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Went from Stage 1A to Stage 4

Forums General Melanoma Community Went from Stage 1A to Stage 4

  • Post
    bdginmo
    Participant

      First time poster here…

      My sister-in-law was diagnosed with melanoma stage 1A on the face with a depth of 0.5m in Novemeber of 2017. At that time margins were clear and she was considered to be at a very low risk of recurrence.

      Fast forward to March of 2019 she woke with headaches and blurred vision and, with a series of rapid emergency room visits and appointments, she was diagnosed with metastatic melanoma of the brain and lungs. There are at least 20 lesions in the brain and 5 in the lungs.

      We are all very shocked by what has just happened in the last couple of weeks. She is already consulting with the Mayo Clinic. We are waiting on the BRAF marker results. Though, based on updated information available as of this morning we think it is BRAF positive, but need confirmation from the doctor first. Follow up is scheduled for March 25th.

      Any advice would be welcome. Thanks!

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    • Replies
        Mark_DC
        Participant

          Dear bdginmo,

          I am very sorry to hear of this and also for your sister in law – this is very unfortunate.

          I am only writing now because i saw your post and wanted someone to respond – others here are far more knowledgeable. All i can say is that you have found a good website and that by searching and reading the posts here you will get good advice, and also going to celeste / bubbles website 

          http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/08/melanoma-intel-primer-for-current.html

          and the other posts there.

          It will be overload but the information on MPIP and Celeste's blog is good information.

          My guess is that if she is BRAF positive then BRAF/MEK inhibitors should help a lot and at least buy time and reduce tumour burden. She may also have to try SRS radiation as long as these brain tumours are relatively small. Then after this done she will want to consider immunotherapy.

          You may want to post more info in your profile (I dont do this!) so then others can look up the details more easily and give advice, but where you live and who your doctor is could be useful too. Because finding a melanoma specialist is key. And people on the board can give you recommendations if you give your location and your doctor.

          I hope others more knowledgeable will contribute but you have found a good place and resources that can help your sister in law. Giving this extra info may allow others to help you more

          good luck, am sorry to have to welcome you to this board but the people here are very friendly and good

          Mark

          melanomamafia
          Participant

            I'm so sorry to hear this for your sister. I was 1A in August of 2018 and for some reason have not been able to stop thinking about this type of thing. I know the 'odds' and 'prognosis' isn't in favor of this happening, but I think it happens far more than we talk about or acknowledge. Therefore, I am hypervigilant about my own health and spreading Melanoma Awareness.

            Just this past month, I started talking to a stranger who had a strange mark on his hand I advised him to get it checked out. He told me it was just a blood blister, but his friend had this exact thing happen to him. And I've heard other stories. 

            I don't want to be a doomsday prepper, but I also don't want to be shocked or unsure of what to do. So I offer you hope in that there are so many people on here beating the beast and at least taming to levels one can live with. I pray this for your sister and hope that you can get loads of good information on here.

            Always,

            xoxox

              bdginmo
              Participant

                Exactly. She essentially defined the odds. It's my understanding that stage 1A exhibits very low progression and recurrence rates. We understand that this was likely an unfortunate luck of the draw scenario.

                And remember, there is a bit of selection bias here with my post. If all had gone well and no other lesions had appeared then you would have never known that someone with stage 1A was cured. It was only because of the sudden stage 4 diagnosis that you were even aware of it. I hope this sets your mind at ease a bit.

                And yes, I agree. This is a lesson for others to be hyper vigilate. If there is a spot on your skin get it checked out sooner rather than later. If it's treated at stage 1 then you have very good odds of a positive prognisis.

                And thanks for the kind words of support! 

              bdginmo
              Participant

                Thanks for the responses. Quick update…she did get a response back from the doctor and he confirmed that it is BRAF+. He had already said that dabrafenib+trametinib would be the likely treatment if this were the result. It is our understanding that BRAF+ is best case scenario since it opens the door to a whole new class of treatment protocols and that these BRAF inhibitors are actually pretty effective.

                bdginmo
                Participant

                  Update…

                  It has been one month since my sister-in-law received a surprise diagnosis of stage IV melanoma. She is BRAF+ and will be doing targeted therapy. She just received the medication this week. She is on dabrafenib (BRAF inhibitor) and trametinib (MEK inhibitor). Considering that she just started taking it yesterday there's no update on how well it is working.

                  One new symptom that just appeared today is that she has lost motor control in her left foot. She can feel it, but can't get it to move. The doctor has ordered an MRI and recommeded that she go to the emergency room. This may happen tomorrow.

                    casagrayson
                    Participant

                      I'm sorry it took a month to get started on the drugs … that must have felt like an eternity!  (Probably didn't change the outcome, but the psychological stress is tough.)  I hope that she has great results!!

                       

                    bdginmo
                    Participant
                      I just wanted to post an update. She has been on dabrafenib and trametinib for 2.5 months now. The last MRI was about 2 weeks. It should significant reduction in the size of existing lesions which is obviously great news. However, there were several new but smaller lesions that appeared. Overall the response to the treatment has been favorable. Side effects have been minor and include very slight thinning of hair and fatigue both of which she reports as being easily manageable.

                      Unfortunately one new symptom that just appeared this morning was confusion followed by a seizure about an hour later. Fortunately this seizure occurred after she had been admitted to the ER. The CT scan showed that these smaller newer lesions are the likely culprit. She was given anti-seizure medication and discharged within a few hours.

                      I’ll try to update this post on an as-needed basis…maybe every couple of months or if something significant occurs.

                      bdginmo
                      Participant
                        There have been some significant developments in the last month.

                        1. A seizure occurred. This was preceded by confusion at which point she was taken to the ER. The seizure occurred immediately upon arrival at the hospital. As a result a police office and hospital staff were able to get her inside where medical care could be administered without delay.

                        2. Stomach and digestive issues developed a week later. She was taken to the ER on two different occasions with the 2nd leading to admittance to the hospital. It was determined that pancreatitis developed most likely as a side effect of the dabrafenib and trametinib treatment. This particular side effect is rare, but is severe and possibly life threatening. She was taken off the D&T drugs at the local hospital via consultation with the Mayo Clinic.

                        3. Her husband drove her to the Mayo Clinic 2 days later where it was decided to terminate the D&T therapy and immediately begin whole brain radiation followed by the possibility of nivolumab treatment.

                        4. Whole brain radiation treatments were completed on Monday (7/28/2019). Half way through the treatment an MRI showed progression of the disease as compared to earlier in July. It was determined that immunotherapy would not occur as had been originally planned.

                        bdginmo
                        Participant
                          The whole brain radiation treatment had little if any effect on the tumors in the brain and it was decided to stop the dabrafenib and trametinib treatment and plans for nivolumab were cancelled as well. Then on Aug. 7th she was taken to the ER in an ambulance due to persistent pain and partial paralysis on the left side of her body. The hospital consulted with the Mayo Clinic and it was determined that all treatments except for the most essential for seizure and pain management would cease. She was sent home on hospice on Aug 12th. There has been a rapid decline in her condition ever since.
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