Father Recently Diagnosed Stage Iii

My father, 73, had SNB and a mole removed from his lower back (right side) in March 2007. Sentinel nodes showed no cancer as well as follow-up CT scan. However, he also had a PET scan which revealed activity in his right groin. Second surgery was July 2, 2007 and surgeon removed 17 nodes - all with melanoma. His medical oncologist recommended interferon (5 days a week for a month and then 3 days a week for a year), but also recommended we seek a 2nd opinion from Sloan Kettering, UPenn or Fox Chase, as my father lives in NJ.  My father chose Fox Chase b/c it is affiliated with his hospital.

At a wound check with his surgeon last monday (for his groin wound) he asked the surgeon to look at his back where the original mole was removed and he had three black nodules the size of pencil erasers so the surgeon scheduled another surgery for this past friday.  In the meantime, on wednesday, we went to Fox Chase. The oncologist we met with there gave us much more information than my father's local oncologist, however she did not recommend the interferon treatment.  She said interferon only increased survival rates by 3-5% and as we have repeatedly heard is extremely nasty. Although, my father's only medical problem is melanoma - he is very healthy, mentally and physically and very active for his age (he still works 4 days a week and enjoys kayaking and boat building)  I wonder if interferon is worth it for him.  Anyway, the Dr. at Fox Chase just recommended radiation and a wait and see approach with PET scans every three months. 

 My father liked her recommendation as he would rather have quality of life over the possibility of a reduced quality of life and no results.  I was also inclined to agree with him, but after reading this msg. board and doing some research I wonder if he should try interferon or some sort of biologic or vaccine therapy.  We aked the dr. at Fox Chase about other possibilities and she only cited a clinical trial of a vaccine therapy they were doing at F.C., but that was currently closed.

I have the impression from what the dr. told us and what I have read on the internet that interferon, while a standard treatment for melanoma, is ineffective, especially in a high risk patient like my dad. On the other hand the reappearance of the melanoma at the site of the original excision scares me to death - it seems to be moving so fast that the dr.'s wait and see approach seems, well, not smart.

My father is meeting with his local medical oncologist on Wed. and then a radiation oncologist on Fri.  I just hope they can suggest a treatment that includes radiation and chemo, immuno, or biologic therapy, because I do not think radiation alone is good enough. As 17 of his lymph nodes were cancerous, I feel like it is just a matter of time that the cells will travel to distant lymph nodes, or god forbid an organ.  At the initial meeting his medical oncologist did mention that thalidamide was being used, in some cases, for melanoma although he said it is generally used for other cancers.  Has anyone heard of this treatment for melanoma?

 Also, Temador was mentioned as a treatment on this msg. board - no doctor has mentioned that thus far. Also they are mum about survival time frames for my dad.  I was with him at his local oncologist and Fox Chase appointments and I felt strange asking the doctors that in front of him, but I would like to know so that I can begin to prepare my mother since she is very much in denial about the fact that this cancer is extremely aggressive and difficult to treat at this stage. 

Sorry for the lengthy post, I suppose I just didn't want to call my sister for the fourth time today to discuss.  My dad is so active and alive  - I still have trouble believing this is happening to him.

Any info. would be appreciated - thank you.

 

 

 

 

 

 

 

JHADaughter, You are a wonderful daughter and this experience will be hard for you because you love your dad so much. My husband was diagnosed with Stage IIIC melanoma just over two years ago. It started under his toenail. His treatments have been clinical trials of chemo and biological as well as chemo/bio combined. It is so hard to advise someone about treatment at this stage as everything is so experimental and everyone responds differently. My husband had an extremely difficult time tolerating high dose interleukin. He is 52 years old and, before the cancer, was healthy. He didn't even have a doctor. The Interleukin treatment was so hard and it didn't stop the cancer from spreading. However, as far as we know, it is still not in his organs. He will have scans next week. He is currently in a Phase I trial and takes one chemo pill a day at home. He started the daily dosing three weeks ago. We can already see an improvement in the appearance of the melanoma on the outside of his leg. The drug is called Pazopanib. The side effects are minimal compared to other treatments he's had. We continue to pray. It is a rough road and I wish you, your dad and family the very best. Try to be as open as possible with him, don't treat him like a child. Make sure he knows he can express his feelings and wishes. He will be hurting for you too. He may supress his feelings for fear it would be too much of a burden on his loved ones to know what he is thinking. Just learn what you can about his condition and treatment so he has someone to talk to about it. Try to remain optimistic. Encourage him to be active if he feels good enough. Take care of yourself. I'm just sort of rambling, but hopefully something I have written will help somehow. God bless you.

MM does have a rather dismal prognosis.  Survival is always hard to guess so most docs dont bring it up, but its usually not much more than a year at this stage.  I would tend to agree that the IFN is a rough treatment with little survival advantage.  At your dads age it would be hard to recommend.  Temodar and thalidomide are being tested in clinical trials, but dont have approval yet.  I would check this site for open trials in your area:

http://www.clinicaltrials.gov/

Please view and let me know if this helps. It is Clinical, however, spectacular results. Best of Luck!

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

I'm sorry for your circumstances. About a year ago, my father had the same diagnosis and options. He elected to have the surgery to remove the lymph nodes and have a pet scan every three months. He had the intial surgery, additional surgery three months later, and died 4 months after that. If you are going to try anything, now is the time. If you wait, you just lose time. My father's quality of life was debatable, he was always waiting for the 'good news'. I think if he could have put this in perspective early, he could have enjoyed the time he had left more. I wish you the best.