Battling skin cancer

Years ago, I had a patient whom I will name Rolando.  He was 48 years old and a balikbayan from the US.  He was here just for a Christmas vacation when he decided to consult for a whitish, slightly macerated (nagbabasa-basa) flat spot which later developed a symptomless, brownish black discoloration on his inner thigh.  Upon seeing the lesion, I felt uncomfortable  so I got a small piece of skin and sent it to a pathologist.  As a physician, I believe that I am often a harbinger of bad news and it is difficult because doctors are as human as are our patients, too.  We carry the burden of shocking information, which can the change the life of our patients forever.   Two weeks later, melanoma (a potentially deadly skin cancer) came as a result of the biopsy.  I called Rolando and told him to undergo PET-CT scans, endoscopy, colonoscopy, and an MRI since it was unclear whether or not the melanoma was a primary growth (originated from the skin) or a result of a metastasis from another location.  Luckily, the results were negative.

The next step was to excise the melanoma completely, along with the sentinel biopsy.   The lymph node (this can be more than one) closest to the tumor was located by injecting a dye around the tumor, with an x-ray taken immediately afterwards.  The first area to absorb the dye is the sentinel node, which is where the cancer cells typically spread first.  If the biopsy is negative, the melanoma has probably not spread, but if it is positive, all the nodes in the area are removed, otherwise melanoma cells can enter the bloodstream through the lymph system, further spreading the cancer cells throughout the body. 

The worst news, so far, was that the biopsy was positive for melanoma.  A radical groin dissection was done wherein the groin was explored thoroughly and the lymph nodes analyzed for melanoma.  Twenty-three lymph nodes were removed and two were positive for melanoma.  Rolando went back to the US where he was given interferon treatment. He was such a good patient that even if he was no longer in the Philippines, he emailed me every now and then.  He was given interferon and while on it, developed flu-like symptoms —this drug, the only approved one for stage 3 melanoma does not increase survival rat; it only decreases the chance of recurrence.  He was later asked to join the clinical trial evaluating a promising antibody a few months later.  These improved his condition until such time when he underwent CT scan of the chest and abdomen.  He was so depressed when he was told that the radiologist saw numerous spots on his lungs, which were not there a few months before.  His doctor in the US insisted on a lung biopsy, but since he had a very important event to attend (the wedding of his eldest child), he decided to delay the biopsy.  After the wedding, he finally did the biopsy and the result was devastating.  His doctor suggested for him to try the interleukin 2 (proleukin), an FDA-approved treatment for stage 4 melanoma.  This treatment is given through a line (skin in the arm) at the intensive care unit because of its serious side effects.  The drug is given every eight hours for 14 doses for two times and then a CT scan is done a month later.  Then, IL-2 was done twice. 12 weeks after the first course.  A repeat CT scan was again performed.  This time, his doctor was all smiles as she handed him the results.  Interleukin treatment had shrunk the tumors by more than 50percent. Only around 14 percent of patients show a response to IL-2 and only six percent show a complete response.  Only the complete responders achieve what is known as a complete and durable remission, meaning many years of survival — partial responders usually have a median time of survival of five months.  Follow-up and monitoring every three months for the following year and twice yearly after that is a must.

Melanoma is a skin cancer that is becoming common worldwide.  Although it is often deadly, it can be cured if caught in its earliest stages.  It is the sixth most common cancer in the US and is the cancer increasing most rapidly.  The estimated lifetime risk for melanoma has skyrocketed from one person in 1,500 for those born in 1935 to one in 75 for those born in the year 2000.  It is a type of cancer that develops from the pigment-containing cells known as melanocytes (found in the lowermost part of the skin’s epidermis). Melanomas typically occur in the skin but may rarely occur in the mouth, intestines, or eye.  Like all skin cancers, melanoma is most common in fair complexioned individuals who have a history of bad sunburns and chronic (recurring) sun exposure, but darker skinned individuals can also develop melanoma, as in the case of Roland.   It also tends to run in some families with a recognized genetic mutation (alteration in hereditary material), that is with a family member that has melanoma.  This gives increased susceptibility to the disease.  For unknown reasons, a small percentage of melanomas occur on areas that are normally protected from sunlight, such as the palms of the hands, soles of the feet, or under the nails.  Seventy-five percent of such tumors undergo progressive change over a period of six months to as long as many years, during which time the malignancy develops, but may not spread to other sites in the body. A frequent checking of moles and other suspicious growths for changes indicating melanoma (e.g. change in size and shape, that is from a well-defined mole to an irregularly shaped one, change in color or change to multiple color, sudden growth or increase in size or new growth beside the original mole, itching, bleeding) may show that your benign mole has transformed into a malignant one.  

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For questions or inquiries, call 09174976261, 09998834802 or 263-4094.  Email gc_beltran@yahoo.com.