Hello Friends and Family,
On December 4, 2019 (his 37th birthday) Jeff was diagnosed with melanoma skin cancer after a visit to the dermatologist for an irregular mole. On December 20 he had surgery to excise the melanoma and area around it, and remove the sentinel lymph nodes. Surgery went well and as of January 13, Jeff had his stitches out and can soon resume normal activity. The surgeon removed eight lymph nodes and sent them for pathology. Of the eight, two were found to have microscopic melanoma deposits contained within the lymph node. Following that pathology, Jeff was sent for a CT scan to ensure the melanoma had not moved further than the lymph nodes. A CT on January 3, 2020 was deemed clear by Jeff’s team. After the surgery he is considered NED (no evidence of disease), and staged at Stage IIIA.
His stage (IIIA) is a grey area for oncology in terms of how to proceed; some doctors recommend doing nothing more, some recommend further treatment. On January 13, 2020 Jeff and Arianna met with an oncologist at the Lombardi Cancer Center at Georgetown Hospital to discuss what they call adjuvant therapy, which is treatment to reduce the risk of recurrence. The treatments for melanoma have drastically changed in the last 10 years with the first line of treatment being immunotherapy and gene therapy since melanomas are resistant to radiation and chemotherapy alone. The oncologist we met does not recommend immunotherapy for Jeff given a decent chance for potential long term side effects (17%), and the relatively low risk of recurrence (20%), as well as potential complications with another immunosuppressive drug Jeff has been on for psoriasis. They are now running a test to see if his melanoma contains the BRAF (pronounced bee-raf) gene mutation to determine if he is eligible for gene therapy, which is what the doctor at Lombardi recommends if he is eligible. We should have those results in a week or two.
After consulting again with his dermatologist, Jeff decided to get a second opinion and is planning to make an appointment at Johns Hopkins to see if another oncologist agrees with the approach of avoiding immunotherapy for now. Jeff and Arianna are also doing some research to make an informed decision about potential adjuvant therapies (risks and benefits) and what Jeff will move forward with. The oncologist says a decision needs to be made and treatment started within 12 weeks of the sentinel lymph biopsy, so by February 28. Alternative to adjuvant therapy Jeff would go back for scans and close observation every 3 months and we would cross our fingers the melanoma does not recur.
If you have any questions you can email us directly jcr204@gmail.com or arianna.nagle@gmail.com. We appreciate your support during this difficult time.
Much love,
Jeff & Arianna
Updates on Jeff's treatment 