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Of Mobs and Moles

Posted by on May 29, 2011 in Immunotherapies (IL-2, IL-15, PD-1s, etc.), MDX-1106, My Health Updates - 1 Comment

 

Something weird happened on the way to my cancer treatment. I got another cancer. Maybe. Well, maybe not. We’re not sure. We’re going in for a biopsy of a rogue mole next week. It has the telltale signs of skin cancer.

Dena and I have been watching the mole for a few weeks now, trying not to be paranoid. Which says a lot, as I am generally a paranoid person. As I’ve noted in this blog many a time, I’m paranoid that Dena may be trying to kill me in my sleep, call it cancer, and collect the life insurance. Luckily I have convinced her that gunshot wounds or head trauma generally rule out carcinomas as the cause of death during autopsies. But that might have worked against me, because it looks like she might have somehow managed to sneak in another cancer on me, clever girl.

We decided to raise the suspicious mole with the oncology team during the last exam, casually so as not to unduly raise alarm bells. Hi, doc, I’m feeling really great. Yes, energy level’s okay. No nausea to speak of. No new pain, just the ongoing back pain. No dizziness. Weight’s stable. Nope, really still no significant side effects to speak of at all except maybe a little melanoma. Man, it was really hot driving in today. I guess summer’s coming on strong, huh? How’re your kids? … What? Did I say melanoma? I don’t know, did I? Haha, whaddya know, I guess I did.

So, I showed them the mole. Actually, showed them a picture I took of it. (I like to think I’m a team player when it comes to gathering evidence for the trial notes.) At the hospital, they took out a little tape ruler and measured it. Somebody mentioned the ABCDs of melanoma, referring to the following classic approach to detecting potential melanoma:

To detect melanomas (and increase survival rates), review the “ABCD” mnemonic (below) and be aware of moles and any changes (shape, size, color, itching or bleeding); show any suspicious moles to a dermatologist:

  • Asymmetrical skin lesion.
  • Border of the lesion is irregular.
  • Color: melanomas usually have multiple colors.
  • Diameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.
  • Enlarging: Enlarging or evolving

Dena and I both tried to use the mnemonic as a guide but quickly gave up, as neither of us can pronounce it. That said, the suspicious mole is asymmetrical; has irregular borders; has variegated colors; is larger than 6 mm; and is enlarging and evolving. It has also bled on more than one occasion.

Kind of freaky how much the mnemwhatever lines up with the characteristics of my mole. My friend Amy, a melanoma specialist, suggested getting it biopsied. Of course, she couldn’t say anything conclusive by simply examining the photo I sent her. (She did, however, recommend that I stop sending pictures of my mole all over the country, as it’s disturbing).

Getting back to our Hopkins team, the suspicious mole sparked some vigorous debate at some kind meeting of the oncologists and radiologists and pathologists who are running the trial.

“You were the subject of much debate this week,” Fabulous Alice informed me when I arrived for my Thursday infusion.

I was vainly pleased to know that I was the subject of discussion at a meeting of the cancer trial team Bigs, but also curious to know that there is such an anonymous team making such all-powerful decisions behind closed doors. Probably with a delicious plate of donuts and muffins. I’m convinced that the group is a mob front; they are the oncological equivalent of the original Mafia Commission set up by Charlie Lucky Luciano back during the days of Prohibition. Disputes between the mob families were settled by the Commission, which was comprised of the godfathers of the five most powerful mob families. Carlo Gambino, Vito Genovese, Tommy Lucchese, and so on – each of these feared mob bosses had a seat at the table, with Luciano sitting at the head of the table as the capo di tutti capi – or Boss of Bosses. Whatever decision they made had to be accepted – otherwise, you’d get whacked.

We face the same situation here, I’m pretty sure – with the Godfather of the kidney cancer family (Dr. Charles Drake) at the table along with the heads of the other families – the Melanoma Mob and the Lung Cancers Crew – all under the Luciano of the Mederex Syndicate, the Principal Investigator of the entire trial, Julie Brahmer, the capo di tutti capi. They would make a final decision, and if any of the oncologists didn’t go along with it they’d be found sleeping with the fishes.

The Commission debate was whether we should ignore the mole on the assumption that it wasn’t malignant or get the mole biopsied. Some wanted to monitor the mole but not go down any rabbit holes unnecessarily by getting it biopsied at this early stage. The rationale was that even if the mole were malignant, even if it were melanoma, it’s in its early stages – and Stage IV kidney cancer is the far greater threat than early stage skin cancer. Moreover, as noted, the trial drug – MDX-1106 – is also being used to treat melanoma and could be attacking the lesion.

The other faction argued that the lesion had to be biopsied, period. There was a need to know, first, exactly what we’re dealing with and, second, to acquire data that might provide valuable insights for the study. For example, maybe the growth is necrotic, signs that the MDX-1106 is working. Could this show that the drug was working on two different cancers at once? Maybe the mole had nothing to do with skin cancer at all but was a hideous infection resulting from my two-year-old’s decision to stab me in the neck with a No. 2 pencil just to see what would happen. (Yes, Josie’s notoriety precedes her, even at Johns Hopkins. She is the Luca Brasi of the oncology Commission.)

Alice informed me that the decision was made that we need to get a biopsy of the mole, and soon. So we’re going to schedule something next week.

“You don’t think I’m gonna get whacked, do you?” I asked her.

“What?”

“You know, the Commission can’t afford to have me messing up the trial data. Better to get rid of any witnesses.”

Alice denied the existence of any “Commission,” of course. You think Carlo Gambino admitted to the Mafia? You think John Gotti would blab about La Costra Nosa and break the code of omerta? Hell no, he was “just a businessman.” Anybody who admitted to the existence of the mafia or the all-powerful Commission ended up taking a swim in the river with cement shoes, and Alice is a good soldier – a made man, so to speak, in the JHU Crime Family. She’s not gonna talk. When I told her I was on to her, she just looked at me and blinked.

“So we’ll schedule a biopsy for next week,” she said.

“A biopsy, huh,” I said. I was careful to use air quotes. “With a surgical knife right up against my jugular, where the mole is conveniently located.”

“Uhhh, yes. We’ll have Derm do the biopsy.”

“Derm? Is that like Tommy Three Fingers? Is he a contract killer?”

“Dermatology. They will do the biopsy because this is a skin lesion.”

She had an answer for everything. Leave the gun; take the cannoli.

So next week, I go in for a “sit-down” with Derm. If you’ve seen “Donnie Brasco” with Al Pacino and Johnny Depp, you know what this means. If I don’t end up with an Italian necktie dumped in the Everglades, I’ll report back here with the results of the biopsy as soon as I know more.

Our hope is that there won’t be much to report.

And that I won’t get whacked.

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