Melanoma

[woodstock]

A friend's daughter is dealing with this. In September she had a few surgeries and they dug up some cancer and apparently are fairly confident they got it all. Nonetheless they put her on interferon treatments. She's not reacting well - at all. At all.

She is actually going to take a leave of absence from her work (and I hope this doesn't turn into a sad insurance story sometime later...).

She's considering dropping the interferon b/c she feels so bad and she learned it only lowers your chances of re-occurrence another 5-10%. She was told the rate of re-occurrence is 50-50 otherwise.

Any words of encouragement I could give her? Does that sound accurate to you? If they dug it out and she is clean, is it far fetched to think she could stay off the interferon and more or less pick up where her life left off and just hope it doesn't come back?

For what it is worth, my Dad had melanoma in 1994 (bad mole), they dug out many many lymph nodes, were sure they got it all, and he hasn't had it come back since. Now, he also tells me he DOES NOT go back in for medical checkups - he just checks visually. That makes no sense to me whatsoever. Shouldn't you get at least semi-regular official checkups?

In a way, my family has acted like, "well, that happened, it's over, move on" and we don't even think about it - should we? Ditto that for my MOM's cancer (one year later, sarcoma) and then my eye issues/blindness. (maybe we are all in denial).

Thanks for any feedback.

 

[AcroBoy]

The chances for recurrence depend on a lot of factors, such as depth of original disease, if and where it's spread, etc. Only the oncologist can give any specifics regarding prognosis. Likewise, tumors can recur in distant organs, but again, the advice should be coming from the treating physicians only.

 

[woodstock]

Thanks Jim.

Actually I thought about it - my Dad said 1994, but my MOM's cancer was 1994 - his was 1993. They've both been clean since then.

My Dad however drives me nuts. Hasn't changed his habits no matter how much I holler. He is a little better about wearing hats, but he mows the lawn - no shirt, middle of the day - LARGE LAWN and it takes several hours on a riding mower... never ever ever ever BUYS sunscreen let alone puts it on (my Mom "is the one to blame" as sexist as that sounds b/c she is the shopper, I don't remember the last time my Dad set foot in a store), and in general hasn't changed a damn thing about his sun habits - he's a gardener, etc.

 

[bbchien]

Woodstock- not quite enough informaton. You have to be 2 years detectable disease free, then if negative, it's a Brain MRI annually and a CT of the relevant nodal drainage bed.

The reason for the 2 year survivial test is that we do NOT understand (like breast ca) why some histologically identical appearing tumors behave differenly over time.

 

[woodstock]

Thanks Dr. B.

Talking about my Dad, here - I don't believe he's ever had a brain MRI - almost certain of it. Not sure what a CT is. Overall, he said he just hasn't been tested in years. He just self monitors (and who knows how often that is).

With him they actually had to remove lymph nodes and all, too. He said he had a Gallium (??) 6 months later which showed nothing amiss.

 

[bbchien]

Thanks Dr. B.

Talking about my Dad, here - I don't believe he's ever had a brain MRI - almost certain of it. Not sure what a CT is. Overall, he said he just hasn't been tested in years. He just self monitors (and who knows how often that is).

With him they actually had to remove lymph nodes and all, too. He said he had a Gallium (??) 6 months later which showed nothing amiss.

Sorry I can't give you any real comfort, but that all doesn't mean a thing. I've seen it come back 15 years later.

 

[steingar]

Keep in mind that even if the primary tumor is completely removed (did is invade past the basal lamina? What does the pathology report say?) there is a reasonable chance of a novel tumor or residual cancer cells. Is the high occurrence in this family environmental? Do they live in the south and participate in an outdoor lifestyle? If not I'm wondering if they wouldn't be good source for study for a melanoma susceptibility gene.

 

[DawnW]

I can't tell people enough, wear your sunscreen!

Metastatic melanoma took my mother, eight years after her first lesion. She had interferon in 2006. It wasn't enough, however, and the cancer hit her with a vengeance. A brain tumor in December, followed by spinal tumors in April, and she was gone on July 1st, 2007. Chemo and radiation were going to kill her before it killed the cancer. It's a vicious disease. I'm hoping for the best for your friend. My mother was a freckly redhead and never spent time in the sun. Her first lesion was on her knee, but I don't recall her ever wearing shorts or short skirts. The doctor speculated it was likely from sun exposure she had as a child.

 

[Rushie]

I can't tell people enough, wear your sunscreen!

Metastatic melanoma took my mother, eight years after her first lesion. She had interferon in 2006. It wasn't enough, however, and the cancer hit her with a vengeance. A brain tumor in December, followed by spinal tumors in April, and she was gone on July 1st, 2007. Chemo and radiation were going to kill her before it killed the cancer. It's a vicious disease. I'm hoping for the best for your friend. My mother was a freckly redhead and never spent time in the sun. Her first lesion was on her knee, but I don't recall her ever wearing shorts or short skirts. The doctor speculated it was likely from sun exposure she had as a child.

Melanoma isn't connected to sun exposure the way basal and squamous cell cancers are. In fact, getting too low on vitamin D may hurt your body's ability to fight cancer.

 

[DawnW]

Melanoma isn't connected to sun exposure the way basal and squamous cell cancers are. In fact, getting too low on vitamin D may hurt your body's ability to fight cancer.

I've read that. Seems it was in the news in the past few years. I don't purport to know too much about anything, but the speculation about the sun exposure as a youngster was passed on by mom's oncologist. The American Cancer Society still lists UV radiation as the biggest risk for melanoma.

 

[steingar]

Melanoma cells are actually viciously difficult to kill. Their precursors, melanocytes, are the skin's primary physiological defense against UV radiation. They are the cells that put the black color in your hair and skin, and as such can put up with lots of UV induced DNA breakage events. Most cells would commit suicide from such events, but melanocytes have their suicide machinery turned down, making them tough. Hence many of the treatments that kill other tumors are less effective against melanoma.

 

[woodstock]

Steingar

If you were talking about my parents, they both are avid gardeners and my Dad is ALWAYS puttering around outside doing something. He is not, and never has been, someone to sit and veg in front of the TV set. Luckily they live in Erie which doesn't have a high sun incidence (compared to the south, anyway).

My Mom had a sarcoma - removed kidney - not melanoma.

If you are talking about my friend's daughter, she is the only one in her immediate family to have cancer. I think her cousin may have had cervival cancer but I don't think anyone else in their family has had cancer. The family lived in DC for years and about three years ago moved to NC. She has lived in NYC, herself, for about 3 years I think?

 

[steingar]

Steingar

If you were talking about my parents, they both are avid gardeners and my Dad is ALWAYS puttering around outside doing something. He is not, and never has been, someone to sit and veg in front of the TV set. Luckily they live in Erie which doesn't have a high sun incidence (compared to the south, anyway).

My Mom had a sarcoma - removed kidney - not melanoma.

If you are talking about my friend's daughter, she is the only one in her immediate family to have cancer. I think her cousin may have had cervival cancer but I don't think anyone else in their family has had cancer. The family lived in DC for years and about three years ago moved to NC. She has lived in NYC, herself, for about 3 years I think?

Sounds like I need to pay more attention. When you said "Dad" in your original post you meant your father. I often refer to the fathers in genetic analysis as "dad". Obviously I misunderstood.

What I said about melanoma is correct though, it is one of the more difficult tumor types. Funny, my old man had a kidney yanked due to a tumor. Showed up in a routine X-ray. Would have killed him otherwise. Best of luck.

 

[woodstock]

Sounds like I need to pay more attention. When you said "Dad" in your original post you meant your father. I often refer to the fathers in genetic analysis as "dad". Obviously I misunderstood.

What I said about melanoma is correct though, it is one of the more difficult tumor types. Funny, my old man had a kidney yanked due to a tumor. Showed up in a routine X-ray. Would have killed him otherwise. Best of luck.

You referred to "family" and I wasn't sure which family you were referring to, as my original post was about both my friend, and my own family.

My point with my Dad is that I think he's sticking his head in the sand - "it's over, move on". He hasn't gone back for testing in years (maybe since the time they pronounced him clean?) and doesn't wear sunscreen. When I tell him he really should at least get tested he gets really defensive. He said, "well, if I get it when I'm 80 I'm not going to worry too much". Well, it's been 15 years and he's not quite 70 yet, he could get it again when he turns 70 and then his grandkids won't have their Grampa after age 6.

 

[steingar]

You referred to "family" and I wasn't sure which family you were referring to, as my original post was about both my friend, and my own family.

My point with my Dad is that I think he's sticking his head in the sand - "it's over, move on". He hasn't gone back for testing in years (maybe since the time they pronounced him clean?) and doesn't wear sunscreen. When I tell him he really should at least get tested he gets really defensive. He said, "well, if I get it when I'm 80 I'm not going to worry too much". Well, it's been 15 years and he's not quite 70 yet, he could get it again when he turns 70 and then his grandkids won't have their Grampa after age 6.

Can't get blood out of a stone. If his remission has lasted a decade and a half the tumor was probably successfully removed. Some guys hate to go to the doctor (I'm one of them). If he was routinely getting sunburned you would think he'd have figured out the sunscreen thing. If he's not routinely getting sunburned he should be fine in the Pennsylvania sun (what little of it there is). Routine physicals are a good idea for older men, but what are you going to do if he won't go? I doubt a brief check-up would find any tumor that wasn't readily apparent except maybe a prostrate lesion, and we guys all have those anyway.

 

[DawnW]

Melanoma cells are actually viciously difficult to kill. Their precursors, melanocytes, are the skin's primary physiological defense against UV radiation. They are the cells that put the black color in your hair and skin, and as such can put up with lots of UV induced DNA breakage events. Most cells would commit suicide from such events, but melanocytes have their suicide machinery turned down, making them tough. Hence many of the treatments that kill other tumors are less effective against melanoma.

That's very interesting. I've heard it's one of the deadliest cancers, but I never knew why.

 

[pmanton]

Woodstock- not quite enough informaton. You have to be 2 years detectable disease free, then if negative, it's a Brain MRI annually and a CT of the relevant nodal drainage bed.

A chap I know had a suspicious spot on his forhead removed and it turned out to be a melonoma. That was perhaps 20 years ago. Simple annual dermatologist checkups since.

Is there cause for concern? He's a very good buddie of mine.

Paul

 

[DawnW]

Is there cause for concern? He's a very good buddie of mine.

I have no medical credentials but will share my mother's story with you in a little more detail. After a liver biopsy and a few other tests in 1999, she was declared "clean". In 2005, she had a small cyst on her leg that wouldn't go away. As it was right above the incision site for a lymph node biopsy she'd had in 1999, they checked her lymph nodes again. Guess what they found? Melanoma. No visible lesions, but the cells were there in her lymph nodes. I don't mean to be a bummer, just to say this is a nasty disease and one can't be too careful. I consider myself a time bomb - a freckly redhead like my mom, just waiting for it to get me - so I tend to get on a soapbox.

 

[Rushie]

I've read that. Seems it was in the news in the past few years. I don't purport to know too much about anything, but the speculation about the sun exposure as a youngster was passed on by mom's oncologist. The American Cancer Society still lists UV radiation as the biggest risk for melanoma.

Sun burns in childhood. Not short, healthy exposures in adulthood. Telling people to slather on sunscreen, wear hats and long sleeves all their adult lives leads to low vitamin D. The experts do not agree on the connection between low vitamin D and cancer, or even what value exactly should be considered "low". It's apparently very controversial. Your vitamin D might be average or better but in a population that spends all day in a cubicle maybe average isn't what we were intended to have. My primary doctor and my rheumatologist, both excellent doctors, have diametrically opposed opinions on the matter. I don't side with either, but one gave me a pill and I'll take it unless someone proves to me I'm ODing on the stuff. I want better hard data. In the meantime I'm thinking about the pros and cons of BCC and SCC vs breast cancer, colon cancer, etc. Hey maybe, there's a middle ground between so low you get rickets and high enough to be healthy; a middle ground where not quite high enough does hurt us in some way. Seems to me blood levels of vitamin D that you'd have if you had to hunt or farm several hours a day in your ethnically ancestral latitude just might be a good guide to normal? I'm just sayin. Or we can drink our fortified milk. With our lactose intolerance. Or eat meat with our animal-rights culture. Or eat fish with its mercury. Or eggs with their cholesterol. Whatever.

Look, I'm not saying you're wrong. Even BCC and SCC aren't fun to have and I have a friend who after living in Hawaii for a decade died of melanoma. But then, his skin type was about right for Norway. So in that case you'd be right to put on sunscreen. Not claiming to know the answer, just saying it's not that simple, and trying to look at it from all sides.