Pink Spot More Sinister Than It First Seemed

Jul 1, 2024 | Stories

Melanoma New Zealand Nurse Educator Gill Rolfe has spent much of her career working with melanoma patients. Now, she is supporting her husband through his own battle with the disease after he was diagnosed last year, just as they were about to start their retirement.

Gill’s vast experience in this field has made her an advocate for sun safety and regular skin checks. She has always been particularly vigilant with her family members, especially the redheads among them.

She says that, given Terry’s number of moles and the years he spent working outside in England without a shirt on, she took every opportunity to go over his skin and look for suspicious lesions.

Late last year, Gill noticed a pink spot on his lower back and kept an eye on it. As soon as it became raised and itchy, they immediately made an appointment with a skin specialist in the community to get it checked.

Gill says both she and the specialist thought it had the characteristics of a basal cell carcinoma and were both shocked when his biopsy results showed he had a 3.3mm ulcerated melanoma with a mitotic rate of 5 – which Gill explains is how fast cancer cells are dividing and growing.

“It was reasonably fast growing and needed treatment, so if we hadn’t had it checked and left it any longer, it would have been deeper and possibly spread further. As the specialist said, sometimes biology throws unexpected things at us,” says Gill

“Terry was referred to North Shore Hospital for further treatment. He then had a sentinel node biopsy, which involved injecting dye into the excision site and having a scan to see where it travelled and which lymph node the melanoma was draining to. He had the two nodal basin biopsies taken from his groins and a PET CT scan with a wide local excision performed at the same time. Thankfully, all the results were negative.”

With no family history of melanoma, Terry says he never thought about skin cancer, particularly back in the 1960s when he said no one used sunscreen in England.

“If you were working outside, you would get burnt, go red, and peel. It wasn’t until people started to go to Europe on holiday, where it was warmer, that they started using sunscreen.”

He said his attitude changed when they moved to New Zealand more than 20 years ago.

“I remember putting a chair outside and thinking I’d have a quick suntan, and in about 10 minutes, I could feel myself burning – which is when I knew you couldn’t sit out in the sun here.”

Unfortunately for Terry, the damage had possibly already been done.

After his diagnosis, he was selected to be part of a clinical trial, which was open to patients with stage 2b to stage 4 melanoma.

The 12-month study, which is now closed to recruitment, involves 17 three-week transfusions of pembrolizumab (Keytruda) plus the study drug vibostolimab.

Gill explains that it is a randomised, double blind study, which means neither the participants nor the medical team knows who actually receives vibostolimab.

“The great thing about being on a clinical trial is that the patients get regular access to otherwise unfunded drugs, checkups with the same people, three monthly CT scans, blood tests every three weeks and a consultation two days before their infusions.

“We’re hopeful that the drugs will mop up any cancer cells that might have strayed into his bloodstream that aren’t visible on scans yet.”

A side effect that Terry experienced from the trial was a severe rash all over his body, which meant he had to come off treatment for a period to have steroids to clear it.

Unfortunately, after resuming the trial, the rash has returned.

Gill says there is a risk that he might have to stop treatment because the study drugs can disrupt the body’s immune system, resulting in thyroid issues or accelerated diabetic risk.

Despite these issues, they both feel extremely fortunate that Terry has had the opportunity to participate in the study.

“This treatment is usually funded only for stage 4 melanoma patients in New Zealand while their bodies respond to it, which not everyone does. If you are not stage 4, you could pay up to $107,000 a year for adjuvant therapy,” says Gill.

Gill advises other melanoma patients to speak to their GP or other specialists to see if they are eligible for clinical trials.

Terry says he is grateful Gill has always encouraged him and the family to be safe in the sun and check their skin.

“The consequences of sunburn and lots of UV radiation can result in melanoma. Make sure you know your skin so you can spot something new or changing.

“Like other regular Joes, I wouldn’t know what to look out for without Gill’s experience, especially pink spots.

“We live on three acres, so I have a lot of lawn to mow and could be out there for a couple of hours. I’m always well covered. I wear long pants, a hat, sunscreen, and gloves.

“If you get melanoma, it’s not just about getting the mole or spot cut out; it’s all the stuff you have to go through afterwards. It’s a journey.”

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