Melanoma teaches patient not to sweat small stuff

John McGrath received treatment for his melanoma at North Shore-LIJ Cancer Institute.

Three long, sleepless weeks stretched between John McGrath’s melanoma diagnosis and a sense of relief. The Floral Park man, just 41, had learned from his dermatologist that a freckle on his lower right cheek — which was there more than 20 years and had recently changed — was the worst possible form of skin cancer.

His dermatologist’s delivery of the news was distressing, recalled Mr. McGrath, but he was able to relax when he met with Mansoor Beg, MD, a surgical oncologist at North Shore University Hospital. The facts hadn’t deviated — Mr. McGrath’s melanoma was thick and potentially dangerous — but Dr. Beg laid out a plan of attack in a calm, reassuring manner.

“He was very nice about it, but didn’t beat around the bush,” said Mr. McGrath, now 43, who immigrated to the United States from Ireland in 1993. “He said, ‘We’ll take it out and that should be it.’”

The surgery, in July 2009, was an all-day affair at North Shore University Hospital. At 6.4 millimeters — or roughly a quarter-inch thick — Mr. McGrath’s cancerous nodule required removal under general anesthesia with a plastic surgeon, collaborating to ensure the incision had the best possible cosmetic outcome. Dr. Beg also biopsied lymph nodes from around the site, which thankfully were negative for cancer.

Next step proves grueling

Still, that didn’t mean the outpatient procedure was the end of his treatment. A 10-month course of self-injected interferon — the only drug for those with high-risk melanoma shown to lower the odds of recurrence — proved arduous for Mr. McGrath and was complicated by his status as a heart attack survivor.

Not only did the medication cause chest and arm pain, it obliterated Mr. McGrath’s get-up-and-go so completely that he could not continue working as a self-employed “The fatigue, I just couldn’t handle it,” he said. “I had absolutely no energy whatsoever. I was more and more tired as I went along.” Furthermore, the stress was taking a psychological toll on Mr. McGrath’s son, who was 8 years old at the time.

“You could almost know that my son knew what was going on,” he said. “He got very emotional about it. We think it was actually harder on him than on my wife and me.”

The combination of ill effects prompted Mr. McGrath and his doctors to discontinue his interferon treatment, but fortunately, subsequent imaging scans — now done every six months — indicated that the cancer has not returned.

Care continues as life moves forward

Dr. Beg and medical oncologist Craig Devoe, MD, who treated Mr. McGrath as an outpatient at the Monter Cancer Center, caution that it will take many years before their patient is completely out of the woods, simply because of the size of his lesion and melanoma’s insidious nature.

“This is a high-anxiety-provoking disease,” Dr. Devoe said. “Thick melanomas have a 40 to 50 percent chance of relapse over 10 years.”

“He’s actually doing well,” said Dr. Beg. “He’s someone who will be followed for life. Passing the two-year point [after surgery] was a big hurdle.”

As a father of three, Mr. McGrath finds himself fundamentally changed from the experience, which he admits has had its share of emotional ups and downs.

“The simple things in life, I worry a bit about them,” he said, “but not as much as I used to.”

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