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Metastatic Melanoma of the Liver

midwest_wife
Posts: 1
Joined: Nov 2014

My husband (now age 60) was diagnosed with stage III melanoma on his back in Feb 2013.  He had the first surgery (2 inch incision) in the doctors office to remove the over grown ulcerated mole.  A week later we were told he had stage III melanoma and they needed to perform more surgery.  This surgery had an incision of approx. 8 inches and the doctor also removed six lymph nodes of which two were cancerous.  They did a third surgery a nd removed the remaining nodes from under his left arm and these were clear.  

We began Interferon daily infusions for a month.  After which we did self injections onMonday, Wednesday, and Friday for eleven months.  During this time we went through PET and CT scans, Ultrasounds and MRI's and dropped approximately 30 lbs.  He went from a 44 waist pants to 36 and those are starting to fall off him.  We also went through stages of fainting.  No cancer could be detected, but the did see what looked to be an approx. 2 cm lesion on his liver.  They didn't seem too worried about it back in Apr 2014. We did weekly, then monthly bloodwork during which his WBC numbers dropped from 11.2 to 1.4.  We finally finished the injections (Jul 2014) and had yet another PET scan that showed nothing. His WBC was coming back up, 4.9.  We thought we were good to go. 

Late in Aug 2014, my husband started developing upper right abdominal pain.  We saw our family physician as directed by the Oncologist and was told she suspected it was from a pulled muscle.  Not really sure how he could have since he really wasn't doing anything to pull a muscle, but she ordered another ultrasound to rule out the gallbladder.  Low and behold, he had a polyp and sand in his gallbladder. But the worse was yet to come.  His doctor went from a pulled muscle to you better get to your surgeron to have your gallbladder out ASAP and have them look at your liver while they are there. There was a lesion of about 5 cm on his liver.  Ok, I'm not a doctor but from 2.3 cm in April to 5 cm in August, that bothered me.

October 2014, they removed his gallbladder and did a biopsy on his liver which turned out to be metaststic melanoma stage IV. They ordered a MRI of his abdomin and it came back with an inoperable 6 x12cm melonoma on his liver.  The thing is very aggressive.  He started Yervoy on Nov 7, 2014.  He is very weak, not sleeping but a few hours a day and in lots of pain.  The doctor hasn't given him anything for pain or sleep but I think I will push for it to give him some comfort.  

I know my story is long but wanted to share in case it could help someone else.  They haven't told us how much time he has, but I can see his color change on a daily basis, his weight go down and his mood is bitter and rude.  He was never this way before.  I am scared out of my mind for him.  Will continue to post his progress through the Yervoy treatment.

joelcairo
Posts: 9
Joined: Mar 2013

Sorry to reply a month later, but I don't usually come by this board. Hepatic mets are very common in uveal melanoma, which has some similarities to and some important differences from cutaneous melanoma. The most notable difference is that UM rarely if ever shows the BRAF mutation. I assume your husband is negative for that?

What I would suggest is targeting the liver rather than relying on any systemic treatment. Or since he is on Yervoy, continue this and employ a liver-targeted therapy as well. These include such treatments as chemo-embolization, immuno-embolization, radio-embolization, isolated hepatic perfusion, percutaneous hepatic perfusion. If none of these can be arranged, then a less effective approach is tumor ablation, for example via radiofrequency or high-intensity ultrasound. A final and more experimental approach could be intratumoral injection of a cytotoxic or immunogenic substance.

There are also some new MEK pathway inhibitors that may have some effect even if there is no BRAF mutation. I can't really speculate about their benefits in cutaneous melanoma, but they do show effectiveness in some situations so they could be worth investigating.

Hope this proves to be of some value.

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