Expert: Claes-Gustaf Nordquist, M.D. - 5/15/2009

Question
Patient is 69 years of age;diagnosed with Hypermetabolic rt. submandibular adenopathy, hypermetabolic osseous metastases in c6 and T8 lamina, hypermetabolic rt. axillary and subcarinal metastatic adenopathy, rt. lower lobe metastatic nodule w/moderately intense activity, 2 add'l rt. middle lobe masses not having significant uptake but are slightly hyperdense.  Milimetric nodules in rt. midddle lobe and left lower lobe; hypermetabolic subcutaneous soft tissue metastasis in left posterolateral chest wall;  hypermetabolic focus likely representing an intramuscular metastasis in left lower extremity; bilateral adrenal masses-metastases; activity at terminal ileum and ileocecal valve. Patient has diabetes, hypertension, high cholesterol.  What course of treatment would you suggest?  What is life expectancy with treatment and without treatment?

Answer
Honestly speaking I see very little - if indeed any - possibilities of any therapy here at present except purely palliative treatment (= symptom relieving treatment)in a hospice. Malignant melanoma is usually not very sensitive to radiation therapy or to chemotherapy so those therapies will most probably not be able to do much here - if anything except side effects! Such side effects will probably not be pleasant either. Interesting and rather promising experiments in immunotherapy are going on but they are still very experimental. So unfortunately I have nothing to offer you really for this very advanced stage 4 melanoma case.