SURGEON GENERAL REVEALS THAT HIS WIFE HAS MELANOMA

The US Surgeon General, Jerome Adams, MD, has announced that his wife has had a recurrence of her melanoma and underwent surgery today to remove affected lymph nodes.

Adams made the announcement on his office's Facebook account.

He said their public disclosure was intended to raise awareness of the disease. "My wife tanned frequently (in the sun and in tanning beds) when she was younger," he wrote.

Lacey Adams also went public with her story 2 weeks ago on a less prominent forum, her personal blog.

Seven years ago, she was diagnosed with a local melanoma on her thigh, which was surgically removed. In the past half-year, she felt swollen nodes in her groin and, after a delay of about 2 months, saw her physician. Imaging revealed three involved lymph nodes, each with 2 to 3 cm of cancer. A postsurgery biopsy will confirm that the affected nodes are melanoma and not another form of cancer.

She was treated at the Walter Reed National Military Medical Center, according to a news account

The good news is that it is not metastatic disease, which would mean the disease spread was to a distant organ, such as the liver or lungs, said Jeffrey Farma, MD, a surgical oncologist and melanoma specialist at Fox Chase Cancer Center in Philadelphia, Pennsylvania, who was approached for comment.  

Lacey Adams' recurrence in the regional lymph nodes is "a potentially curative situation," he said.

"I know patients like this who are living years and years after such a diagnosis," he told Medscape Medical News. 

In the past, the 5-year overall survival rate in such cases would have been around 60%, he estimated. However, there have been so many improvements in melanoma therapy that those numbers are now dramatically changed and currently in flux.

"There's been amazing progress in the treatment of both recurrent and metastatic melanoma," he said.

Both Jerome and Lacy Adams, on their respective web forums, said that she will receive immunotherapy. Once approved only for use in metastatic disease, the immunotherapies, including nivolumab (Opdivo) and ipilimumab (Yervoy), both from Bristol-Myers Squibb, are now also approved for postsurgery or adjuvant use in recurrent melanoma, such as in this case.

In general, immunotherapy with such checkpoint inhibitors has dramatically increased median overall survival in treated patients. The drugs work by activating the immune system to attack cancer. But they can also cause an attack on normal tissues, which is a form of treatment toxicity. "Those adverse events can be drastic but most can be treated with steroids," said Farma.

In terms of recurrence, melanoma is an especially unpredictable cancer, he added. Like breast cancer, it can recur up to 20 years after initial treatment. It is not like, say, colorectal cancer, which is generally considered cured if it does not return in 5 years after surgery, Farma said.