Malignant Melanoma: Will the Winner of the World’s Ugliest Cancer Contest Please… Go Away

Dr. Patty Khuly

They’re some of the ugliest tumors we see, the malignant melanoma. But while this typically blackish knob may look more at home on a walking carcass in World War Z than on your otherwise healthy dog, it’s not unusual to find it peeking out from under pristine paw fur or secreted stealthily away in his mouth (among other unsavory locations), and when melanoma masses get to breaking and bleeding, they’re even less likely to compete against Miss Venezuela for the coveted sash and crown. Miss Universe they are not.

Unfortunately, their unsightliness doesn’t seem to impact their ubiquity one bit. In fact, malignant melanoma is the most common malignant tumor of the mouth, accounting for nearly 40 percent of all cancerous masses of the oral cavity. But it can also be found elsewhere, most notably in the eyes, on foot pads or nail beds, and wherever the skin meets the mucous membranes, and what’s worse is that they’re notoriously tough customers when it comes to making them go away.

Which probably explains why I see so many of them, often on a second opinion basis. Last week I received one such request in the guise of an email asking whether or not I’d be willing to take a look at a toe mass that had just been biopsied and subsequently deemed a malignant melanoma. The owners of this Schanuzer mix were especially agitated over the possibility of amputating his toe.

“Do you really think we need to remove his whole toe?”

I know it sounds dramatic, but why not? The month before, when I’d biopsied one of these nasty black bulges from a twelve year-old Pug’s mouth, I’d discussed the possibility of removing half of her jaw even before the pathologist had gotten a chance to cut into those greedy black cells. That’s how aggressive we tend to get around the subject of the malignant melanoma.

Toe amputation, mandibular hemimandibulectomy (removing half of the lower jaw), and enucleation (complete eye removal) are a trio of impressive surgical procedures undertaken by way of treating these tumors.

But first up, we’d need a trio of X-rays confirming no spreading to the lungs. This, along with a clean bill of health and the pathologist’s report validating our suspicions, is typically required before we’ll undertake any kind of painful procedure –– impressive or otherwise.

If there is a tumor in the lungs (along with a nasty malignant melanoma in the mouth, toe, or elsewhere) it tends to signal the spread of this cancer. Which means we can now add the term “metastatic” to the diagnosis of malignant melanoma. But that still doesn’t mean we’ve reached the limit of what we can achieve when it comes to malignant melanoma treatment.

We can always take on the tumors with the much-touted melanoma vaccine.

Though the melanoma vaccine is only approved for use in dogs who suffer malignant melanomas of the as yet non-metastatic variety (i.e., the solitary, black toe mass), it has been used to halt the rapid spread of late-stage manifestations of this cancer.

Without the vaccine this little guy likely has less than a month to live. With $3,000 of melanoma vaccine therapy, his owners can buy him six to seven months of comfortable “cure,” on average… and, of course, there are no guarantees.

The good news, and there is some, is that the vaccine has no side effects (that we know of). The application of this non-drug is blissfully painless and practically stress-free…for the patient, that is. But for the rest of us?

It’s a tough choice, knowing that several paychecks will need to go to your dog’s last few months. The time bomb factor. The worry if you do. The guilt if you don’t. It’s enough to hope for a speedy end so these decisions can be denied their intrinsically agonizing nature.

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