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HIV & Malignant Melanoma
Nov 21, 2005

Hello and thank you ALL for your contributions to this forum.

I'm a 33yo male. In December, 2003 I tested HIV-Negative. In September, 2004 I tested HIV-Positive with no co-infection.

I began monitoring the status of my HIV infection and was advised to initiate HAART in May, 2005.

Shortly after my HIV diagnosis I began noticing a small spot on the left cheek of my face.

My doctor encouraged me not to worry about it and I trusted her, living with it for quite some time.

In June, 2005 I went to Urgent Care with a case of shingles. I was told this was probably an "immune-reconstitution" issue since I had started HAART in May - and the shingles resolved on their own.

That day, while I was at Urgent Care I again asked the Doctor about the spot on my face which had grown and was turning a blue-ish color.

She referred me to a Dermatologist - who did an initial biopsy that came back as "inconclusive".

About a month later, upon complete removal of the lesion I received word that it was Malignant Melanoma; Stage 2 or 3 (I was told the Stages were somehow debatable).

The lesion was almost the size of a dime and the depth of invasion measured 2.4mm.

I had both a CT and PET Scan. One lymph node in my neck was "lighting-up" but they were unsure if it was related to the Melanoma.

On November 11, I had a wide excision (Parotidectomy) on my left cheek which removed the remaining cancerous tissue. At the same time I had 17 lymph nodes removed from my neck.

After recovering I was told that 2 of the lymph nodes came back "positive" for Malignant Melanoma. One of the lymph nodes had been the one that "lighted-up" on the CT & PET Scans and the other had a smaller amount of cancer cells in it. I assume the remaining 15 lymph nodes were normal.

I am now told that I will be meeting with a Tumor Board/Panel through my HMO in which I will discuss my case with an Oncologist, Doctor, Nurse and a Dentist - all in one sitting... much like a round-table discussion.

My VL has been steadily undetectable and my Tcell count has been a steady 450 since I initiated HAART in May.

I am unsure how any treatment options or clinical trials might affect or be affected by my HIV status (or if I am even eligible).

I have learned that Malignant Melanoma is an aggressive cancer if not treated early and yet I have no evidence of spread beyond the 2 lymph nodes which were removed.

Since I have learned of my HIV status I have been told time & time again that as long as my "numbers" are good I should be treated for most conditions as if I was HIV-Negative however, I am unsure how Malignant Melanoma and it's treatments may affect my HAART therapy and visa-versa.

I have had 100% adherence using my first round of HAART (Sustive & Truvada) and I am worried about my options at this point.

Having HIV is one thing and after adjusting to the reality of this disease I was "sucker-punched" with a cancer that may be completely unrelated to my HIV status although the Melanoma began showing itself soon after being diagnosed HIV-Positive.

It appears at this point I may be battling two very important diseases and I am unsure what my options are.

I know the Tumor Board/Panel I will be meeting with will leave all of the options up to me as to the extent of treatment available, if any.

I am worried that these two potentially-lethal diseases have presented themselves at the same time... making my "fight for life" all the more difficult.

I have come to realize that life with HIV is possible - yet this seemingly more serious diagnosis of a primary Malignant Melanoma may throw a wrench into everything I have put into my "survival".

I have no knowledge of Interfeuron-alpha, radiation, chemo or other adjuvant therapy for use against Malignant Melanoma in someone whom is also HIV-Positive.

I understand the Doctors may take a "wait & see" approach or they may ask what I wish to do...

I know so little about having 2 diseases like this and research is proving very tough.

I would greatly appreciate any comments you may be able to share as I am facing some critical decisions.

Again, thank you for your help and I encourage EVERYONE to "stay the course" and remember the true meaning behind HIV; Health Is Victory!

Regards, Positive Outlook

Response from Dr. Wohl

You are having to deal with a lot. I have had other patients who have had to confront both HIV and malignant melanoma. It is not clear they are related but I would not be surprised if they are in some way.

Control of your HIV can only help your fight against both diseases and I would place an emphasis on keeping you undetectable. I do not think your HIV therapy per se or being HIV + should preclude at all therapy for the melanoma, if that is indicated.

I think you need to talk with the oncologist about what the recommended therapy would be if you were HIV uninfected and how your well controlled HIV changes that, if at all. I would hope that your HIV doc will be at the tumor board meeting.

Generally, most people with stage 2 can be cured. For stage 3, the rates are not as good but still about half of these people will be disease free at 5 years.

Being frightened is understandable and natural. You need clinicians who you trust and who are accessible. Support from a counselor may also help get you through the rough spots.

Good luck

DW



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