Expert: Claes-Gustaf Nordquist, M.D. - 12/6/2010

Question
My father was diagnosed with stage iv melanoma 8 months ago with tumors found all through his body and eventually diagnosed with 7 tumors throughout his brain. The doctors treated him with chemotherapy ( still ongoing) and radiation therapy on his brain June 2010. Although the chemo is found to be shrinking the tumors in his body, so far there is no change to the ones in his brain. Up until 2 weeks ago he was fighting fit until he got sick from an infection and hospitalized for intravenous antibiotics. Since then he has changed dramatically showing signs of confusion, paranoia, weakness and has just seemed to deteriorate overnight. Three weeks ago he was independent and still working, now he needs full time supervision and care. We are currently waiting for an MRI to see if there are any changes to the brain mets. What I want to know are the general stages of deterioration, what i should expect and what to look out for as at the moment I feel very clueless about his illness and what's likely to happen next.  

Answer
Unfortunately I have to tell you that a stage 4 malignant melanoma is at present incurable and always eventually lethal. Malignant melanomas are usually at present not very sensitive to available chemotherapy and radiation therapy. Since it has spread to his brain the symptoms from there will dominate his clinical picture - as you have already noticed. I estimate his remaining life span to be at most a few months but it may be as short as a few weeks or even shorter. Over time he will be more and more confused. He may also develop stroke like symptoms and even epileptic fits. He will also sleep more and more. When he sleeps all the time his end will be near. He will then drift into a coma and then pass away. There will be little pain - if any. I'm sorry I have nothing better to tell you!



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