MEL AND I

Let me start by saying I don't like Mel, never did like Mel, never will like Mel. First acquaintance was in the late '80s or early '90s and although fairly innocuous, Mel still had to be forcibly removed from me. Since then, however, our relationship has has gotten downright ugly. Mel showed up again in 2006, acting very threatening. With a little help, I was able to call the bluff and Mel, I thought, was gone for good. Unfortunately, this year, Mel is back with a vengeance.

Mel's full name is Malignant Melanoma, but since we are on such familiar terms, it's just "Mel."

Its initial visits were small pigmented lesions in sun-exposed areas, which were easily removed in the Dermatologist's office. The next visit was a little more involved as I had an occasionally crusty lesion removed from my scalp. It was with Mohs surgery, so the margins were microscopically clear and it was very shallow in the skin. I was counseled to have regular derm check-ups and, of course, use sun block.

Fast forward six years (during which I saw dermatologists at least every 6 months, had little sun exposure and always used sun block) when a lump on my neck was identified as a melanoma tumor in my parotid (salivary) gland. << A little medical semantics lesson here - since it was in the lymphatic drainage area of the scalp lesion which had been excised, and was not in a major organ, it was considered an "extension," and not a metastasis.>>

A full-body work-up showed no other lesions or tumors, so I had the tumor, the parotid gland and 32 lymph nodes (one of which had a few melanoma cells) in my neck surgically removed. Recommendations were to have post-op radiation to my neck, so I ended up with 20 fractions (sessions) over a month which totaled up to 4,800 rads. No other therapy was recommended since the risk of a recurrence was about the same with or without standard Stage III therapy and the treatment had significant negative side effects.

Other than the challenge of recovering from radiation (much more difficult than I thought it would be), things were looking okay. I was feeling well, back to my usual activities and life was good.

After a routine derm visit 4 months post radiation, a biopsy of a small lump in the neck incision scar revealed recurrence of Mel. Further work-up over the next month uncovered recurrent lesions in my neck, a metastatic lesion in my leg and more metastases in my lungs. So that's where I'm at right now - Stage IV Malignant Melanoma.

Now, when I was in medical school in the '70s, this would have been a death sentence. The more cynical docs in the lounges would have talked about telling the patient not to fill up their gas tank all the way, and even consider not buying green bananas. Luckily, things have changed. Although there are no outcome guarantees, therapies now exist that have had some remarkable longevity statistics. I have enrolled in a Phase III clinical trial of an investigational drug and will start treatment in a week or so.

Any wonder I don't like Mel?