slholmdahl

I have psoriasis and PSA which is fully in remission.

I took low dose methotrexate before melanoma, which was 1a or insitu, depending on which pathologist you choose to believe.

I also have a narrow band UVB light box which I use once a week, before melanoma I used it twice a week.  I have been able to scale the treatment down with no impact on the control of my psoriasis.

After consulting with a Stanford dermatologist and one at UCSF, I am convinced these treatments did not cause the melanoma.  My dermatologist concurs, and I have continued the treatment post my one experience with melanoma, which was five years ago.

In my experience, some doctor’s overreact and say you should not use methotrexate, light or biologics to treat your psoriasis and PSA, if you have had melanoma.

However, they are also serious diseases and can cause severe damage and ruin your quality of life.  Educate yourself and make your own decision,  I consulted doctors outside my main insurance because I was concerned they might limit my treatment no matter what my decision.

Your decision depends on a lot of things the severity of your melanoma, psoriasis and PSA,  If you have control over the psoriasis and PSA.    I personally have chosen to continue to treat without too much concern that these treatments cause melanoma.  Most studies on narrow band UVB and methotrexate indicate they do not increase your risk.  Read, educate yourself, consult outside experts and make your own treatment decision.

My dermatologists were much more helpful than my rheumatologist.

I hope this helps.

 

 

You need to have confidence in your doctor. If you feel like he is doing to many biopsies, by all means find a new doctor. I am almost five years out with with bi-annual skin checks and my doctor never has done a biopsy. There are ranges with each doctor. You have to fee comfortable, if you have doubts try a new dermatologist, someone who has some experience with melanoma.

Mike, I’m so sorry you have to go through all that has transpired. I think you know my opinion of KP, but that said their specialists can be the best in their field.

I hope they put together a plan you are comfortable with and works for you.

You can appeal the denial of your referral. In my experience it takes three appeals to get their attention. I hope it is not necessary but you do have that option in the future.

I hope the pain in your butt is under control soon, literally and figuratively! I hope this plan is the one that brings you success! We are all thinking of you and admire you strength and determination.

Julie,
You have helped me many times by responding to a comment or question. I am very glad you have a plan and I wish you well! Your spirit is strong and you are a shining light for those of here on this board. Keep us posted on your progress.

Peace!

I know you will have a wonderful trip! Hopefully next week will go well. Its good to read your update, sorry about the medical bureaucracy!

No side effects currently. We have slowly lowered the dose and I take 7.5mg a week, the lowest therapeutic dose. At much higher dosages my white blood cell count would drop but that is easily remedied by a dosage adjustment.

(Sue)

Hello,

I have been taking methotrexate for my psoriasis for over ten years.

I was diagnosed with a melanoma insitu over three years ago.

The regimen of once a week methotrexate rarely has much impact on the immune system. It is more a anti-inflammatory action.

My immunologist and dermatologist feel there is no risk in taking the once a week methotrexate. It keeps my skin clear.

Everyone has to make their own decisions regarding medication but I don’t hesitate to take the methotrexate.

There are also some new biologics that attack very specific inflammatory markers, which they also believe are safe to take and do not increase your risk for melanoma.

I’m not a doctor but both my doctor’s are experts and I have put my faith in their opinions.

I hope you find a treatment that works for you.

This is a great summary of how to advocate for yourself with this medical HMO system. I’m sorry Mike that you have to work so hard to get the care you need and deserve. Sorry about the kitty on top of everything else you are going through at the moment. I wish you all the best and I hope things work out for you very soon!

Hello Ed,

Just to be clear I didn’t say it would be a definitive diagnosis, but only used to augment her argument to get a biopsy in the UK. The doctors I was referring to both do happen to be melanoma specialists.

I understand only too well the legal ramifications of giving medical advise as I do practice as a medical malpractice attorney.

Ii will watch the video with interest. It was actually my cousin, who is a dermatopathologist who made the suggestion of a video consult, not as a final diagnosis but as a step in aiding the attainment of a biopsy.

Well here is hoping the spot is gone by the 29th. I definitely understand the anxiety. I have psoriasis so I get new spots randomly, so I truly understand. Good news is my psoriasis is mostly under control, so I have to wait and see if the spots clear with cortisone and act like psoriasis. Sometimes even after having psoriasis for years, I can’t tell w.hat they are. There are so many things that can pop up on your skin

Medical care here can be easy like you described, but it can be hard with some of the HMO’s. My free insurance through my husband, called kaiser would not necessarily biopsy just because I requested it.
However, my current dermatologist, private outside of the HMO, is great and will biopsy if you ask, but is very confident in identifying troublesome spots. He hasn’t found any in the three years since my lovely melanoma popped up in July of 2016.

One suggestion, there are a lot of dermatologists, mine included you can email with a picture and they are fairly good as giving you a diagnosis with good pictures. The cost is I think $60 dollars. It is not definitive, but could be used to augment your argument to your primary care doctor there in the UK, if they felt your sport was a problem. Maybe the dermatologist in Texas would do it for you?

Other than roasting in the heat, all is well.

Sue

This is Sue we have had other conversations here, about melanoma and auto-immune diseases., I think Ed is right, highly unlikely to be anything of concern.

The statistical odds are with you, especially three years out. , I definitely understand your concern given your prior treatment experience.

However, since you have had a previous melanoma, I would hope they are more likely to be concerned, if you are and insist on a biopsy.

I hope the red spot clears and you don’t have to worry about it. I’m still in hot, sunny California and I see you are still in London.

Best wishes! Sue

Hello,

I fully understand the balancing act of having psoriasis and melanoma. At first, I thought I was going to have to stop treating the psoriasis, but that was not the case.

I can’t stress enough, find a doctor you really trust, and who understands and treats both diseases.

I suffered without help, as in medical for about two years after my melanoma diagnosis, and then I found a doctor who backed up my own conclusions about the diseases and my treatment.

I use an abbreviated schedule of narrow band UVB and methotrexate, which is working fo me. Current medical literature seems to indicate no increased risk with these treatments.

I was diagnosed as !a and I think you are more concerned with immunotherapy.
I’m not qualified to answer those questions, but you have given some links to follow, I hope they help, I had some similar questions about balancing the two diseases, and I was helpfully provided a link in my last post, ANGRY Second Opinion! You may find that link helpful.

I truly understand the additional burden of having an auto-immune disease along with melanoma. Reach out if I can help.

Sue

I’m glad it helped! I am well and less bothered by all this most of the time. Still living in California, but have resumed vacationing in Maui, with all the necessary precautions. I hope you are doing well too. London sounds like a nice place to live and I hope you are continuing to enjoy it. There is an author who lives in Texas but writes about England, but has never lived there. Her name is Deborah Crombie and her books are really good. They are mystery, crime thrillers.

Sue