{"id":1207,"date":"2011-05-29T08:02:37","date_gmt":"2011-05-29T08:02:37","guid":{"rendered":"http:\/\/www.ackc.org\/?p=1207"},"modified":"2012-01-27T19:05:52","modified_gmt":"2012-01-27T19:05:52","slug":"mobs-and-moles","status":"publish","type":"post","link":"https:\/\/www.ackc.org\/jayedit\/mobs-and-moles\/","title":{"rendered":"Of Mobs and Moles"},"content":{"rendered":"<p>Note: This\u00a0<a href=\"http:\/\/kidneycancerchronicles.com\/the-mdx-1106-chronicles-of-mobs-and-moles\/\">article\u00a0<\/a>is cross posted from The Kidney Cancer Chronicles.<\/p>\n<p>Something weird happened on the way to my cancer treatment. I got another cancer. Maybe. Well, maybe not. We\u2019re not sure. We\u2019re going in for a biopsy of a rogue mole next week. It has the telltale signs of skin cancer.<\/p>\n<p>Dena and I have been watching the mole for a few weeks now, trying not to be paranoid. Which says a lot, as I am generally a paranoid person. As I\u2019ve noted in this blog many a time, I\u2019m paranoid that Dena may be trying to kill me in my sleep, call it cancer, and collect the life insurance. Luckily I have convinced her that gunshot wounds or head trauma generally rule out carcinomas as the cause of death during autopsies. But that might have worked against me, because it looks like she might have somehow managed to sneak in another cancer on me, clever girl.<\/p>\n<p>We decided to raise the suspicious mole with the oncology team during the last exam, casually so as not to unduly raise alarm bells. <em>Hi, doc, I\u2019m feeling really great. Yes, energy level\u2019s okay. No nausea to speak of. No new pain, just the ongoing back pain. No dizziness. Weight\u2019s stable. Nope, really still no significant side effects to speak of at all except maybe a little melanoma. Man, it was really hot driving in today. I guess summer\u2019s coming on strong, huh? How\u2019re your kids? \u2026 What? Did I say melanoma? I don\u2019t know, did I? Haha, whaddya know, I guess I did.<\/em><\/p>\n<p>So, I showed them the mole. Actually, showed them a picture I took of it. (I like to think I\u2019m a team player when it comes to gathering evidence for the trial notes.) At the hospital, they took out a little tape ruler and measured it. Somebody mentioned the ABCDs of melanoma, referring to the following classic approach to detecting potential melanoma:<\/p>\n<p><em>To detect melanomas (and increase survival rates), review the &#8220;ABCD&#8221; mnemonic (below) and be aware of moles and any changes (shape, size, color, itching or bleeding); show any suspicious moles to a dermatologist:<\/em><\/p>\n<p>&nbsp;<\/p>\n<ul>\n<li><em> <strong>A<\/strong>symmetrical skin lesion.<\/em><\/li>\n<li><em><strong>B<\/strong>order of the lesion is irregular.<\/em><\/li>\n<li><em><strong>C<\/strong>olor: melanomas usually have multiple colors.<\/em><\/li>\n<li><em><strong>D<\/strong>iameter: moles greater than 6 mm are more likely to be melanomas than smaller moles.<\/em><\/li>\n<li><em><strong>E<\/strong>nlarging: Enlarging or evolving<\/em><\/li>\n<\/ul>\n<p>Dena and I both tried to use the mnemonic as a guide but quickly gave up, as neither of us can pronounce it. That said, the suspicious mole is asymmetrical; has irregular borders; has variegated colors; is larger than 6 mm; and is enlarging and evolving. It has also bled on more than one occasion.<\/p>\n<p>Kind of freaky how much the mnemwhatever lines up with the characteristics of my mole. My friend Amy, a melanoma specialist, suggested getting it biopsied. Of course, she couldn\u2019t say anything conclusive by simply examining the photo I sent her. (She did, however, recommend that I stop sending pictures of my mole all over the country, as it\u2019s disturbing).<\/p>\n<p>Getting back to our Hopkins team, the suspicious mole sparked some vigorous debate at some kind meeting of the oncologists and radiologists and pathologists who are running the trial.<\/p>\n<p>\u201cYou were the subject of much debate this week,\u201d Fabulous Alice informed me when I arrived for my Thursday infusion.<\/p>\n<p>I was vainly pleased to know that I was the subject of discussion at a meeting of the cancer trial team Bigs, but also curious to know that there is such an anonymous team making such all-powerful decisions behind closed doors. Probably with a delicious plate of donuts and muffins. I\u2019m convinced that the group is a mob front; they a<img loading=\"lazy\" decoding=\"async\" class=\"alignright\" style=\"margin: 5px;\" title=\"Godfather of Kidney Cancer\" src=\"http:\/\/3.bp.blogspot.com\/_R83ZO2Zs0Uo\/TPE8_Ha7b9I\/AAAAAAAAAMk\/U0V6UCi59s4\/s1600\/mafia.jpg\" alt=\"\" width=\"227\" height=\"309\" \/>re the oncological equivalent of the original Mafia Commission set up by Charlie Lucky Luciano back during the days of Prohibition. Disputes between the mob families were settled by the Commission, which was comprised of the godfathers of the five most powerful mob families. Carlo Gambino, Vito Genovese, Tommy Lucchese, and so on \u2013 each of these feared mob bosses had a seat at the table, with Luciano sitting at the head of the table as the <em>capo di tutti capi<\/em> \u2013 or Boss of Bosses. Whatever decision they made had to be accepted \u2013 otherwise, you\u2019d get whacked.<\/p>\n<p>We face the same situation here, I\u2019m pretty sure \u2013 with the Godfather of the kidney cancer family (Dr. Charles Drake) at the table along with the heads of the other families \u2013 the Melanoma Mob and the Lung Cancers Crew \u2013 all under the Luciano of the Mederex Syndicate, the Principal Investigator of the entire trial, Julie Brahmer, the <em>capo di tutti capi<\/em>. They would make a final decision, and if any of the oncologists didn\u2019t go along with it they\u2019d be found sleeping with the fishes.<\/p>\n<p>The Commission debate was whether we should ignore the mole on the assumption that it wasn\u2019t malignant or get the mole biopsied. Some wanted to monitor the mole but not go down any rabbit holes unnecessarily by getting it biopsied at this early stage. The rationale was that even if the mole were malignant, even if it were melanoma, it\u2019s in its early stages \u2013 and Stage IV kidney cancer is the far greater threat than early stage skin cancer. Moreover, as noted, the trial drug \u2013 MDX-1106 \u2013 is also being used to treat melanoma and could be attacking the lesion.<\/p>\n<p>The other faction argued that the lesion had to be biopsied, period. There was a need to know, first, exactly what we\u2019re dealing with and, second, to acquire data that might provide valuable insights for the study. For example, maybe the growth is necrotic, signs that the MDX-1106 is working. Could this show that the drug was working on two different cancers at once? Maybe the mole had nothing to do with skin cancer at all but was a hideous infection resulting from my two-year-old\u2019s decision to stab me in the neck with a No. 2 pencil just to see what would happen. (Yes, Josie\u2019s notoriety precedes her, even at Johns Hopkins. She is the Luca Brasi of the oncology Commission.)<\/p>\n<p>Alice informed me that the decision was made that we need to get a biopsy of the mole, and soon. So we\u2019re going to schedule something next week.<\/p>\n<p>\u201cYou don\u2019t think I\u2019m gonna get whacked, do you?\u201d I asked her.<\/p>\n<p>\u201cWhat?\u201d<\/p>\n<p>\u201cYou know, the Commission can\u2019t afford to have me messing up the trial data. Better to get rid of any witnesses.\u201d<\/p>\n<p>Alice denied the existence of any \u201cCommission,\u201d of course. You think Carlo Gambino admitted to the Mafia? You think John Gotti would blab about La Costra Nosa and break the code of omerta? Hell no, he was \u201cjust a businessman.\u201d Anybody who admitted to the existence of the mafia or the all-powerful Commission ended up taking a swim in the river with cement shoes, and Alice is a good soldier \u2013 a made man, so to speak, in the JHU Crime Family. She\u2019s not gonna talk. When I told her I was on to her, she just looked at me and blinked.<\/p>\n<p>\u201cSo we\u2019ll schedule a biopsy for next week,\u201d she said.<\/p>\n<p>\u201cA biopsy, huh,\u201d I said. I was careful to use air quotes. \u201cWith a surgical knife right up against my jugular, where the mole is conveniently located.\u201d<\/p>\n<p>\u201cUhhh, yes. We\u2019ll have Derm do the biopsy.\u201d<\/p>\n<p>\u201cDerm? Is that like Tommy Three Fingers? Is he a contract killer?\u201d<\/p>\n<p>\u201cDermatology. They will do the biopsy because this is a skin lesion.\u201d<\/p>\n<p>She had an answer for everything. Leave the gun; take the cannoli.<\/p>\n<p>So next week, I go in for a \u201csit-down\u201d with Derm. If you\u2019ve seen \u201cDonnie Brasco\u201d with Al Pacino and Johnny Depp, you know what this means. If I don\u2019t end up with an Italian necktie dumped in the Everglades, I\u2019ll report back here with the results of the biopsy as soon as I know more.<\/p>\n<p>Our hope is that there won\u2019t be much to report.<\/p>\n<p>And that I won\u2019t get whacked.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Something weird happened on the way to my cancer treatment. I got another cancer. Maybe. Well, maybe not. We\u2019re not sure. We\u2019re going in for a biopsy of a rogue mole next week. It has the telltale signs of skin cancer.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[4],"tags":[9,46,47,12],"class_list":["post-1207","post","type-post","status-publish","format-standard","hentry","category-blog","tag-kidney-cancer","tag-mdx-1106","tag-mdx1106","tag-rcc"],"_links":{"self":[{"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/posts\/1207","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/comments?post=1207"}],"version-history":[{"count":18,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/posts\/1207\/revisions"}],"predecessor-version":[{"id":1783,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/posts\/1207\/revisions\/1783"}],"wp:attachment":[{"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/media?parent=1207"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/categories?post=1207"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.ackc.org\/jayedit\/wp-json\/wp\/v2\/tags?post=1207"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}