Special Issues Concerning Advanced Skin Cancer

Skin cancer is becoming an increasing risk to people in the United States and around the world.  Skin cancer has been diagnosed more often in patients than in people who have breast, colon, lung, and prostate cancers combined.1  Almost 800,000 Americans are living with a history of the deadliest skin cancer, melanoma.  Skin cancer has become so prevalent that 20% of Americans will deal with it at some point in their lives. Melanoma represents 7 percent all skin cancers tracked by central cancer registries.1 

The key to survival against skin cancer is to detect early.  However, sometimes, despite the best efforts of doctors and patients, skin cancer progresses to an advanced stage where treatment options are limited and to where death will be the likely outcome at some point.  This is especially the case with the deadliest form of skin cancer, melanoma, as well as with neuroendocrine (also known as Merkel Cell Carcinoma).  One of the reasons why these two cancers are so deadly and involved in many skin cancer deaths is because they can spread to other parts of the body rapidly, which is known as “metastasis.”2

Treatments for Advanced Skin Cancer Can Only Do So Much, and with What Complications or Side Effects?

If the skin cancer, such as melanoma, has spread to distant sites such as internal organs, it has reached stage IV, which is classified as the last stage of melanoma.  Consequently, this stage is the most life-threatening, and at the time of this writing, there are very liimited treatment that have limited effectiveness in curing a person with Stage IV melanoma.3  There are several treatment options available for Stage IV melanoma, but many of them have significant side effects that limit their usefulness. Other treatments can be used to help to relieve the uncomfortable symptoms that are caused by the melanoma.  These treatment options include the following options:

  • Surgery
  • Systemic therapies
  • Chemotherapy
  • Immunotherapy
  • Radiation therapy

In most cases, you should not expect these options to cure you, but rather, make it more tolerable for you to handle the pain and complications caused by Stage IV melanoma.  Eventually, the probability is that you will die from Stage IV melanoma.  Therefore, you and your loved ones must decide how much treatment you are going to apply to Stage IV melanoma.  All of the treatment options above can help to reduce the pain and complications from skin cancer such as melanoma, but some of these treatments come with their own set of risks as well.

Surgery can cause considerable disfigurement, plus may not always remove all of the cancer from the skin, especially if the melanoma has penetrated to the tissues and organs.  Chemotherapy not only causes damage to abnormal skin cancer cells, but also to the normal cells in the body, leading to physical weakness, hair loss, and inflammation in the digestive tract.4  Radiation therapy can cause both fatigue and skin problems.5

As you can see, there are several factors to consider before undergoing these procedures, especially since they have not been proven to treat Stage IV melanoma or other advanced skin cancer.  It all depends on how many complications and pain, you, the patient, choose to endure from your treatment(s).  Only you can decide, along with input from your family and friends, what level of treatment you want to endure.

Family Issues that Arise from Advanced Skin Cancer

While it’s often hard for patients to hear the news that there are very few treatment options available to cure the cancer you have, it’s often as difficult or even more difficult for family members and friends to hear.  It’s also difficult to hear your cancer care team give estimates of how much time you have remaining to live.6

You and your family must decide on the next course of action when it comes to hearing the diagnosis that no treatment will cure the cancer within you.  There are several issues that must be decided upon.

One such issue is whether you will decide to continue to receive treatment for your advanced skin cancer or not.  Some people decide that they should continue to receive treatment as long as it has a chance of helping to eliminate or reduce the cancer.  Other people decide that the small chance of benefits is not worth the pain, side effects, or inconvenience of the treatments and decide to stop the treatments.  Only you can make the choice of whether to continue treatment or not.

Another issue you and your family must decide upon is whether you will stay at home, head to an assisted living center, be placed inside of a nursing home, or if you be placed into hospice.6  Most people like to be in familiar surroundings for as long as possible, but receiving treatment or feeling as well as possible isn’t always possible at home.  Therefore, you and your family must decide if another location is a better option to increase your chances of enjoying life for a longer period of time, and what that location might be.

How to Prepare for the Eventual Loss of Life

Getting your life affairs in order is a critical issue that you should deal with while you are still able to.  Certainly, you’d like to have everything in place so that when you pass on, your family, who will be dealing with the emotions of losing you to advanced skin cancer, will not have to also scramble and struggle with taking care of your life affairs.  If you know that you have no realistic chance of a full recovery, you should do everything you can to get all of your life affairs in order as quickly as possible to try to lessen the burden on your family after you have passed on.

Having Advanced Skin Cancer Does NOT Mean You Have to Stop Living

Even if you face the grim prognosis of not being able to recover from advanced skin cancer, this does not mean that you should just give up enjoying life.  Often, patients make the best of the situation by choosing to enjoy the time that they have left with family and friends, as well as doing the activities that they always wanted to do (i.e. what many call a “bucket list”).

This is why many patients will still choose to receive treatment even when treatment won’t lead to recovery: so that he or she can still do the activities that he or she wants to do for as long as possible.  Whatever choices you decide to make regarding your treatment and lifestyle, you should do whatever you can to enjoy life as long as possible with your family and friends.

References

1 Skin Cancer Statistics. (2011). Centers for Disease Control and Prevention. Retrieved from: www.cdc.gov/cancer/skin/statistics/

2 Metastatic Cancer. (2011). National Cancer Institute. Retrieved from: www.cancer.gov/cancertopics/factsheet/Sites-Types/metastatic

3 Melanoma Center – Treatment By Stage – Stage IV Treatment. (2010, January). From The Melanoma Center:
www.melanomacenter.org/treatment/stage4.html

4 Chemotherapy and You: Support for People With Cancer.  (2011). Retrieved from: www.cancer.gov/cancertopics/coping/chemotherapy-and-you/page1

5 Radiation Therapy Effects. (2011). From The American Cancer Society: www.cancer.org/Treatment/TreatmentsandSideEffects/PhysicalSideEffects/RadiationTherapyEffects/index

6 Advanced Cancer Overview. (2011). From The American Cancer Society: www.cancer.org/Cancer/AdvancedCancer/OverviewGuide/advanced-cancer-overview