MPIP: Melanoma Patients Information Page

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The MPIP is the oldest and largest community of people affected by melanoma hosted through the Melanoma Research Foundation. It is designed to provide support and information to caregivers, patients, family and friends. Once you have been touched by melanoma—either as a patient or as a family member or friend of a patient—you become part of a community. It is not a community anyone joins willingly. But if you must be part of this group, you will find no better place to find the tools you need in your journey with this cancer, and the friends who can make that journey more bearable.

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Replies by: studiodad

it has characteristics of becoming in situ melanomic.

my question: isn't that what the nivo is supposed to treat?

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Andrea67's picture
Replies 7
Last reply 2/27/2020 - 6:15am

I had my first opdivo/yervoy treatment at the end of January. I was supposed to get treatment number 2 last Friday but during my pre treatment blood test my liver numbers were VERY elevated. I'm talking, close to 1200. I was put in the hospital for 5 nights with IV steroids and they had my numbers down to closer to 500. I'm now home and expected to go for another blood test on Friday to see where my numbers are. My oncologist really freaked me out by saying that if my liver numbers are not normal I won't be able to continue with the immunotherapy. I simply just didn't even let that be an option for me and for the first time I'm really getting a sense that maybe this won't work for me. Have any of you gone through something similar and were able to resume treatment? I need a little hope here.

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MelanomaMike's picture
Replies 1
Last reply 2/27/2020 - 10:08pm
Replies by: lkb

Case Report:
CASE REPORTSURGICAL PATHOLOGY REPORT                         Case: SJH20-00715                              Authorizing Provider:  Mark B Faries, MD: Collected on: 01/30/2020 Ordering Location: PROVIDENCE-SAINT JOHN'S  Health Center. Received:  01/30/2020 1300 hrs. Clinical Information are as follows:
51 year-old male with a history of metastatic melanoma. He has a metastasis on his left lower abdomen (and others in multiple areas of his body) this particular mass is markedly inflamed and is tender.
FINAL DIAGNOSIS:

SKIN AND SUBCUTANEOUS TISSUES FROM LEFT LOWER ABDOMEN, MASS, EXCISION:

MALIGNANT EPITHELIOID S0X10 POSITIVE NEOPLASM, CONSISTENT WITH METASTATIC MELANOMA, 7.0 X 6.5 X 6.4 CM, INVOLVING DEEP SUBCUTIS AND ADHERENT FASCIAL TISSUE, WITH EXTENSIVE NECROSIS (APPROXIMATELY 75%), APPROXIMATELY 10 MITOSES/MM2, AND FOCALLY BRISK TUMOR INFILTRATING LYMPHOCYTES, NARROWLY EXCISED WITH A CLEARANCE OF LESS THAN 1 MM FROM THE INKED SURGICAL MARGIN.
MICROSCOPIC DESCRIPTION:
Sheets of cytologically malignant cells have an epithelioid morphology with abundant pink cytoplasm and contain large, round to irregular nuclei with conspicuous nucleoli. Several mitotic figures are seen. There is extensive necrosis and focally brisk tumor infiltrating lymphocytes are seen. Melanin pigment is not present. By immunohistochemistry, the tumor cells are positive for SOX10, and are negative for MART-1 and HMB45.
The morphologic findings, in conjunction with these immunohistochemical results, are consistent with metastatic melanoma. The melanoma is narrowly free of the inked surgical margins in these planes of section.
AP SPECIAL STUDIES-
IMMUNOHISTOCHEMICAL STAINS:
Block: A1
MART-1- Negative
HMB-45- Negative
SOX10- Strongly and diffusely positive
Interpretation: While HMB45 and MART-1 are more specific markers of melanocytic differentiation, the presence of SOX10 positivity, in conjunction with the morphology of this tumor, supports the diagnosis of metastatic melanoma.
Positive controls demonstrate appropriate reactivity...
GROSS DESCRIPTION:
A. Labeled “left lower abdominal mass”: The specimen consists of a 13.2 x 4.7 cm pink-red erythematous ellipse of skin without orientation and excised to a depth up to 7.5 cm. The skin is stretched over a bulging palpable 7.0 x 6.5 x 6.4 cm encapsulated mass. The specimen is inked as follows: Superficial radial margins–blue; deep–red. Sectioning reveals the mass to have a predominantly pink-yellow necrotic friable cut surface comprising approximately three fourths of the specimen. Only a few red fleshy more viable appearing foci are noted at the periphery. Representative sections including the more viable appearing foci are submitted in A1-6. MK/SK.mk
Microscopic H&E stained sections are prepared and interpreted.

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MelanomaMike's picture
Replies 11
Last reply 2/27/2020 - 12:02am

Hello ya'all, i hope everyones in good spirits & stable. Boy has it been a terrible month for me, i had my surgery Jan 30th, that was a God send as you know, the pain i endured up til then, unbearable!. But, now that that bitch is gone, my Sigmoid tumor (now 5.7cm) seems to wanna rule the roost & be the next bigshot to cause me grief. I almost tapped out last week to go to the ER, cause up till last Wednesday, i hadnt had a decent bowel movement in over 2 weeks, i tried it all and nothing worked, i even bought the gadget "Squatty Potty" (or is it called "Stool Stool" I forget?) for better bowel movement posture. Finally after munchin pounds of apples, pears i finally went a lil bit all thru the day & ever since. By me not going for so long, it caused SEVERE cyatica (spelling?) nerve pain 24-7...ive lost about 11 or 12 lbs. (USA Weight) in under 25 days, i was at 180 now im at 169, it caused me not to want to eat, but i do look Fab-U Luuuus! I can fit into some cool cloths iv had for years that i didnt wear haha..It was all so terrible..That damn tumor is about 2 inches and the Sigmoid area is the smallest "inner" diameter of the colon at just under 1 inch so, do the math, colon walls can only give very little to alow something to pass and my stupid tumor happens to reside in the Lumens area of the colon wall wich is basicly dead center, smack dab in the middle like a golfball stuck in a pipe!(haha), i knew this day would come if meds didnt work. Surgerys an option but, for Palliative care reasons only, and im fine with that BELIEVE you me!. Ill post a separate post of my Pathology Report on that side tumor they dug out, a growing "Necrotic" beast that dished out pain like it was totally living!! (The UnDead?) , very strange but, i dont wanna ruin the report for you, youll see why it grew...Tomorrows my infuse #2, of the ICOS & OX40 all day adventure. I love you guys, we'll make it to the finish line one way or the other.....
Love & Respect,
SOX-10 Mike

Melanoma Will Not Beat Me or my MRF Family! www.wespark.org www.covvha.net

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jennifer83's picture
Replies 14
Last reply 2/25/2020 - 2:07pm
Replies by: Hukill, jennifer83, tkoss, JudiAU, Edwin, Anonymous

I've finished my four rounds of combo therapy (Nivo/ipi) and had my first nivo only infusion last Saturday - double dose. After my 4 rounds of combo, my scans revealed promising results of tumors shrinking and/or disappearing!

For those who have gone this route, have you experienced any odd side effects switching over to just nivo? Or good side effects? My doc says I'll be doing this infusion every 4 wks for the next 12 months.

Has anyone done combo, gone to just nivo, and then had progression? Of course I'm optimistic, but you know us melanoma patients with re-occurrence are always waiting for the shoe to drop...

Lastly, I did develop hypothyroidism after my third combo treatment and am on medication for it. Every since then, my face (especially eye area) has remained dreadfully swollen and puffy. It looks like I either haven't slept in days or like I've been crying for days. Very self conscious about it since no one knows at work that I'm going through treatment. Doc said this is likely a side effect from the hypothyroidism and that we'll work on my med dosage after a month or two. Wondering if anyone else has experienced this?

Many thanks for everyone's awesome advice and input!!

Jennifer

Primary 1B in 2014 - WLE and SNB negative. Recurrence Dec 2019 - Stage IV with mets in liver and lungs. Currently on ipi/nivo combo @ MD Anderson (Houston, TX).

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DT1985's picture
Replies 7
Last reply 2/26/2020 - 6:23am

Stage 1b (as of now until we find out what SLNB says Thursday) Nodular melanoma, back of the right leg calf. 1.5mm deep, no known ulceration, but marginal mitosis present.

1. How deep is a standard shave biopsy? If they can determine the 1.5mm depth, I am guessing the total shave would have been deeper than that? For example you can determine something is a foot long if there is only 6in to measure.

2. How deep have you heard of a melanoma growing without lymph node mets? Conversely how shallow have you seen/heard of one with lymph node mets?

3. The 10yr survival rate of a stage 1b melanoma patient (according to the American Cancer Society) is 86%. How is it determined those 14% are not surviving? Is the melanoma coming back in the same spot? Is it a different melanoma that develops? Or are these people in their study dying in other ways?

4. Moving forward after the WLE & SLNB, should everything come back clear, how often should I get checked? Should I have any/every mole removed? (For two years they told me that the mole was ok) Is it only a matter of time before I get another melanoma somewhere else?

5. Should I get a full body scan to check the rest of my body just in case? PET Scan, MRI, CT Scans, etc... I’m paranoid I’m filled with all types of cancers now and have no idea...

Any and all help you folks can provide is greatly appreciated. I hope you’re all doing well and on the road to clean scans.

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almostalice's picture
Replies 2
Last reply 2/24/2020 - 3:37pm
Replies by: Bubbles, sks2019

I didn't expect 15 years later to gain so many new insights into my case. I came up CDKN2A positive and after over a year of insurance battles I'm finally getting a CT tomorrow focused on pancreas. 6mm depth Nodular 15 years ago was the highest staged primary but since then I've had several SSM's and an insitu.

I got to thinking more and asked around about slow melanoma's.

I had severe hypothyroidism found about 5 years after my first encounter with Melanoma. My TSH spiked up to 56 (not a typo ...). We got it down to range 0.9 to 2. If I don't take thyroxine my TSH creeps back up.

Has there been any research into metabolism and melanoma? The more I put the puzzle pieces together the more it becomes logical that a failing thyroid could have saved my life.

The longer time goes on and the more I reflect the thyroid issues came on around a time of severe tiredness. I was diagnosed with Narcolepsy with AHI 30 (awoken once every two minutes), I was bradycardic BPM 59, but treatments didn't work and was then correctly found to have Sleep Apnea. That will over time drive down and destroy thyroid function.

All of that is now under control ... I am left still with FAMMM and CDKN2A+ but I just wonder if metabolism can be a key factor in the survival outlook.

What's happening with my holistic medical history that's leading me to be able to tell my story of melanoma with no upstaging (so far over 15 years)?

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Amy0223's picture
Replies 4
Last reply 2/24/2020 - 8:33pm
Replies by: Amy0223, Becky, casagrayson

I was diagnosed with mucosal melanoma of the right hard palate and left soft palate in October of 2019, after having just had my reconstruction from breast cancer. I was cancer free in August 2019. I have lupus and scleroderma, so my oncologist and rheumatologist did not want me to do immunotherapy or radiation. Chemotherapy has not shown to be effective with mucosal melanoma. Surgery was not an option due to the hard and soft palate being involved. I am BRAF negative and C-KIT negative.

I started TVEC injections in my mouth in November 2019. This is the first time my oncologist at the James has tried this procedure in the mouth. I have not found anything anywhere that can give me any information about anyone out there that has had this treatment done in their mouth and the outcome. I have positive changes occuring, but they could not do a sentinel node biopsy due to the location, and the PET scan is not that reliable for detecting lymph nodes in that area. I did not have metastasis to any organs or brain at the time of the PET scan at the end of October.

History: I went to my dentist after my mastectomy with a sore in my mouth in June 2019. She gave me medication for infection. Went back 3 weeks later and it was worse. She sent me to the periodontist, and a few weeks later he said he didn't know what it was and was going to do a biopsy. My rheumatologist instead wanted it performed by a dermatologist. A few weeks later I went to my regular dermatologist who said that the area was too vascular and wanted a surgeon in their office to do it. A few days later I went in and he said the lesion looked vascular and no worries. Did the biopsy. He called me a week later and apologized because he said he only has seen two of these in his entire career, and mine was the second. It was a blow, because I knew how serious and aggressive this cancer is. It had grown significantly between June and October, when I was finally diagnosed.

I am telling this story to help others who may not take a sore in their mouth seriously. I thought I had an infection, as well. Has anybody on this forum had mucosal melanoma and TVEC injections? Thank you!

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Tsvetochka's picture
Replies 7
Last reply 2/21/2020 - 12:46pm
Replies by: tkoss, Tsvetochka, ed williams, hxcadam, Anonymous

In May 2019 I was diagnosed with Stage 4 melanoma, no known primary. I started Keytruda in June. It's gone pretty smoothly. Fast forward to now: my doctor ordered a PET CT. When I look at the results, it seems like there's still some cancer. Two tumours are still there, but inactive and smaller than the last CT scan. One lymph node is still active: "1.9SUV," which is supposedly not significant?

I sent the results to my doctor, and she just answered that they're good, we'll stop treatment. I have an appointment with her in a week or so, and I know we'll discuss it then. But I am just wondering what does this mean? I'm not really NED, right? Is it (almost) No Evidence of (active) Disease?

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sks2019's picture
Replies 3
Last reply 2/21/2020 - 12:00pm
Replies by: jbronicki, JudiAU, tkoss

In case people have been looking at my posts and wondering what has been going on with my mom. I am writing an update more of to vent it out.
Mom's liver mets are growing and growing fast. PET/CT on Jan 10 the biggest tumor size was 7.6x7.7 cm with many small ones 2- 3 cm . Now CT on Feb 14 showed biggest tumor is 9.2x6.8 cm
so almost 2 cm in less than 30 days. CT also reveals spot on right kidney not sure what it means but given how things have been going on with her. I woudnt be surprised if its mets.

SHe had no treatment since nov 5 (ipi/nivo side effects) , Is very tired and nausauted , having adrenal insufficiency so taking 15mg hydrocortisone for that.

Tumor burden is taking over as her energy is gone and she has lost appetitie due to nausea .
Today she will be starting a trial with NIRAPARIB. Please pray it works for her.
At this point I am just preparing myself for the worst scenario :(

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Replies by: lkb, JudiAU

"For the past three years, cancer researchers at two of the UK’s leading institutes have been showcasing the unexpectedly beautiful side of their work through a special award.

Staff from the Institute of Cancer Research (ICR) and the Royal Marsden NHS Foundation Trust, both in London, submitted the images they felt exemplified the beauty and complexity of their work for the ICR Science and Medical Imaging Competition."

Read more: https://www.newscientist.com/article/2234301-close-up-image-of-brain-can...

Two scaning electron microsope images of a melanoma cell get mentioned among the top six images in a medical imaging competition.

https://www.newscientist.com/article/2234301-close-up-image-of-brain-can...

1. Melanoma cell invasion in 3D
Vicky Bousgouni and Chris Bakal

"This picture of an aggressive melanoma cell (green) growing into a matrix of collagen was taken by Vicky Bousgouni, Chris Bakal and David Robinson. It is one of the first 3D images of cancer cells to be taken using scanning electron microscopy. Collagen matrices are used to model how cancers invade tissues during the metastatic process. Here, the cancer cell pulls on its fibres and wraps itself in collagen to remodel its environment and increase the chances of survival."

2. Melanoma on a Chip
"A metastatic melanoma cell that has been blasted open
Nick Moser and Chris Bakal

Imagine cutting an apple in half and looking at its core – that is a little like what has happened to this metastatic melanoma cell. Nick Moser and Chris Bakal used an ion beam to blast away part of the cell, a technique known as ion-beam milling.

The triangular shape was caused by the angle of the beam as it cut into the cell and the silica substrate it is growing on, creating the illusion of depth. The method allows researchers to see inside cancerous cells in unprecedented detail and understand what is going on internally.

As melanoma cells attach to surfaces using structures called focal adhesions, removing part of the cell lets them see what happens when these structures form. The spread of cancers around the body is the primary cause of death from the diseases, so understanding how such cells attach to tissues is vital to cutting death rates."

I am sharing this article I came across in hope that these bring more insight into the world of melanoma and also help us visualize melanoma demise.

Melanie

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swissie's picture
Replies 5
Last reply 2/20/2020 - 10:56am
Replies by: swissie, ed williams, MelMel

Hello all

As many off you, I feel lonely during a difficult time of waiting for results.
My history: 1992 first melanoma, 2008 second melanoma.
2009 spread to the lymph nodes (with spreading in surrounding fat tissue).
2009, Participated in a double-blind trial with 10 mg/kg ipi, however I was in the placebo group.
So basically, I am an untreated Stage IIIb patient without recurrences.

Had 3 moles removed since 2009. Two on my request, they were ok. One as the doctor saw it, this was atypical.
Last week another mole was removed. I’ll have the results next week. And I’m freaking out.

I do not want to scare my friends and family. Most new friends have no clue what it is.
One of my best friends is in the hospital with a burn out and she totally freaked out when she heard. I ended up comforting her.
But I am scared. The numbers are pretty much against me, right?

My last scan (in the trial) was in 2016, after that my doctors told me I’m too young for regular scans (46). If the cancer is back, I will request a scan.
Any advice from you on having scans? Shall I ask anyway? I know this beast can always come back, but as I’ve been clean so far, I don’t know if I should ask or not.
Also, if you have any advice on how to get through the next week?
Thanks

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Had surgery on Jan.31st to remove 2cm mass on outside wall of sigmoid colon that was suspected to be melanoma,. Surgeon called to check on me and let me know path report said was not melanoma! Finally some good news! So fingers crossed for PET and Mri fisrt of March. Hope everyone here gets some good news this year as well. Great site with great people and great information! Thankyou all for all your support for me and others that end uo here!

Joe

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tkoss's picture
Replies 4
Last reply 2/24/2020 - 12:01pm
Replies by: almostalice, Becky, tkoss, JudiAU

does the melanoma take hold at the place on the epidermis exposed, or can iit show up on other parts of you skin, maybe adjacent , maybe not so adjacent?

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Lori0529's picture
Replies 4
Last reply 2/20/2020 - 12:01pm
Replies by: Lori0529, Bubbles, tkoss

2008 -- Melanoma in situ (lower right leg)
2015 -- Melanoma 2B upper right leg (Sentinel Node Negative)

2020 -- CT scan showed swollen right groin lymph node -- Biopsy confirms Melanoma -- now stage 3b

Treatment plan is Opdivo/Yervoy -- followed by a Superficial Inguinal Lymph Node Dissection
(Lymph node with checked along the way to evaluate effectiveness of Immunotherapy)

Surgeon also recommended a Plastic Surgeon work WITH him to o perform a Lymphovenous Bypass during Superficial Inguinal Lymph Node Dissection to lower the risk of lymphedema.
(veins are used for fluid drainage)
It's my understanding that this surgery has mostly helped alleviate lymphedema from PREVIOUS surgeries. This surgeon tries to prevent it.

Now the plot twist:
Met with the plastic surgeon today.
He is concerned that a Lymphovenous Bypass on the right side will drain fluid from the right leg directly into the veins without "filters".
This is concerning should I still have melanoma cells in the right leg or have a recurrence there in the future.

He would like to consider a Lymph Node Transfer during the Superficial Inguinal Lymph Node Dissection.
Lymph nodes will be taken from my left underarm and placed in the right leg

He said this surgery has successfully helped alleviate lymphedema in patients experiencing swelling from a previous surgery, but there is not a lot of outcome evaluation for patients getting this surgery DURING Superficial Inguinal Lymph Node Dissection.

Has anyone had this surgery?
Those who have had Superficial Inguinal Lymph Node Dissection -- what should I be considering?

My thinking:
Priority #1
Do everything possible to minimize melanoma spread/recurrence

Priority #2
Try not to end up with life-long leg swelling

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