Vivian W. Bucay, MD
Clinical Assistant Professor
Dept of Physician Assistant Studies
University of Texas Health Science Center - San Antonio, TX
"As a dermatologist in clinical practice since 1991, I have had many opportunities to make a positive impact on patients' lives by being the first to diagnose and treat skin cancers, above all nonmelanoma skin cancers. Fortunately, almost every patient has had a good outcome, primarily because of early diagnosis and intervention. Like most dermatologists, I understand that if I encounter high-risk melanoma or advanced disease, clinical management will most often become the responsibility of surgical and medical oncologists, while I will navigate shallower waters, such as screening family members and reviewing pertinent but often confusing literature to assist the patient and family in making important decisions regarding treatment.
I have gained quite a new perspective on melanoma, however, since becoming an advanced melanoma patient myself in 2006. I have previously chronicled my personal battle with the disease twice before, first in San Antonio Medicine, a publication of the Bexar County Medical Society, in an issue dedicated to the physician as patient,1 and second, in the 2008 Skin Cancer Foundation Journal, a publication targeted to the lay public.2
My purpose in this issue of The Melanoma Letter is twofold: to present treatment options for Stage III and Stage IV melanoma in the manner in which they became relevant for me, and to emphasize that good outcomes are not only possible, but becoming more attainable every day despite seemingly unfavorable odds.
DIAGNOSIS
On May 5, 2006, I asked my physician assistant (PA) to look inside my umbilicus to see whether or not she noticed anything unusual; I had noticed a white "residue" that appeared on dark clothing. There was no itching, bleeding, or tenderness, just a whitish discharge that had appeared intermittently for the previous few weeks. I had no recollection of any existing abnormality in the region, keeping in mind that I had seen my umbilicus at its peak convexity during each of my three pregnancies. Nonetheless, as I mentally reviewed the differential diagnosis — psoriasis, eczema, seborrheic dermatitis — melanoma was not on the list while I was undergoing a routine shave biopsy; my PA chose to do the biopsy for safety's sake despite noting nothing unusual herself.
So we were both surprised when we received the diagnosis by phone on May 10 from the dermatopathologist to whom I routinely send my patients' biopsies: amelanotic malignant melanoma, possibly metastatic. I suspected (or hoped) that it was a false positive produced by using a shave specimen rather than a full excisional biopsy. However, there was no error in the diagnosis, as immunohistochemistry proved positive for S-100, HMB-45, and MART-1."
The rest can be found at Surviving Advanced Melanoma..A DERMATOLOGIST'S PERSONAL PERSPECTIVE
I am amazed how similar my treatment and Dr. Bucay's was, and how we had the same outcome NED. This reinforces my scientific theory on the combination of the two treatments.
I am in the process of trying to get in touch So we can compare time lines.
Take Care,
Jimmy B
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