Thread: MELANOMAS, The Woman Who Survived Five Melanomas

Meet the woman who survived five melanomas - Telegraph


Recent advances mean that most people now survive melanoma, but it is still the leading killer of younger women

Justine Sheils has a large scar on her scalp, three more on her chest and a hole the size of an ice-cream scoop between her breasts – all from surgery she has undergone in recent years to remove malignant tumours.

Yet the vivacious 42-year-old from Liverpool considers herself lucky. After years of intensive sunbathing, she has survived malignant melanoma, the most virulent of all the skin cancers.



She is not alone. Promising advances in melanoma treatments mean that doctors are starting to outsmart this lethal disease, the fifth most common cancer in Britain. More than eight in 10 people with malignant melanoma now survive it, compared with about half this number in the early Seventies, according to new figures from Cancer Research UK.

“Melanoma is a horrible disease if it takes hold – the writer Solzhenitsyn called it the 'queen of tumours’,” says Dr Niall Wilson, consultant dermatologist at the Royal Liverpool and Broadgreen University Hospitals NHS Trust. “For oncologists, it used to be a disaster area; there were no treatments that worked. But there have been very exciting developments in understanding melanoma and in developing new approaches.”

Justine, an administrator for the NHS, had hardly heard of melanoma when in 2005 she noticed a small lesion between her breasts. “I’m a keen runner, and I thought it was caused by my running bra, so I left it for about 15 months. One day, I called in at the GP to pick up a routine prescription and saw a leaflet with a picture of a melanoma. It was a mole and it looked identical to the lesion on my chest.”

Justine was urgently referred to a consultant dermatologist, whose first question, she says, was whether she used sunbeds. “He told me the skin on my chest resembled that of an 80-year-old.

“In those days, I used sunbeds all year round to get a base tan before going on holiday, and then to top up afterwards,” she recalls. “But I also sunbathed as a young girl, when I was taken to Spain and France by my parents, for two or three holidays a year.

“Later, in my twenties, the fashion was to have a deep tan. I had fair skin but I sunbathed using coconut oil. We didn’t know about the dangers then.”

Removal of the mole and a biopsy revealed that she had a malignant melanoma which had grown through the surface layers of skin to attach to the breast muscle. “They told me I was very lucky. Had I left it three weeks longer, I would have had to have both breasts removed.”

She had an operation called a wide local excision, in which skin and tissue from the area around the melanoma, down to the level of the muscle, is removed to ensure no abnormal cells have been left behind. Surgeons also removed a further cancer on Justine’s back, although, thankfully, a biopsy of her lymph nodes found no evidence that the disease had spread.

Six months later she found an open sore on her scalp, which proved to be another cancer.

“The consultant removed it but it had grown quickly – I woke up with a large hole in my head and they grafted muscle from my stomach to rebuild it. The scar is the size of a golf ball.” Since then Justine has had three further melanomas removed from the chest area – the last one, in June, taken off the top of her left breast.

“I have been upset by all the scarring, especially the last one. The dermatologist said the damage had been done years before,” she says. “I now go for three-monthly check-ups. It has been a horrible experience – but at least I am here to tell the tale.”

Nearly 13,000 people are diagnosed with malignant melanoma annually – four times higher than 30 years ago. Cancer experts say that, as with other, less dangerous skin cancers (called squamous-cell and basal-cell carcinomas), this is mainly due to the advent, 30 years ago, of cheap package holidays and the “concentrated sun exposure”, they have provided for Brits obsessed with getting a tan. Sunbed use is known to increase the risk.

“This disease affects young people disproportionately – it is the leading killer of women between 25 and 39, taking account of all causes,” says Prof Richard Marais, director of Cancer Research UK’s Paterson Institute for Cancer Research, at the University of Manchester.

Melanoma develops, he says, when UV rays cause DNA damage to skin cells called melanocytes, which then grow rapidly, invading the collagen barrier beneath the surface of the skin. “Melanoma is more lethal than other skin cancers because it is highly migratory and very aggressive. It’s not the cancer cells in the skin but the rapid spread to other organs which kills patients.”

One reason for the improvement in survival rates is greater public awareness of melanoma, which in turn has led to earlier diagnosis: as with most cancers, if a melanoma is caught in the early stages, when it can be removed with surgery, the chances of survival are higher. The two-week rule – whereby anyone going to their GP with a suspicious lesion gets an urgent appointment with a specialist –has also helped, says Dr Wilson.

“And nowadays most melanoma surgery is carried out by specialists – dermatologists or plastic surgeons – rather than general surgeons, with research showing they have better outcomes.”

Improvements in surgical techniques have also been a key factor in better survival rates, with guidelines in place to advise surgeons on precisely how much “normal” tissue should be removed at the margins of a cancer, according to its thickness (usually measured by a system called the Breslow scale).

“Melanoma cells tend to migrate some way from the original site – even when there is an early diagnosis – and surgeons have always found it difficult to know how much tissue to remove,” says Prof Marais. “Now we know that the thickness of the tumour is an important indicator of how far cells have migrated.” Sentinel node biopsies, performed routinely on any patient whose melanoma is thicker than 1mm, also give a more precise idea of the risk of spread.

For those with advanced disease, the discovery by scientists of a mutation on a gene called BRAF V600, carried by about half of all melanoma patients, has led directly to the development of the first new treatment for melanoma for over a decade – a biological drug called vemurafenib, which blocks the BRAF protein that makes cells divide.

“Used alone, verumafenib extends the lives of those with hbhb melanoma by about seven or eight months,” says Prof Marais. “Used in combination with another biological drug called trametinib, which blocks another protein activated by BRAF, it can extend life by 12-14 months.”

Trametinib is only approved in the US, although Prof Marais is hoping the combination treatment will soon be available here.

A third drug called ipilimumab, a monoclonal antibody which triggers the immune system to attack cancer cells, has even been found to “cure” some people with advanced melanoma (a cure being defined as being symptom-free at five years).

These types of drugs are used for several cancers, but are particularly valuable for melanoma, where conventional anti-cancer drugs and radiotherapy have poor response rates.

Prof Marais points out that the disease still causes 2,500 deaths annually, but he is optimistic. “Previously drug developers were reluctant to do clinical trials because melanoma was thought untreatable. Now it’s become the poster child of targeted therapy,” he adds. “Seeing the effect of these new drugs in people who previously didn’t respond to treatment, it’s difficult to convey how exciting that is.”

Nowadays, Justine takes holidays abroad in the spring or autumn, rather than high summer, religiously follows textbook advice about covering up and staying in the shade between 11am and 3pm, and uses factor 30 sunblock.

The tan culture still exists, she says, and certainly in Liverpool. “There is a lot of pressure on young girls to tan, what with the Wag culture and reality TV.”

She has been enjoying this glorious summer – but in moderation. “I still like sunny weather, but I don’t want any more pieces taken out of me.”


THE DAILY TELEGRAPH

Malignant melonoma is something i can relate closely to, having being diagnosed in February of this year (several tumours appearing on my scalp).

6 months of care and treatment followed in the UK (NHS) where during initial meetings with specialists i was informed that i had advanced melanoma (stage 4) and that my days were indeed numbered.

Despite the prognosis, 3 CT scan's have failed to establish any spread of cancer cells to my major organs or lymph nodes and i continue to fuction perfectly well.

Originally Posted by taxexile

“Melanoma cells tend to migrate some way from the original site – even when there is an early diagnosis – and surgeons have always found it difficult to know how much tissue to remove,” says Prof Marais. “Now we know that the thickness of the tumour is an important indicator of how far cells have migrated.” Sentinel node biopsies, performed routinely on any patient whose melanoma is thicker than 1mm, also give a more precise idea of the risk of spread.

The melonoma had grown into the fat layer 3 months after appearing but i still have no signs of cell spread although the risk clearly remained. I would have preferred surgical removal as a first option although the specialists believed that treatment would be more beneficial.


The Clark scale

You might hear your doctor talk about Clark levels. This is a way of measuring how deeply the melanoma has grown into the skin and which levels of the skin are affected. You can see the main layers of the skin in this diagram.




Here are what the different levels of the Clark scale mean

• <LI abp="781">Level 1 is also called melanoma in situ – the melanoma cells are only in the outer layer of the skin (the epidermis) <LI abp="782">Level 2 means there are melanoma cells in the layer directly under the epidermis (the papillary dermis) <LI abp="783">Level 3 means the melanoma cells are throughout the papillary dermis and touching on the next layer down (the reticular dermis) <LI abp="784">Level 4 means the melanoma has spread into the reticular or deep dermis
• Level 5 means the melanoma has grown into the layer of fat under the skin (subcutaneous fat)

It is important not to confuse Clark levels with the TNM stage or number stage (described lower down this page). The Clark levels only look at the depth of melanoma cells in the skin. The number stage is looking at whether the melanoma has spread to lymph nodes or another part of the body.


Stages of melanoma : Cancer Research UK : CancerHelp UK


If you refer to the Berlow Scale in the above attachment i was unable to comprehend how the medics concluded that i had advanced melanoma. Indicators were that i had Stage 2 although following lengthy discussions with the team and with no surgical removal being planned i was aware of remaining at risk of further spread so opted for the treatment plan.

A 3 week course of Chemotherapy didn't prevent other satellites appearing on my scalp so i was placed on a 12 week course of Ipilimumab (Immunotherapy) whilst also receiving 50 doses of radiation to the tumours over a period of 6 weeks.

A final body scan in August revealed that all was still well and with much persistance from myself the professor agreed to arrange surgical removal. I fear that i will have some serious evidence of surgery on my scalp as a result although more importantly i will have peace of mind and will be able to move on with my life with regular checks being the norm for the next 2 years or more.

Keeping an eye on things during the current 4 months break from treatment before returning to the UK for decapitation.