Expert: Claes-Gustaf Nordquist, M.D. - 6/30/2008

Question
QUESTION: I was taken to the hospital on April 11 and they found a golf ball size tumor
in my brain, left side, almost right above my ear. They removed it
successfully. There were two more much smaller melanoma spots but not
candidates for surgery. I had gamma knife treatment on those 2 weeks later
and the Doctors said they were successful, but I won't really find out until the
end of July when I get an MRI done. I also have 2 small ones in my lungs. That
seems to be the only places at the moment. they checked the liver and found
nothing, bones nothing, just haven't found them anywhere else. I started
kemo over a week ago and scheduled to do it 3 more times 30 days apart.  
This is stage 4 melanoma. I was going to try the imunotheraphy  thing but
was told I couldn't until the brain was clear. As I write this its been 51 days
since diagnosed with stage 4 melanoma. My first surgeon said I had 6 to 8
months to live. My Oncologist said I could live 5, 10, 20+ years. Obviously I
like the Oncologists answer, but would like to get a 3 opinion. Thanks

ANSWER: Are you still a candidate for immuno therapy? If not you probably should try it if possible. Malignant melanomas are usually not very sensitive to radiation therapy or chemo therapy. Your lung lesion should - if possible - be deleted for example by radio frequency ablation. With new methods of treatment coming in it is difficult to predict the outcome. Based on earlier experiences your surgeon was more realistic but with new methods maybe your oncologist may have some weight to his prediction.


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

QUESTION: I'm not sure if I am, they told me the lesion in the brain would have to be gone
first. In your opinion do they have to be gone before trying immuno therapy?
What is radio frequency ablation? Never heard it offered to me. I'm willing to try
anything that has a higher chance of success than radiation and kemo. 5 more
years would be a God send.

ANSWER: Well the lesion in your brain has been removed. It seem they want to give you chemo therapy first. Afterwards immuno therapy - if possible - should be tried. With radio frequency ablation you burn the lesion to destruction electrically. It works in a way like a mini micro wave oven. A needle is introduced into the lesion and it is destroyed. Good luck!


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

QUESTION: thanks for the answers. I was talking about the other 2 small lesions or whatever
they call them in the brain. They have to be gone before immuno therapy I was
told. They said they could explode with such a procedure ,I think, if I tried
immuno therapy. Is this wrong or right. Can I try immuno therapy now or must I
wait for the results?

Answer
Oh I thought those had been taken care of by the GammaKnife. Yes I agree you have to be sure they have been taken care of before the start of any immuno therapy. Probably the same for your lung lesions. I'm certainly not sure they would explode but it is best that your tumor burden is as small as possible when immuno therapy is applied.