The 2012 edition of The Skin Cancer Foundation Journal features medically reviewed, reader-friendly articles such as tanning, the increasing incidence of skin cancer diagnoses among young women, & the prevalence of melanoma among white males over 50.
HEALTH
biopsy of the local lymph nodes (to see if the cancer had reached them), part of my parotid (saliva) gland removed, and the left side of my face reconstructed by my plastic surgeon. The new biopsies found no melanoma cells, but due to the staging and depth of the melanoma, I required extensive follow-up, so I was referred to a melanoma specialist at Johns Hopkins Hospital. Dr. Sharfman, who reviewed
my case, said I could do nothing or have a year-long course of inter- feron (a type of "immunotherapy" or biologic therapy that harnesses and increases chemicals naturally occurring in the body to attack the cancer). Injectable interferon (IFN) alpha-2b is the only drug with FDA approval to treat high-risk Stage II and Stage III melanomas. Or, I could join a clinical trial of
a melanoma vaccine that might help prevent a recurrence. Dr. Sharfman recommended the last option. The National Institutes of Health in Bethesda, Maryland, was recruiting patients, and the NIH is near where I live. I was enrolled in the vaccine trial in
2008, but when the treatment ended, it appeared that the melanoma had returned and probably spread to my lungs, where it would be inoperable. To confirm this, I had to wait three long months for another lung scan, and every minute of every day I thought about my disease. Unfortunately, the second set of CT scans confirmed that I had metastatic (spreading) melanoma that had reached my lungs. I was now a stage IV cancer patient, with the most advanced form of the disease.
I was referred back to Johns Hopkins Hospital
for interleukin-2
(IL-2) treatment, another immuno- therapy that stimulates the immune system to attack the melanoma. Until recently, in fact, IL-2 ("Proleukin") was the only FDA-approved im- munotherapy used to treat Stage IV metastatic melanoma; it has saved the lives of some, but not most, patients. Two rounds of IL-2 did not cure me.
I was now out of traditional treatment options, so I was directed to a clinical trial for a new experimental treatment. My "Hail Mary" treatment was a drug called ipilimumab, now also known as Yervoy. Yervoy is an immune protein that binds to a molecule
treatment, the lung X-rays showed that the largest of the tumors had completely disappeared and the other tumors were shrinking. I continued, receiving an infusion of ipilimumab every three weeks, and CT scans every 12. At every appointment, scans showed that more tumors had disap- peared, and finally I was cancer-free. Ipilimumab was approved by the
The melanoma had returned and probably spread to my lungs, where it would be inoperable.
called CTLA-4 and inhibits it from functioning. CTLA-4 is a kind of brake on the immune system that keeps it from over-functioning. By blocking it, ipilimumab kicks the immune system into higher gear to identify, attack and eliminate melanoma cells. I started the clinical trial in
September, 2009, almost one year after my initial diagnosis. At the end of the initial stage of the trial, I had more CT scans of my chest, and the results showed miraculous changes. I had begun the trial with six lung tumors, but after the first round of
FDA on March 25, 2011 for the treat- ment of advanced melanoma. I have been cancer-free for two years now, and it is a blessing for me to be part of such a significant breakthrough. I am back working, and happy to be a "real" person again — a father, husband, and state trooper who no longer spends every conscious moment wondering how long I have left. Cancer has a way of intruding into everything you think and do. But now, when I go to work, I have the opportunity to help care for someone who needs my help.
BOBBY HARSH is a flight paramedic and state trooper with the Maryland State Police. He lives with his wife, Donna, and their children in Williamsport, MD.
THE STAGES OF MELANOMA
IN SITU: The melanoma is superficial and has not invaded the skin.
STAGE I: The melanoma has invaded the skin, but is not more than 1 mm thick.
STAGE II: In general, the melanoma is at least 1 mm thick, but has yet to spread.
STAGE III: The melanoma has spread from the original tumor site, either to the local lymph nodes or to the skin between the primary tumor and the nearby lymph nodes.
STAGE IV: The melanoma has spread to distant lymph nodes, limbs, or internal organs.
Left to right: Harsh at work; The Harsh family at home 58
SK IN CANCER FOUNDAT ION JOURNA L