9 Questions to Ask About Metastatic Melanoma Treatmentby Erin L. Boyle Health Writer
There you are, sitting on the exam table in your doctor’s office, in complete shock. You’ve just received some of the toughest news of your life: You have metastatic melanoma. What’s the next step? What does the future look like? If you were too rattled during your appointment to ask or absorb much of anything, consider yourself perfectly normal. We have the essential questions to bring with you next time you see your doc so you can be a partner in your treatment.
What Is Metastatic Melanoma?
Start here. Your doctor will likely explain to you: Metastatic melanoma is an aggressive, serious skin cancer that has spread in the body, possibly to the lymph nodes, liver, lungs, or brain, says Trevan D. Fischer, M.D., a surgical oncologist, assistant professor of surgical oncology, and assistant program director of the Complex Surgical Oncology Fellowship program at John Wayne Cancer Institute at Providence Saint John’s Health Center in Santa Monica, CA. Its typical signs: Changes in a mole’s appearance or a pigmented area of skin.
Is It OK if I’m Nervous About Having Metastatic Melanoma?
Absolutely! Dr. Fischer says being nervous or anxious is a typical response to a cancer diagnosis. It’s OK to not have it all together when you get this news and after—because while new treatments have significantly helped people with this type of cancer (more on that later), it’s still an overwhelming experience. In fact, if a patient is acting as if a cancer diagnosis isn’t a big deal, Dr. Fischer is careful to set expectations: “Yes, we can cure you with this, but you have to be on top of this and listen to what we recommend and take it seriously,” he says.
What Is My Prognosis?
It’s important to know what your unique situation is, like where your cancer has spread, what stage it’s in, and if genomic testing has been done—about half of all melanomas have a mutation called BRAF that can be treated very effectively with targeted therapy, says Vadim Gushchin, M.D., a surgical oncologist and director of The Melanoma and Skin Cancer Center at Mercy Medical Center in Baltimore. Knowing where you are in your cancer journey will tee up you ask your next question, which could be…
Will I Need Surgery?
Ask your doctor if surgery, or a resection, is possible for you. Surgery can be an effective treatment option for this cancer type, Dr. Gushchin says, especially in the early stages. A lymphadenectomy—a surgical procedure in which your lymph nodes are removed—is sometimes used in stage III metastatic melanoma cases with good results.
What Treatment Options Are Best for My Situation?
Your doctor can walk you through what therapy might work best for you. Two major advances in metastatic melanoma treatment—targeted therapy, as we’ve mentioned, and immunotherapy—have significantly increased five-year survival rates for this cancer type in the last 15 years. “Immunotherapy unlocks the brakes on our immune system to attack cancer,” Dr. Fischer explains. “I think of it as re-teaching, or exposing cancer, so our body can take care of it in that way it’s supposed to.” Other treatments include radiation therapy and sometimes chemotherapy, though it’s not used often now.
What Side Effects Might I Experience?
New treatment options for metastatic melanoma might be highly effective, but they do come with side effects, Dr. Gushchin points out. These include diarrhea, rash, fever, chills, itching, and in some serious cases, inflammation from an activated autoimmune response. “These side effects are easy to talk about, but in reality, patients might have trouble coping with them,” he says, so it’s important to discuss the benefits vs. risks of adverse events and treatment options for your metastatic melanoma with your doctor. During treatment, you’ll want to keep the communication flowing, telling your doc about any side effects you’re experiencing.
How Will We Know Treatment Is Working?
Typically, you’ll have an idea of whether your metastatic melanoma treatment is going well because your healthcare team is carefully monitoring your cancerous lesions via imaging at regular intervals to see if they’re shrinking. “Our methods have not evolved much, compared to 20, 30 years ago, so we still use a ruler and compare two centimeters with 2.5 centimeters, for example. That’s how we know if the treatment is working or not working,” Dr. Gushchin says. Asking your doctor this question can help you determine the path your treatment might take in the coming weeks and months.
What Happens After Treatment?
Asking your doctor this question can help you envision what life as a metastatic melanoma survivor looks like. You’ll ideally continue to see your doctor regularly to catch and treat any recurrences. “I always tell my patients that no matter what stage for melanoma they are, [you’ll be having] a lifelong relationship with your medical team to keep an eye on this.” Dr. Fischer says. Patients often see their cancer teams twice a year, with imaging every 6 to 12 months for at least three to five years.
How Can I Ask You Questions Most Effectively?
If you’re sitting in your doctor’s office and at a loss for words, there’s something you can do before you get there, Dr. Fischer says: Prepare. “I always tell patients to write down questions,” he says. It’s so easy to forget what you want to ask, so keep a running list on your phone or a notepad and add to it as questions pop up. Bring that to your next appointment. For those q’s that can’t wait, ask your doc her preferred way of hearing from you (via email, a patient portal, or by phone). Communication is key to a successful treatment, and now you’re already off to a good start.