Dr. Roach: No universally accepted level for post-melanoma monitoring

Keith Roach
To Your Health

Dear Dr. Roach: My husband developed melanoma, and had 16 of his lymph nodes removed. He was considered a cancer survivor, as one of the nodes was cancerous. He went for skin check-ups twice a year and was given an OK. Yet he died two months ago from tumors on his liver, lungs and brain. He was stage 4 by the time we knew the cancer was back. Is there some test or scan we could have had to know about the cancer earlier? My children are worried, as this cancer can be hereditary.

K.D.

Dear K.D.: I am sorry to hear about your husband.

Malignant melanoma is a common cancer and by far the most serious o–-

f the skin cancers. Most people with melanoma that has been caught early can expect to be cured, but when even a single lymph node is positive, the situation is much more serious. Ninety-three percent of people will survive five years, and 88% for 10 years.

Dr. Keith Roach

There is no universally accepted answer for how aggressively to monitor people with melanoma and a positive lymph node, but most experts do skin checkups as your husband did. There is no definitive evidence that additional testing, such as scans, would have been of benefit. Despite the best treatment, some people with melanoma will succumb to the disease. Treatment for melanoma is dramatically improving, though, but still not perfect.

About 10% of melanomas are thought to be familial. People with a strong family history – many family members, multiple melanomas in the same family member or very early disease – should have a regular skin exam by a trained doctor as screening. Prevention is important for everyone, which means sun avoidance and protection. This is particularly so for a person with a family history of melanoma.

Everyone should know how to identify the worrisome appearance of a melanoma:

A for asymmetry, meaning one side is different from the other.

B for border irregularities.

C for color differences within the lesion.

D for a diameter greater than 6 mm (a pencil eraser).

E for enlargement or evolution of color, change, shape or symptoms.

Any new darkly colored skin lesion that looks different from the others a person has should be evaluated.

Dear Dr. Roach: I have a question about the coronavirus vaccines. My mother is 79 and has allergies. I have PBC, an autoimmune disease. Which type of coronavirus vaccine is better for each of us?

R.Z.

Dear R.Z.: Most autoimmune diseases, such as primary biliary cirrhosis, where the immune system attacks bile ducts, or autoimmune thyroid disease (which many people write me about), won’t keep you from getting vaccinated. There is controversy about some autoimmune diseases, such as multiple sclerosis. Here there is a theoretical risk that the increase in immune system activity due to the vaccine could trigger a worsening of the autoimmune condition. This appears to be rare, while the benefit from vaccination is large and proven.

In the current coronavirus pandemic, the vaccines do not have any long-term safety data. However, given the choice between a risk that is at best possible but unlikely, and a benefit that is large not only for the person getting the vaccine but their family and close contacts as well, my opinion is that the vaccine has far more benefit than risk and should be given. Of course, you need to consult your own physician to be sure.

Any available COVID-19 vaccine is appropriate, and I would recommend you get the first one that is available to you.

Readers may email questions to ToYourGoodHealth@med.cornell.edu