Living with Malignant Melanoma

Even now in an age of miracle cures, there is one word people dread their doctor saying: "Cancer". For many patients and their families, this word conjeres an image of pain and imminent death. The WHO lists the three cancers that killed most people worldwide in 2020 as: lung cancer; colorectal cancer; and liver cancer. Yet despite this, many cancers are now treatable with a low chance of recurrence or are even preventable. For instance, as a GP we were encouraged to do regular cervical screening on most women every five years, but now, the HPV vaccine has reduced cervical cancer diagnoses by almost 90% in women in their twenties and there were zero cervical cancer deaths in young women between 2020 and 2024, giving them an almost zero risk of death from this cause. Every week, we hear of new treatments for prostate cancer, or breast cancer, or some rare esoteric malignancy.

I have experienced two cancers. The bladder cancer was treated with local resection and intense radiotherapy; this was eight years ago, and after multiple follow-ups with cystoscopies, I was signed off the books at the five-year stage with no signs of recurrence. At no stage was there pain or suffering, other than from the treatments!

But malignant melanoma is in another ocean altogether. Across all cancer types, malignant melanoma ranks much lower in mortality. It is the fifth most diagnosed cancer in the UK but only the nineteenth most common cause of cancer death. It can be easily visible as a changing, irregular dark mark, and if caught early, its 5-year relative survival rate is well over 90%. It is, however, the most dangerous and deadliest type of the skin cancers because, although it accounts for only 1% of all skin cases, it causes the vast majority of skin cancer deaths due to its aggressive tendency to spread insidiously (metastasise) to vital organs like the lungs, liver, and brain. I passed the five-year survival mark four years ago, after much intensive surgery and multiple courses of radiotherapy. The team also tried immunotherapy, but I had severe reactions ending up in Addenbrookes with acute renal failure, and tests showed that my type of melanoma was unresponsive to chemotherapy. 

But 一 and here's the nasty side of melanoma 一 it continues its relentless march through my body so every day I am a little weaker, a little more breathless, eat ever smaller meals, lose a little more weight, and get more tired. I am fortunate that so far it has spared my brain and bones; if either of these gets involved, by life will cease through dementia or pain; but it has spread widely elsewhere, to my lungs, and liver, and throughout the abdomen. It has now burst out in visible form with multiple large, tense swellings in many muscles and below the skin. It swells in the intercostal muscles, pushing the ribs together 一 or apart, depending if your reference point is the rib or the tumour 一 and Edwin has suggested I give them names of people I don't like; I guess the big one in the gluteus is Donald, so I can squash it down every time I sit.

While the pain is controllable, I can shrug off the disease and enjoy what remains of my time; but, as so often, it is the unseen carer who suffers most: in this case, Ann. She has been forced to live for years with a husband in declining health, seeing me doing and eating less, sleeping more, and now covered in ugly swellings till I look like the left-over bits from The Elephant Man. It is Ann who has to think of tempting, nutritious foods and protein-rich drinks to sustain me. She it is who searches out soft cushions to ease the pain of the lumps on my back and buttocks. She who encourages me to continue with life, and not retire to bed to slink into morbid decline. No doubt, if one of the larger lumps starts to suppurate, she will be there with the dressings and deodorant to decontaminate the horrific smells I anticipate. Ann gets scant praise or recognition for any of this, yet everyday she is there and my thanks are in my prayers of gratitude for her, and all the great things we have enjoyed together over these many years. Thank you, Annie!