Question about melanoma recurrence

Hi Trisha,

Unfortunately my husband is going through something similar right now.  He had a tumor removed from his neck in June and has been undergoing Interferon treatments.  This past week he had another bump that has appeared very close to where the previous tumor was removed.  His oncologist thought it was an infection but he met his surgeon today and he isn't too sure about that.  He had a needle biopsy done today and a ct scan is scheduled later this week and we meet the Dr. again next Tuesday.  It is going to be a very long wait….I will let you know what we find out…please do the same.

Thanks,

April

Hi Trisha,

Unfortunately my husband is going through something similar right now.  He had a tumor removed from his neck in June and has been undergoing Interferon treatments.  This past week he had another bump that has appeared very close to where the previous tumor was removed.  His oncologist thought it was an infection but he met his surgeon today and he isn't too sure about that.  He had a needle biopsy done today and a ct scan is scheduled later this week and we meet the Dr. again next Tuesday.  It is going to be a very long wait….I will let you know what we find out…please do the same.

Thanks,

April

Trisha, Sorry to read about your dad's deep tumour. I assume that it was over 4mm in depth, but I am not sure what you mean by the 11cm measurement. If you can fill in some details on the profile page for him, that would help us to help you better.

Once any melanoma cells enter the bloodstream they can spread throughout the body. Unfortunately, melanoma is unpredictable in what it does and nobody can say for certain what it is going to do in any individual.

If you have a copy of the pathology report, it would be an idea to tell us what it says. Perhaps you could scan it and paste some details in your next post?

As melanoma can recur and spread quickly, CT and PET scans are normally recommended in order to get an accurate assessment of what is going on.

Hope this helps.

Frank from Australia

Trisha, Sorry to read about your dad's deep tumour. I assume that it was over 4mm in depth, but I am not sure what you mean by the 11cm measurement. If you can fill in some details on the profile page for him, that would help us to help you better.

Once any melanoma cells enter the bloodstream they can spread throughout the body. Unfortunately, melanoma is unpredictable in what it does and nobody can say for certain what it is going to do in any individual.

If you have a copy of the pathology report, it would be an idea to tell us what it says. Perhaps you could scan it and paste some details in your next post?

As melanoma can recur and spread quickly, CT and PET scans are normally recommended in order to get an accurate assessment of what is going on.

Hope this helps.

Frank from Australia

Hi Trisha,

I am very sorry to hear about your dad!

As much as I know, melanoma can really spread fast, so pay attention to any changes that occur. Maybe your dad should combine chemo with medicine which would improve his immune system and activate the healthy cells (something like virotherapy or alternative medicine), cuz the most important thing through recovery is to strengthen the body in order to effectively undergo treatment. From the experience with my cousin, her worst fear was of cancer coming back once it was seemingly gone. In her case she combined radio plus virotherapy in order to get rid of nasty side-effects of radio and to be sure that no malignant cell would appear. Anyhow, maybe consult your doctor about such possibilities.

Wishing you and your father all the best!

Hi Trisha,

I am very sorry to hear about your dad!

As much as I know, melanoma can really spread fast, so pay attention to any changes that occur. Maybe your dad should combine chemo with medicine which would improve his immune system and activate the healthy cells (something like virotherapy or alternative medicine), cuz the most important thing through recovery is to strengthen the body in order to effectively undergo treatment. From the experience with my cousin, her worst fear was of cancer coming back once it was seemingly gone. In her case she combined radio plus virotherapy in order to get rid of nasty side-effects of radio and to be sure that no malignant cell would appear. Anyhow, maybe consult your doctor about such possibilities.

Wishing you and your father all the best!

Hi Trisha,

I am very sorry to hear about your dad.  It sounds like he is going through a similar situation like my father.  My father also has acral melanoma, which started from the bottom of his right heel.  He had surgery to remove the tumor and it came back about a year later. He now has alot of lesions on his right calf and some on hisi upper thigh and groin area.  I dont know whether your father's tumor is a recurrence or not but I would think it is a good idea to have it check out and explore treatment options.  When my dad had surgery to remove his tumor, the surgeon didnt think my father was in good enough condition to start treatment right away.  And unfortunately, it came back.  In retrospect,we should have been more aware that there is a chance that it could recur. I have read that melanoma does tend to recur.  My father just started his first dose of Yervoy(IPI) last week.  I hope this helps. 

Chau

Hi Trisha,

I am very sorry to hear about your dad.  It sounds like he is going through a similar situation like my father.  My father also has acral melanoma, which started from the bottom of his right heel.  He had surgery to remove the tumor and it came back about a year later. He now has alot of lesions on his right calf and some on hisi upper thigh and groin area.  I dont know whether your father's tumor is a recurrence or not but I would think it is a good idea to have it check out and explore treatment options.  When my dad had surgery to remove his tumor, the surgeon didnt think my father was in good enough condition to start treatment right away.  And unfortunately, it came back.  In retrospect,we should have been more aware that there is a chance that it could recur. I have read that melanoma does tend to recur.  My father just started his first dose of Yervoy(IPI) last week.  I hope this helps. 

Chau

Hi Trisha,

I am so sorry to hear about your dad.  My husband is also battling a recurrence of melanoma.  The first episode was in March 2010 when he had a tumor taken off of his neck (really deep but I forget the actual measurements).  At that time the sentinel node biopsy came back clear and the pet scan came back  clear also.

In April of 2011 he developed a hoarse throat and what we thought was the respiratory stuff going around at the time.  Chest exrays showed five tumors in his lungs and multiple tumors in his chest area.

Has your fathers oncologist mentioned trying your dad on yervoy or testing him for the braf600 mutation gene for the new treatment , zelobraf, that is given by pill?  My husband tested negative for the braf gene but took four treatments of yervoy and his latest ct scan only showed two tumors in his lungs that are less than a cm each and nothing else in the chest.  He has another scan  in November to see if that one showed correctly

I certainly know some of what you are going through and I wish the best for you and your dad. 

Kay

Hi Trisha,

I am so sorry to hear about your dad.  My husband is also battling a recurrence of melanoma.  The first episode was in March 2010 when he had a tumor taken off of his neck (really deep but I forget the actual measurements).  At that time the sentinel node biopsy came back clear and the pet scan came back  clear also.

In April of 2011 he developed a hoarse throat and what we thought was the respiratory stuff going around at the time.  Chest exrays showed five tumors in his lungs and multiple tumors in his chest area.

Has your fathers oncologist mentioned trying your dad on yervoy or testing him for the braf600 mutation gene for the new treatment , zelobraf, that is given by pill?  My husband tested negative for the braf gene but took four treatments of yervoy and his latest ct scan only showed two tumors in his lungs that are less than a cm each and nothing else in the chest.  He has another scan  in November to see if that one showed correctly

I certainly know some of what you are going through and I wish the best for you and your dad. 

Kay

Trish, Chau

For melanomas that start on the bottom of the foot, they are likely to be Acral lentiginous melanoma. 

My melanoma  is c-kit mucosal melanoma.  I went from clear lungs in a mid Jan 2007 PET/CT scan to having innumerable lung tumors in a late Feb 2007 Lung CT scan. I was essentially stable on IL-2 for 20 months.  Then had innumerable additiional new lung tumor between Dec 2008 and March 2009 and additional tumors elsewher.  Inspite of the lack of approval for Gleevec by the FDA for melanoma, My Melanoma specialist, based  on the one published peer reviewed publication of Gleevec working on c-kit (and work being done by Dr Wen Jen Hwu at MDA), prescribed it off-label for me.  My tumors became stable within 30 days and have remained stable for another 2 1/2 years.  

   Since that time there has been much more work and trials fo drugs targged at the C-kit mutations.  I strongly recommend getting the oncoprotein stain test (The first test for c-kit – can be done by any local lab).  If positive, a c-kit mutation test can be conducted by a specialized lab.

Below is information about drugs that help when one has the c-kit oncoprotein overexprssion and the c-kit DNA mutations.

http://mmdm.cancercommons.org/ml/index.php/C-KIT

Activating c-KIT mutations have been implicated in a variety of cancers (Lennartsson 2005) starting with GIST (Gastrointestinal stromal tumors) and CML (Chronic Myelogenous Leukemia). Because of this, there are both approved drugs and drugs in clinical development that target c-KIT including Imatinib, Sunitib, Nilotinib and Dasatanib.

In 2006, Boris Bastian's group conducted a systematic study evaluating the frequency of c-KIT aberrations in melanoma and found mutations and/or copy number increases in 39% of mucosal, 36% of acral and 28% of melanomas on chronically sun-damaged skins but not in melanomas on skin without chronic sun damage (Curtis 2006). Several additional studies have investigated frequency of c-KIT aberrations since and are summarized below. Also, 30% of melanoma with c-KIT mutations also show increased copy number/amplification of c-KIT.

c-KIT is increasingly considered a leading therapeutic target for melanoma. So far, supporting data has primarily come from case reports and small studies (Hodi 2008, Lutzky 2008, Satzger 2010). However, both approved and new drugs are being testing in melanoma with c-KIT aberrations and results are awaited

Drugs Targeting C-Kit

	Drug Class	Company	HasDevelopmentStatus	Clinical Trial
Dasatinib	C-KIT inhibitors	Bristol-Myers Squibb	Approved for chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL)	NCT01092728 NCT00436605 NCT00597038 NCT00792545
Gleevec	C-KIT inhibitors	Novartis	Approved for Philadelphia chromosome–positive chronic myeloid leukemia (Ph+ CML), Kit (CD117)–positive gastrointestinal stromal tumors (GIST)	NCT00424515 NCT00470470 NCT00667953 NCT00881049 NCT00421317 NCT01046487
Sutent	C-KIT inhibitors	Pfizer	Approved for advanced kidney cancer and Gleevec-resistant GIST	NCT00631618 NCT00577382 NCT00859326 NCT01216657 NCT01005472 NCT00489944
Tasigna	C-KIT inhibitors	Novartis	Approved for drug-resistant Chronic Myeloid Leukemia (CML)	NCT00788775 NCT01168050 NCT01028222 NCT01099514

Relevant Subtypes: Subtype 2.1

Relevant Trials:

Trials	Status	Title
NCT00421317	Recruiting	Imatinib in Adult Patients With Metastatic Ocular Melanoma
NCT00424515	Recruiting	Imatinib in Patients With Mucosal or Acral/Lentiginous Melanoma
NCT00436605	Active but not recruiting	Dasatinib in Treating Patients With Stage III Melanoma That Cannot Be Removed By Surgery or Stage IV Melanoma
NCT00470470	Recruiting	Imatinib Mesylate in Treating Patients With Stage III or Stage IV Melanoma That Cannot Be Removed by Surgery
NCT00489944	Recruiting	Sunitinib, Tamoxifen, and Cisplatin in Treating Patients With High-Risk Ocular Melanoma
NCT00577382	Recruiting	SU011248 in Patients With Metastatic Mucosal or Acral/Lentiginous Melanoma
NCT00597038	Active, not recruiting	A Phase I/II Study of Dasatinib and Dacarbazine
NCT00631618	Recruiting	Clinical Trial of Sutent to Treat Metastatic Melanoma
NCT00667953	Active not recruiting	Study of Temzolomide and Gleevec in Advanced Melanoma
NCT00700882	Suspended	Dasatinib in Treating Patients With Locally Advanced or Metastatic Mucosal Melanoma, Acral Melanoma, or Solar Melanoma That Cannot Be Removed By Surgery
NCT00788775	Recruiting	Nilotinib in TKI Resistant or Intolerant Patients With Metastatic Mucosal, Acral, or Chronically Sun Damaged Melanoma
NCT00792545	Recruiting	Dasatinib and Bevacizumab in Treating Patients With Solid Tumors That Are Metastatic or Cannot be Removed by Surgery
NCT00859326	Recruiting	Combination of Temozolomide and Sunitinib in Treatment of Patients With Metastatic and Unresectable Malignant Melanoma
NCT00881049	Completed	Trial of Imatinib (Gleevec®) in Selected Patients With Metastatic Melanoma
NCT01005472	Active not recruiting	Temozolomide and Sunitinib Malate in Treating Patients With Stage III or Stage IV Malignant Melanoma
NCT01028222	Recruiting	A Study of AMNN107 Against Dacarbazine (DTIC) in the Treatment of Metastatic and/or Inoperable Melanoma Harboring a c-Kit Mutation (TEAM)
NCT01046487	Recruiting	Imatinib Mesylate And Cyclophosphamide In Metronomic Administration: Dose Escalation Study Of Imatinib Mesylate (PALANGI3)
NCT01092728	Not yet recruiting	Treatment With Dasatinib in Patients With Acral Lentiginous, Mucosal, or Chronic Sun-damaged Melanoma
NCT01099514	Recruiting	Study of Nilotinib in Metastatic Melanoma With KIT Aberrations
NCT01168050	Recruiting	Efficacy of Nilotinib in First or Second Line Treatment of Primary Melanomas Stage III Unresectable Melanomas.
NCT01216657	Recruiting	Trial of Single Agent Sunitinib for Patients With Chemo-refractory Metastatic Melanoma

**********************************************************

Also look at;

http://oncologystat.com/journals/journal_scans/KIT_as_a_Therapeutic_Target_in_Metastatic_Melanoma.html

Even if one does not have the C-kit nor BRAF (they are mutually exlusive) One cannot ubequivalently state that "chemo doesn't touch melanoma."  There are many chemo's that have made some melanoma patients NED or else slowed their disease (Most only in the 1-3% range).  The problem is that they have not yet learned why they work on the few that they do work on.

   IL-2 and Ipi (Yervoy), Immunotherapy treatments (not considered chemo), have  record of helpiing around 20% of across the board melanoma stage IV patients.  Again they don 't know exactly why, but these broad spectrum treatments can be effective for many.  So far IL-2 has the highes long term "remission/cure" rate for about 5% of stage IV patients.

Good luck with the testing.

Trish, Chau

For melanomas that start on the bottom of the foot, they are likely to be Acral lentiginous melanoma. 

My melanoma  is c-kit mucosal melanoma.  I went from clear lungs in a mid Jan 2007 PET/CT scan to having innumerable lung tumors in a late Feb 2007 Lung CT scan. I was essentially stable on IL-2 for 20 months.  Then had innumerable additiional new lung tumor between Dec 2008 and March 2009 and additional tumors elsewher.  Inspite of the lack of approval for Gleevec by the FDA for melanoma, My Melanoma specialist, based  on the one published peer reviewed publication of Gleevec working on c-kit (and work being done by Dr Wen Jen Hwu at MDA), prescribed it off-label for me.  My tumors became stable within 30 days and have remained stable for another 2 1/2 years.  

   Since that time there has been much more work and trials fo drugs targged at the C-kit mutations.  I strongly recommend getting the oncoprotein stain test (The first test for c-kit – can be done by any local lab).  If positive, a c-kit mutation test can be conducted by a specialized lab.

Below is information about drugs that help when one has the c-kit oncoprotein overexprssion and the c-kit DNA mutations.

http://mmdm.cancercommons.org/ml/index.php/C-KIT

Activating c-KIT mutations have been implicated in a variety of cancers (Lennartsson 2005) starting with GIST (Gastrointestinal stromal tumors) and CML (Chronic Myelogenous Leukemia). Because of this, there are both approved drugs and drugs in clinical development that target c-KIT including Imatinib, Sunitib, Nilotinib and Dasatanib.

In 2006, Boris Bastian's group conducted a systematic study evaluating the frequency of c-KIT aberrations in melanoma and found mutations and/or copy number increases in 39% of mucosal, 36% of acral and 28% of melanomas on chronically sun-damaged skins but not in melanomas on skin without chronic sun damage (Curtis 2006). Several additional studies have investigated frequency of c-KIT aberrations since and are summarized below. Also, 30% of melanoma with c-KIT mutations also show increased copy number/amplification of c-KIT.

c-KIT is increasingly considered a leading therapeutic target for melanoma. So far, supporting data has primarily come from case reports and small studies (Hodi 2008, Lutzky 2008, Satzger 2010). However, both approved and new drugs are being testing in melanoma with c-KIT aberrations and results are awaited

Drugs Targeting C-Kit

	Drug Class	Company	HasDevelopmentStatus	Clinical Trial
Dasatinib	C-KIT inhibitors	Bristol-Myers Squibb	Approved for chronic myeloid leukemia (CML) and Philadelphia chromosome-positive acute lymphoblastic leukemia (Ph+ ALL)	NCT01092728 NCT00436605 NCT00597038 NCT00792545
Gleevec	C-KIT inhibitors	Novartis	Approved for Philadelphia chromosome–positive chronic myeloid leukemia (Ph+ CML), Kit (CD117)–positive gastrointestinal stromal tumors (GIST)	NCT00424515 NCT00470470 NCT00667953 NCT00881049 NCT00421317 NCT01046487
Sutent	C-KIT inhibitors	Pfizer	Approved for advanced kidney cancer and Gleevec-resistant GIST	NCT00631618 NCT00577382 NCT00859326 NCT01216657 NCT01005472 NCT00489944
Tasigna	C-KIT inhibitors	Novartis	Approved for drug-resistant Chronic Myeloid Leukemia (CML)	NCT00788775 NCT01168050 NCT01028222 NCT01099514

Relevant Subtypes: Subtype 2.1

Relevant Trials:

Trials	Status	Title
NCT00421317	Recruiting	Imatinib in Adult Patients With Metastatic Ocular Melanoma
NCT00424515	Recruiting	Imatinib in Patients With Mucosal or Acral/Lentiginous Melanoma
NCT00436605	Active but not recruiting	Dasatinib in Treating Patients With Stage III Melanoma That Cannot Be Removed By Surgery or Stage IV Melanoma
NCT00470470	Recruiting	Imatinib Mesylate in Treating Patients With Stage III or Stage IV Melanoma That Cannot Be Removed by Surgery
NCT00489944	Recruiting	Sunitinib, Tamoxifen, and Cisplatin in Treating Patients With High-Risk Ocular Melanoma
NCT00577382	Recruiting	SU011248 in Patients With Metastatic Mucosal or Acral/Lentiginous Melanoma
NCT00597038	Active, not recruiting	A Phase I/II Study of Dasatinib and Dacarbazine
NCT00631618	Recruiting	Clinical Trial of Sutent to Treat Metastatic Melanoma
NCT00667953	Active not recruiting	Study of Temzolomide and Gleevec in Advanced Melanoma
NCT00700882	Suspended	Dasatinib in Treating Patients With Locally Advanced or Metastatic Mucosal Melanoma, Acral Melanoma, or Solar Melanoma That Cannot Be Removed By Surgery
NCT00788775	Recruiting	Nilotinib in TKI Resistant or Intolerant Patients With Metastatic Mucosal, Acral, or Chronically Sun Damaged Melanoma
NCT00792545	Recruiting	Dasatinib and Bevacizumab in Treating Patients With Solid Tumors That Are Metastatic or Cannot be Removed by Surgery
NCT00859326	Recruiting	Combination of Temozolomide and Sunitinib in Treatment of Patients With Metastatic and Unresectable Malignant Melanoma
NCT00881049	Completed	Trial of Imatinib (Gleevec®) in Selected Patients With Metastatic Melanoma
NCT01005472	Active not recruiting	Temozolomide and Sunitinib Malate in Treating Patients With Stage III or Stage IV Malignant Melanoma
NCT01028222	Recruiting	A Study of AMNN107 Against Dacarbazine (DTIC) in the Treatment of Metastatic and/or Inoperable Melanoma Harboring a c-Kit Mutation (TEAM)
NCT01046487	Recruiting	Imatinib Mesylate And Cyclophosphamide In Metronomic Administration: Dose Escalation Study Of Imatinib Mesylate (PALANGI3)
NCT01092728	Not yet recruiting	Treatment With Dasatinib in Patients With Acral Lentiginous, Mucosal, or Chronic Sun-damaged Melanoma
NCT01099514	Recruiting	Study of Nilotinib in Metastatic Melanoma With KIT Aberrations
NCT01168050	Recruiting	Efficacy of Nilotinib in First or Second Line Treatment of Primary Melanomas Stage III Unresectable Melanomas.
NCT01216657	Recruiting	Trial of Single Agent Sunitinib for Patients With Chemo-refractory Metastatic Melanoma

**********************************************************

Also look at;

http://oncologystat.com/journals/journal_scans/KIT_as_a_Therapeutic_Target_in_Metastatic_Melanoma.html

Even if one does not have the C-kit nor BRAF (they are mutually exlusive) One cannot ubequivalently state that "chemo doesn't touch melanoma."  There are many chemo's that have made some melanoma patients NED or else slowed their disease (Most only in the 1-3% range).  The problem is that they have not yet learned why they work on the few that they do work on.

   IL-2 and Ipi (Yervoy), Immunotherapy treatments (not considered chemo), have  record of helpiing around 20% of across the board melanoma stage IV patients.  Again they don 't know exactly why, but these broad spectrum treatments can be effective for many.  So far IL-2 has the highes long term "remission/cure" rate for about 5% of stage IV patients.

Good luck with the testing.