Expert: Claes-Gustaf Nordquist, M.D. - 2/2/2008

Question
In May ,2007 my 58 year old husband was diagnoised with metastic melonama in his entire brain and brain stem and a very small spot in his lung. He had no sympthoms until about 2 weeks before his diagonis when he began having trouble using his left hand and had a few tremors in his left arm. We went right to the Dr and they did an MRI and found this cancer. He was doing amazing well, pretty normal in all ways and the Dr were amazed considering the extent of his cancer in his brain. He had 10 radiation treatments and did very well for about 6 weeks. They did PET and CT scans and found no other cancers , nor could they find the origin. He had three rounds of chemo and then he started to fail and spent his last 3 weeks in the hospital. He eventually went into a deep sleep and very peacefully left this earth on Aug 2,2007 , just a few short months after diagonis. The Dr told me then that he didn't think he would live more than 4 months. In about 1997 he had a large dark mole removed from his back and the lab report came back normal. My question is this, if they miss-diagoised that mole, is it possible he could have lived over 10 years with this cancer in his body. He had no problems at all until early May. I find it hard to understand how this cancer could have consumed his brain so quickly. Can you help me understand this better? Thank you so much. Linda

Answer
First of all I'm sorry for your loss! Malignant melanoma can reappear many years after the original tumor was removed. So if his original mole that was removed around 10 years ago somehow was misdiagnosed and truly was - at least partly - a malignant melanoma I'm not really surprised. That could happen. Then we have the rapid growth of the tumor and your husband's rapid deterioration and death. That is in this situation not surprising either.  If the growth rate of a tumor is constant it takes just as long to grow from 1 mm to 2 mm (1/25 to 2/25 of an inch) as from  5 cm (50mm) to 10 cm (100 mm) (2 inches to 4 inches). That means that even though the growth rate may be constant the tumor seems to "explode" as it grows bigger! Unfortunately malignant melanomas are usually not very sensitive to radiation therapy or chemo therapy!
Unfortunately I doubt - with the actual biology of this tumor - that the outcome would have been much different even if the diagnoses had been made around 10 years ago.