Expert: Claes-Gustaf Nordquist, M.D. - 2/24/2009

Question
My husband started experiencing loss of cognition, loss of right-side peripheral vision (both eyes), loss of reading skills (characters looked like foreign language), loss of balance and loss of muscle control at an alarming rate from approx Sept 08 until he was convinced to see a doctor Jan 5, 09. On Jan 12 he was given an MRI and was diagnosed with a baseball-sized mass. He was scheduled for surgery Jan 22, at which time they removed the mass & he was diagnosed with metatastic melanoma. He recovered his cognition and balance, but the peripheral vision has not returned: Visual fields tests done in Feb 08 showed no loss of vision, done in Feb 09 showed significant loss. He had gamma knife surgery at the base of the tumor Feb 20, and the neurosurgeon & oncologist were very satisfied with the outcome.

He is scheduled for a PET scan tomorrow morning, and we meet with another oncologist the following day to review the results.

In 2003, he had Stage II melanoma removed from his back, and was assured that the margins were clear.

Given these facts, do you feel his fears of chemotherapy being a useless treatment are well-founded? What would you suggest we prepare for?

Answer
I'm sorry to read about his - and your - problems. No one can guarantee anything when a malignant tumor is removed especially not when it is more advanced (an in situ tumor = stage 0 has a good chance of being cured if removed but stages 1 and even more so 2 are much less certain). Now he has a stage 4 malignant melanoma which in principle at present is incurable. Furthermore this kind of tumor is usually not very sensitive to conventional radiation therapy and chemotherapy. GammaKnife treatment is another matter but is only useful for rather small lesions. If a melanoma has spread to somewhere like here it has usually also spread to elsewhere even if not yet detected - maybe not even yet detectable. The risk is therefore big that he still has melanoma in his brain and perhaps also elsewhere. Experiments in immunotherapy are going on - even promising and interesting - but still very much experimental. So unfortunately this situation may turn out to be fatal. So I think his fears are well founded and I'm sorry but I have no solution to offer at present.