Expert: Claes-Gustaf Nordquist, M.D. - 1/18/2009

Question
QUESTION: In 2001 I noticed a small black dot on my sister's left arm, she went to the dermatologist to have it removed, pathology came back melanoma, surrounding tissue negative.  Physician tested lymph node, one node (not primary) had small dot on it, he removed all the nodes under her left arm.  All went well, prognosis was good.  In Nov. 2008 she was becoming forgetful, and had headaches, which she thought was hormonal and she was under alot of stress.  Went to the ER and CAT scan revealed a shadow, MRI showed mass and 2 days later had a lime size tumor (single lesion) successful removed.  PET scan after surgery showed no other lesions.  She is beginning her first of 15 rounds of radiation therapy.  My question is this:  How much time is a good estimate?  Most patients that have mets brain melanoma do not seem to have the lesion removed, maybe to the number of tumors or the location.  Also, she has not experienced any seizures postop.  Thank you

ANSWER: Well we can always hope that this was a single lesion, now removed. Though unfortunately bitter experience from the past does show us that once a malignant melanoma has spread to somewhere it has usually also spread to elsewhere even if - as here - not detected or even detectable yet. Also malignant melanomas are usually not very sensitive to radiation therapy. So unfortunately I do not believe this to be the end of it. I do hope it will turn out that I'm wrong but I fear that her survival time can be measured in months and I do not think it can be measured in years. I'm sorry I have nothing better to tell you!


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

QUESTION: Your response is basically the same as I've seen previously.  I know the PET scan was done for the entire body which they indicated no other tumors, but I do realize it can't detect the actual "cells".  This tumor sounds as if it was more aggressive, could any breakdown in her immune system have also added to the speed of growth?    She was also struck with MRSA in 2006/2007 and misdiagnosed, but then properly treated and came back negative with a nasal swab prior to her brain surgery.  Why are vitamins not to be taken during radiation?  She also took supplements (ie: E, C) but was told to discontinue during radiation; it just seems like anything to help your immune system should continue, just wondering...  My other question is why, if melanoma is not treatable by chemo/radiation do physicians suggest patients receive it?  Is it the "hope" factor?   It just seems that if you are near the end of life you shouldn't be subjected to the side effects of chemo and or radiation.
My sister has not experienced any side effects, but she is just in her second treatment.  She says she feels good, just a little tired, I found a cancer site that suggests alot of proteins to keep up your energy.  She is scheduled to have another MRI at the end of Radiation (Feb '09) and then another PET scan in a few months after that.  

Answer
It is possible that her immune system may have played a role but a lime sized tumor must have been there quite some time. There is as far as I know no reason not to take any vitamins then - any other medication that may have been influenced? Yes you do have the "hope factor" that it MAY work in this case - unlikely but not impossible. There is anyway more or less nothing else to offer.