No universally accepted level for post-melanoma monitoring
DEAR DR. ROACH – My husband developed melanoma, and had 16 of his lymph nodes removed. He was considered a cancer survivor, as one of the nodes was cancerous. He went for skin checkups twice a year and was given an OK. Yet he died two months ago from tumors on his liver, lungs and brain. He was stage 4 by the time we knew the cancer was back. Is there some test or scan we could have had to know about the cancer earlier? My children are worried, as this cancer can be hereditary. – K.D.
ANSWER – I am sorry to hear about your husband.
Malignant melanoma is a common cancer and by far the most serious of the skin cancers. Most people with melanoma that has been caught early can expect to be cured, but when even a single lymph node is positive, the situation is much more serious. Ninety-three percent of people will survive five years, and 88% for 10 years.
There is no universally accepted answer for how aggressively to monitor people with melanoma and a positive lymph node, but most experts do skin checkups as your husband did. There is no definitive evidence that additional testing, such as scans, would have been of benefit. Despite the best treatment, some people with melanoma will succumb to the disease. Treatment for melanoma is dramatically improving, though, but still not perfect.
About 10% of melanomas are thought to be familial. People with a strong family history – many family members, multiple melanomas in the same family member or very early disease – should have a regular skin exam by a trained doctor as screening. Prevention is important for everyone, which means sun avoidance and protection. This is particularly so for a person with a family history of melanoma.
Everyone should know how to identify the worrisome appearance of a melanoma:
A for asymmetry, meaning one side is different from the other.
B for border irregularities.
C for color differences within the lesion.
D for a diameter greater than 6 mm (a pencil eraser).
E for enlargement or evolution of color, change, shape or symptoms.
Any new darkly colored skin lesion that looks different from the others a person has should be evaluated.
DEAR DR. ROACH – I have a question about the coronavirus vaccines. My mother is 79 and has allergies. I have PBC, an autoimmune disease. Which type of coronavirus vaccine is better for each of us? – R.Z.
ANSWER – Most autoimmune diseases, such as primary biliary cirrhosis, where the immune system attacks bile ducts, or autoimmune thyroid disease (which many people write me about), won’t keep you from getting vaccinated. There is controversy about some autoimmune diseases, such as multiple sclerosis. Here there is a theoretical risk that the increase in immune system activity due to the vaccine could trigger a worsening of the autoimmune condition. This appears to be rare, while the benefit from vaccination is large and proven.
In the current coronavirus pandemic, the vaccines do not have any long-term safety data. However, given the choice between a risk that is at best possible but unlikely, and a benefit that is large not only for the person getting the vaccine but their family and close contacts as well, my opinion is that the vaccine has far more benefit than risk and should be given. Of course, you need to consult your own physician to be sure.
Any available COVID-19 vaccine is appropriate, and I would recommend you get the first one that is available to you.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
DAYTONA BEACH, Fla. — Give him good cars and Christopher Bell will win races. But in his second race? With a new team? That seemed unlikely.
Bell defied the odds Sunday and earned his first career Cup series victory — in just his second race since Joe Gibbs Racing pulled him back into its inner circle — to close out an unpredictable week of racing at Daytona International Speedway.
Michael McDowell was the surprise Daytona 500 winner and then Bell earned an earlier-than-expected first trip to victory lane. It’s just the third time in NASCAR history the first two races of the season were won by first-time winners. It was previously done in 1949 and 1950 — NASCAR’s first two seasons.
More important, Bell and McDowell have snagged coveted berths in the 16-driver playoff field, a troubling trend for midpack teams that need all 26 regular-season races to point their way into the championship picture. Race winners earn automatic berths and the re
maining spots are decided by the points standings.
“The dynamic has changed dramatically,” Brad Keselowski said. “We’re very early in the season and it’s now turned into a points race for those last few spots. If you don’t win, you’re in a lot of trouble because it’s not looking like you’re going to be able to get in the playoffs.”
Bell chased down Joey Logano on the winding Daytona road course to grab his first victory. Logano had a commanding lead but Bell, on fresher tires than Logano, reeled him in and passed him with just over one lap remaining.
“This is one of the highlights of my life,” Bell said. “I’ve prepared my whole life for this moment to race in the Cup Series.”
The 26-year-old Oklahoman is a longtime Toyota development driver who won 16 Xfinity Series races driving for Gibbs. But there’s only four Cup seats in the organization and they were full last season when it was time to move Bell to the big leagues.
He was instead loaned to Leavine Family Racing, and although it was also a Toyota team, the one-car operation wasn’t nearly as strong as the Gibbs group. Team owner Joe Gibbs last summer decided not to renew Erik Jones, who said he was blindsided by the move, and instead bring Bell back into the fold.
It put the pressure on Bell to deliver and he did after a rocky opening a week ago. Bell was running at the front of the Daytona 500 pack when he gave Aric Almirola too big of a shove and triggered a 16-car crash on just the 14th lap of NASCAR’s first race of the season.
Bell’s win bookended a statement weekend for JGR’s young drivers. Ty Gibbs, the 18-year-old grandson of team owner Joe Gibbs, won the Xfinity Series race Saturday night in his first career national series start.
McDowell, meanwhile, backed up his Daytona 500 win with a career-best road course finish of eighth.
Logano for the second week came up empty but without the dramatics of his last-lap crash with teammate Keselowski as they raced for the Daytona 500 win. Logano finished second.
“I hate being that close,” Logano said.
Denny Hamlin was third to give Gibbs two cars in the top three. Kurt Busch finished fourth and Keselowski wound up fifth for a decent Team Penske rebound.
Keselowski and Logano before the race had their first interaction since the Daytona 500 crash — Logano called it “a healthy conversation” — and the teammates will now try to move forward.
“We’re as good as we can be,” Keselowski said.
Kevin Harvick finished sixth and AJ Allmendinger, in his first Cup race
since the 2018 season finale, finished seventh. It was the highest finish in three Cup races for Kaulig Racing, an Xfinity Series team formed in 2016 that wants to be fulltime Cup next season.
Ryan Preece was ninth for a pair of top-10 finishes at Daytona. JTG-Daugherty Racing no longer has a charter to guarantee Preece a spot in the field every week, and without it the team can’t promise it will race every week this season. With this start, Preece is currently seventh in the points standings.
Chase Elliott again had the most dominant car but his streak of four consecutive victories in points-paying road races was snapped. He led a race-high 45 laps and was out front when caution for rain 15 laps from the finish forced Hendrick Motorsports to make a strategic call.
Elliott traded track position for new tires, pitted from the lead and fell to 15th. He worked his way up to to fifth but spun when he ran into the back of Kurt Busch. Elliott finished 21st.
“Cautions like that kind of makes for a mixed bag, who stays and who goes, it’s a bit of a gamble,” Elliott said. “I thought tires was the right move.”