melanoma per se. And given that your brother is an adult, sometimes all we can do as family is make sure that they are aware of the facts and let them, as their own person, make their own decisions.

8:20 PM  
Anonymous Anonymous said...

I just wanted to let the person with her brother that was "all cleared" of melanoma know I feel their pain. Just let him know this. Melanoma DOES KILL! I just lost my Mother (Sept 21,2006) to stage 4 Malignet Melanoma. I remember when my mom was diganosed with it....it was already in stage 4. It was removed from her temple also. She had to have a skin graph to replace the skin that was eaten up with Melanoma. She came home after surgery and shortly after she was going to the Cancer Center here in town for Radiation. She had 4 treatments of Radiation. She lost her hair, and the ability to taste. About 4 months later she had a MRI. They found legions on her Liver. They did a biopsy and found that cancer had spread to her liver. She was offered Chemo if she was to gain some strength and some weight, cause she had lost 60lbs. She never was able to gain the weight and she lost her battle with Melanoma. It took her fast, she was walking and talking one week....the next she had dementia and basically starved herself to death. It's sad to watch someone go through this. I also think its sad that your brother was given a second chance and he's blowing it. Trust me, it comes back...most times...and when it does...most times...you never get a third chance.

11:29 PM  
Anonymous Anonymous said...

to the last anonymous poster... I am sorry you lost your mom to melanoma. It is truely a terrible disease.

I, too, have melanoma. I was originally diagnosed in August of 2006. I have won the melanoma trifecta, of sorts. I was diagnosed with my 3rd melanoma in just 5 months. Fortunately, I guess, I am only a stage 2c, so far.

There is NO CURE for invasive melanoma. None--Zilch, zip, nada. So the 'brother' who is able to move on and live his life, should be commended. I, for one, would like to know his secret.

11:54 PM  
Anonymous Anonymous said...

My boyfriend is 35, a healthy firefighter for over ten years. He was diagnosed with stage 3 nodular melanoma - his mole was just over 4 mm. deep and one of his lymph nodes was cancerous.

He has decided to stop taking Interferon after much research. He feels that only high doses are beneficial. So much to my dismay, eight weeks into this year long treatment he is off the medication.

This has effected our lives in such a way I had never dared to imagine possible. We have gone from planning our future to such pretending and hoping things will work out.

As a teacher myself, I am astounded by the number of my Kindergarten students who come to school with no sunscreen being applied at home or wearing a hat. Our program includes a thirty to forty minutes of outdoor play time block and I cringe to take them.

I began to wear my Melanoma pin to work each day in hopes that someone would ask me the meaning behind it so that I could pass on some information about the seriousness of sun exposure and the ignorance I once had. Months later, not one person has asked.

5:59 PM  
Blogger wandering visitor said...

Hi Anonymous,

I'm sorry to hear about your boyfriend. Interferon can be a difficult medication to tolerate - I hope he has talked to his physician about his decision.

You are right - many children still go to school without sun protection. Many teens still sunbathe for that coveted tan.

It's important for people to become aware of how to protect their skin. Just applying sunblock is NOT enough. We tell people to try to avoid the sun between 10am and 4pm, and if not possible, to use physical barriers such as long sleeves and pants. It's hard to try to get young people to understand that a tan is not worth the fleeting sense of "beauty" that comes with it.

6:39 PM  
Blogger Angelica said...

My mother is dying of malignant melanoma right now. She has days to live. We have known she is "terminal" for months now, and feel lucky to have had this time to peacefully spend with her.
It metastesized from a large mole on her leg which was removed 12 years ago, into brain tumors. What a shock 12 years later when melanoma was found in her lymph nodes, and then, even more shocking, when her left leg was suddenly paralyzed from the brain tumors nobody knew were there! We are lucky she has lived nearly 10 months from the initial brain tumor shock.
My mother is 51 and was the healthiest person you can imagine. Friends with smokers, junk food eaters and alcoholics, she vigilantly raised us on natural, whole foods and plenty of exercise. The one thing she did wrong was overexposure of her freckled skin in her youth, and taking too long with the diagnosis and removal of that mole 12 years ago.
I don't feel angry though, as I believe I would if she were dying of (for example) lung cancer from smoking, or a heart attack from too much junk food. Perhaps this disease could have been prevented, but I feel like it was out of her control. I find some comfort in the fact that it was something natural: the sun, that is killing her.
Nobody realized at the time how dangerous sun exposure could be. Think of how long it took for them to understand smoking was dangerous! What sort of things do we expose ourselves to now: plastics, pollution, chemicals in products, cell phones... about which one day we're going to be saying "Duh..."

5:59 PM  
Blogger Jennieb1307 said...

To the individual who said her brother ignores his previous and diagnosis and to the person who wants to know how to do it. I can understand wanting things to feel as normal as possible, but imagine how impossibly normal things will be if the melanoma comes back as stage 4 and hope is something you feel once in a blue moon. My mom was diagnosed in June 2006 (just before my wedding) with stage 2 melanoma. She had surgery to remove it and PET scans through January, 2007 showed that it was gone. We moved on.. In April 2007 she felt a small lump on her back. Her doctor assumed it was nothing, but thought that he would play it safe and have it biopsed. Turns out it cam back as stage 4 and had spread to her bones. My mom, the strong , healthy one. The compassionate parent. I absolutely hate that she is going through this and normalcy seems like a distant memory or fairy tale now. I just want her to be okay...

2:33 PM  
Blogger evija777 said...

It is so sad to read all the story's about melanoma, I have one too.. My grandma has it I am not sure what stage..She is 75 , My guess this are the last days of her life, I feel so bad that I can't go visit her. She is in Europe. I hope she will forgive me.. and also I feel so stupid that I wasn't reading about melanoma earlyer , only now I know You can't get well from that thing..it's get's worse and worse..Now she can't walk, and lift her arms, she is in a huge pain.
Also I went to doctors,visit was quick..I hope doctor did not miss any off my many moles..Reading story about mole who was taken off 12 years ago ..I am getting scared to get rid of mine on face,so is it true if you cat it off, and it shows it is not good one,it means the cancer will go on or how it is, maby someone has expierence taking them off these days?Doctor was talking about cutting not freezing them..only if I wan't to. And I have to see him every 6 mounths because of fam.history.
God bless us all..!!!! And we have everything but medicine for cancers..we are so helpless sometimes

4:09 PM  
Blogger Ryan Alexander Jarman said...

Hi,
I'll be 29 in July. I lost a good friend to melanoma metastatis (sp) back in the fall.

Ive always been someone who burns and then tans. As a kid I baked away. Recently my 'beauty marks' have started changing. two have become larger and assymmetrical and Ive developed a new, larger one. Ive also got a number of new little brown spots on my arms, back, chest and now on my neck and a couple starting on my face. At first I thought these were possibly age spots (I did alot of drugs/drinking/partying in my teens right up until I was 27, when I went into recovery for my addictions). But looking into people who get these new spots and also those whos spots change, Im getting a bit scared. Im also being tested for Huntingtons right now as it runs on my dads side. I thought this could wait. But I guess not. Im scared to ask my doctor as when my anxiety was bad I thought I was always dying. Ive shown a couple friends of mine and they said they dont think my mind is playing tricks on me with these spots.

But I know I need to ask him so I will. Ove the last week Ive become terrified of sunlight :p

12:32 AM  
Blogger daidai said...

i am 25...i was misdiagnosed with melanoma,stage 1,it appeared to be atypical spitz nevus...now,i dont know who to believe anymore,since these two types of lesions are very similar,the first pathologist made a mistake and turnes out i dont have melanoma.I went to tnning salons practically every day for about 2-3 years...yeah,stupid,stupid, what are we thinking when we do such stupid things? you dont get anything from tanning salon other than you will look about 10-15 years older when you get old,you spend money,time,the fear for me still will always be there because nobody can say for 100 percent that it indeed was spitz nevus and not melanoma,god bless us all

6:47 PM  

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