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Stage IV Melanoma Patient Story

During my visit to a dermatologist’s office in 1982 for treatment of an acne condition, the doctor noticed moles on my arms and warned me that I was at risk of developing melanoma. I learned that I satisfied all of the risk factors, e.g. light complexion, blonde hair, green eyes, many moles, Anglo-Saxon ancestry, and a history of occasional cases of sunburn (almost everyone from my age cohort fits that criterion). Those moles were excised and found to be benign, but ever since then I have been examined on at least an annual basis for skin cancer. Over the next three decades I was fortunate enough to be diagnosed only with the far milder affliction of basal cell carcinoma. I was usually fairly diligent with respect to the precautions that you all know should be taken.

Despite this lengthy period of smooth sailing, thankfully I never let my guard down.

Fast forward to the fall of 2012, when I observed on my right cheek one of the signs of cancer – that fabled sore that would not heal. I scheduled a series of visits to my regular dermatologist as well as another local dermatologist, but the result of the first four visits was watch and wait. The diagnosis was missed because I had developed a rare form of melanoma called the oxymoronic amelanotic melanoma that lacks the tell-tale, conspicuous pigmentation.

Eventually as the sore appeared to be growing, my regular dermatologist kindly agreed to excise it on my fifth visit in March of 2013. He had to dig deeper into my cheek than he expected, and was concerned that it had grown. Nevertheless, when I asked him whether it was melanoma, his response was negative.

Seven days later he telephoned me at my office and delivered the terrible news contained in the pathology report. It was an ulcerated nodule almost 12 mm deep with microsatellites. One might say that my persistence paid in a somewhat macabre fashion. “This is a very serious diagnosis” he declared, but he also said “Of course there is hope for you”. Within two days, I saw the top head and neck surgeon and the top melanoma specialist at the Ottawa Regional Cancer Centre. Nine days earlier, I had a cancer-free mindset. The long-term survival statistics that they revealed to me were well south of 50%, but that information was useful for choosing a course of treatment. Easter of 2013 was not a happy time.

The first bits of good news started to trickle in. Surgery was scheduled after the results of a bone scan and CT scans of the neck, chest, and abdomen were negative. Five weeks later, I underwent surgery that transformed me from “cancer-face” to “scarface.” In mid- May, the pathology report came back. The same surgeon who was not optimistic announced before removing the sutures that a) the excision was “free at the margins.” and b) ALL of the lymph nodes were clear. My condition was stage 3c rather than stage 4. I was temporarily in a state of reverse denial; it seemed to be too good to be true.

When my wife and I met with the melanoma specialist a few days later, he mentioned the possibility of participation in clinical trials as well as the “watch and wait option.” At this point my wife intervened. Having done an enormous amount of research in the medical literature, she knew the nitty-gritty of my pathology reports, and knew something about how the system operated. She politely insisted that I did qualify for one of the trials, specifically immunotherapy involving ipilimumab (“ipi”). The doctor consulted his notes and concurred. As long as the results of a full-body PET scan and a head MRI were negative, I would be in the trial. Then providence intervened again, notwithstanding my pessimistic outlook. I was randomly selected into the treatment arm of the trial as opposed to the interferon arm.

Over the course of the spring and summer of 2013, I underwent four rounds of immunotherapy. For every single visit to the Cancer Centre for any reason, my wife accompanied and supported me. There were certainly setbacks related to the inevitable side effects. I had to cease treatment after the fourth round. In November of 2013 I was hospitalized after suffering an adrenal crisis, as a result I will be dependent on steroids for the rest of my days. As far as the cancer is concerned, however, the only bad news that I ever received was the initial diagnosis. I am so grateful to my wife Catherine, the team at the Ottawa Cancer Centre, my dermatologist, Bristol-Myers Squibb, the Ottawa Hospital Foundation and Lady Luck for showing no evidence of metastatic disease for over five years. – David Gray

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