Expert: Claes-Gustaf Nordquist, M.D. - 1/13/2008

Question
QUESTION: My best friend is in a coma following surgery to remove a malignant melanoma 'brain tumor' 8 days ago. She was misdiagnosed with benign positional vertigo prior to collapsing through paralysis and eventually stopping breathing briefly in the ambulance.

The tumor has been removed although MIR reveals a shadow of residual cancer. The tumor was at the base of teh brain near spine/ brain stem.

She is in a coma and not responding fter 9 days post-op. She is 38. They cannot locate original melanoma.

What is your prognosis?


ANSWER: Unfortunately her prognosis is most probably very bad. I'm sorry I have nothing better to tell you!


---------- FOLLOW-UP ----------

QUESTION: When you say that...what exactly do you mean?

Answer
The worst scenario possible is unfortunately the most probable here. It is improbable that she will ever wake up from her coma after her surgery so close to her brain stem (the formatio reticularis there which probably has been damaged by her tumor and maybe also by her surgery is critical for being concious at all). Her malignant melanoma that has spread to her brain and where the location of her primary tumor is unknown will most probably kill her within at most a few months but her survival time may be MUCH shorter unfortunately. She may even die at any moment with this brain damage since cardiovascular and breathing brain centers are also close to her damaged brain site. If her tumor has spread to her brain it is also very probable that it also has spread elsewhere even though not detected or even detectable yet! Malignant melanomas are usually not very sensitive to radiation therapy or chemo therapy so those are hardly any options. In this condition she is also hardly a likely candidate for any more surgery. Again, I'm VERY sorry I have nothing better to tell you!