Stage Iv Melanoma

My brother-in-law was just recently diagnosed with Sage IV melanoma on his back. He is awaiting a scan (I'm not sure what kind) for futher results and treatment options. Has anyone out there had any experience with this type of Cancer? Any/all info would be greatly appreciated. I'm a nurse, so medical lingo is fine - the more details the better. I would like to research treatment options and results, so I can prepare my/his family for what to expect. They are terrified and very upset, as he is only 50-some years old. Thanks for your help.

Where are the mets?  It is helpful if they can be removed.  DTIC and Temodar are most commonly used, but interferon and IL2 can be used also.  I recommend looking into clinical trials as current practice offers little hope.

On 6/29/2007 Oncrx wrote:

Where are the mets?  It is helpful if they can be removed.  DTIC and Temodar are most commonly used, but interferon and IL2 can be used also.  I recommend looking into clinical trials as current practice offers little hope.

Are you certain he was diagnosed with Stage IV melanoma, and not having a Clark's level IV? 

 Clark's Levels are as follows: (from www.skincancer.org)

Very thin tumors are classified according to Clark's level of invasion, based on the number of layers of skin penetrated by the tumor.

• Clark's level I.  The melanoma occupies only the epidermis.
• Clark's level II.  The melanoma penetrates to the layer immediately under the epidermis, the papillary dermis.
• Clark's level III.  The melanoma fills the papillary dermis and impinges on the reticular dermis, the next layer down.
• Clark's level IV.  The melanoma penetrates into the reticular or deep dermis.
• Clark's level V.  The melanoma invades the subcutaneous fat.

Breslow's thickness measures in millimeters the distance between the upper layer of the epidermis and the deepest point of the tumor's penetration. 

• In situ melanoma remains confined to the epidermis
• Very thin tumors are less than 1.0 millimeter
• Thin tumors are 1.01-2.0 mm
• Intermediate tumors are 2.0-4.0 mm
• Thick melanomas are 4.00 mm or more.

Stages I - II are dependant on a tumor's breslow's thickness and Clarks level.

Stage I. This category is subdivided according to the thickness of the primary (original) tumor.

• Stage 1a: The tumor is less than 1.0 mm in Breslow's thickness without ulceration and is in Clark's level II or III.
• Stage Ib: The tumor is less than 1.0 mm in Breslow's thickness with ulceration and/or Clark's level III or IV, or it is 1.01 - 2.0 mm in thickness without ulceration, or has spread to the closest lymph nodes. 

Stage II. This is also subdivided according to gradations in thickness and/or depth, the presence or absence of ulceration, and regional lymph node metastases. 

• Stage IIa: The tumor is 1.01 - 2.0 mm  in Breslow's thickness with ulceration, or is 2.01-4.0 mm in thickness without ulceration.
• Stage IIb: The tumor is 2.01-4.0 mm in Breslow's thickness with ulceration, or is greater than 4.0 mm in thickness without ulceration.
• Stage IIc:  The tumor is greater than 4.0 mm in Breslow's thickness with ulceration.
  

Stages III and IV
By the time a melanoma advances to Stage III or beyond, the Breslow's thickness is by then irrelevant and is no longer included, but the presence of microscopic ulceration continues to be used in staging, as it has an important effect on the progression of the disease.

Stage III. A tumor is assigned to Stage III if it has metastasized or spread through the lymph system.  In-transit or satellite metastases are also included in Stage III. In this case, the spread is to skin or underlying tissue (subcutaneous) for a distance of more than 2 centimeters (1 cm equals 0.4 inch) from the primary tumor, but not beyond the regional lymph nodes.

Stage IV. The melanoma has metastasized to lymph nodes far away from the primary tumor or to internal organs, most often the lung, followed in descending order of frequency by the liver, brain, bone and gastrointestinal tract.

On 6/29/2007 Sam673 wrote:

Are you certain he was diagnosed with Stage IV melanoma, and not having a Clark's level IV? 

 Clark's Levels are as follows: (from www.skincancer.org)

Very thin tumors are classified according to Clark's level of invasion, based on the number of layers of skin penetrated by the tumor.

• Clark's level I.  The melanoma occupies only the epidermis.
• Clark's level II.  The melanoma penetrates to the layer immediately under the epidermis, the papillary dermis.
• Clark's level III.  The melanoma fills the papillary dermis and impinges on the reticular dermis, the next layer down.
• Clark's level IV.  The melanoma penetrates into the reticular or deep dermis.
• Clark's level V.  The melanoma invades the subcutaneous fat.

Breslow's thickness measures in millimeters the distance between the upper layer of the epidermis and the deepest point of the tumor's penetration. 

• In situ melanoma remains confined to the epidermis
• Very thin tumors are less than 1.0 millimeter
• Thin tumors are 1.01-2.0 mm
• Intermediate tumors are 2.0-4.0 mm
• Thick melanomas are 4.00 mm or more.

Stages I - II are dependant on a tumor's breslow's thickness and Clarks level.

Stage I. This category is subdivided according to the thickness of the primary (original) tumor.

• Stage 1a: The tumor is less than 1.0 mm in Breslow's thickness without ulceration and is in Clark's level II or III.
• Stage Ib: The tumor is less than 1.0 mm in Breslow's thickness with ulceration and/or Clark's level III or IV, or it is 1.01 - 2.0 mm in thickness without ulceration, or has spread to the closest lymph nodes. 

Stage II. This is also subdivided according to gradations in thickness and/or depth, the presence or absence of ulceration, and regional lymph node metastases. 

• Stage IIa: The tumor is 1.01 - 2.0 mm  in Breslow's thickness with ulceration, or is 2.01-4.0 mm in thickness without ulceration.
• Stage IIb: The tumor is 2.01-4.0 mm in Breslow's thickness with ulceration, or is greater than 4.0 mm in thickness without ulceration.
• Stage IIc:  The tumor is greater than 4.0 mm in Breslow's thickness with ulceration.
  

Stages III and IV
By the time a melanoma advances to Stage III or beyond, the Breslow's thickness is by then irrelevant and is no longer included, but the presence of microscopic ulceration continues to be used in staging, as it has an important effect on the progression of the disease.

Stage III. A tumor is assigned to Stage III if it has metastasized or spread through the lymph system.  In-transit or satellite metastases are also included in Stage III. In this case, the spread is to skin or underlying tissue (subcutaneous) for a distance of more than 2 centimeters (1 cm equals 0.4 inch) from the primary tumor, but not beyond the regional lymph nodes.

Stage IV. The melanoma has metastasized to lymph nodes far away from the primary tumor or to internal organs, most often the lung, followed in descending order of frequency by the liver, brain, bone and gastrointestinal tract.

Hope this helps!  :)

 

Can you help me understand prognosis for metastasized melanoma?  My father had 4 occurrences of melanoma - 3 in the same place on his temple.  The first occurrence was in 1994 on his arm.  Last resection was 3 years ago taking lymph nodes from his temple area and neck.  The doctors were satisfied that they had physically removed the cancer.  No drug or radiation treatment was used.

In December 2006, he began having back pain in the same area where he had previously had back surgery.  After a long diagnosis process, first thinking the pain was related to the surgery, he was diagnosed on June 1, 2007 with metastasized melanoma in the lumbar 3 area of the spine.  Approximately 4-5 weeks ago he was having difficulty with turning as he walked (coordination) and noted a significant loss of hearing in his left ear.  He was put on a Fentinol (sp?) patch and an oral pain killer.  Two Mondays ago (last week of June), he was hospitalized in the middle of the night with extreme pain in his back.  We were advised that they did not believe he was going to make it, but after treatment with steroids and additional pain medication including oral morphine, he perked up remarkably and came home last Thursday.  A PET scan conducted the same day revealed cancer in his cerebellum and lungs.  He is at home now.  He is barely able to walk and spends most time in a wheelchair or the home "hospital" bed.  He has a catheter to prevent any pressure build up on his lower spine.  He has started to switch words/name that are close "Clint" instead of "Kent" and has misstated some information such as ages of acquaintances, but otherwise seems to have fairly good mental clarity.

No one has told us a time frame to expect.  I am concerned that we have some idea so we can support and help plan for my mother who is 73, has health issues of her own and is the primary caregiver.

He is 74 (75 in September).  He has had two heart attacks, bypass surgery approximately 10 years ago and has 4 stints currently.  He has high blood pressure controlled with medication and depression also treated.

From what I have read and what we have been told, his expected prognosis would be 3 - 3.6 months and that he should "Focus on comfort, do what he wants to do and see who he wants to see."  We have not had a revised prognosis since we found out about the cancer spreading to the lungs and cerebellum.  I know hard numbers cannot be given, but even a rough estimate or average would do a great deal to help me cope.  We have been doing anything and everything we can think of to aid him and my mother.  This is the missing piece of information that is causing me a great deal of anxiety.  I am a data person.  Not having information causes me more stress than being very difficult news.

Any assistance would be greatly appreciated. 

Melissa

Only pain management at this point...possibly radiation and one chemo drug which is not supposed to be toxic.  I don't have the name of the drug or plan for radiation.  We do not have the definitive plan from the Dr. at Duke yet (out this week).  My Dad has been quite clear that his preference is for quality of life over time. 

Thank you for any thoughts you are willing to share.

 Melissa

Please View and let me know if it could help. This is in Clinical stages but may be of some very positive use. Best of luck!

http://wcbstv.com/video/?id=101812