Dr. Gombos confirmed Dr. Allison’s diagnosis: I have a melanoma in my right eye. And one of the take home lessons of this visit so far is that once you have melanoma, the risk of further melanoma (or melanoma in another place) never goes away – in this life. That means that whichever course of action we select, we will always have to be vigilant for melanoma.
Courses of action? Assuming that another reading of my CT scan gives my liver a clean bill of health, we can address two options with the eye: radiation or removal.
At the conclusion of several hours in the ophthalmology section of MD Anderson that included re-doing a fluorescein angiogram, we met with Dr. Dan Gombos, his nurse Suzanne, and his PA, Megan. Key points follow:
The current melanoma size-wise is at the upper end of “medium.” It is nearly 1 cm in height, and it has spread into the fringes of the center of my vision.
Radiation: Because of the tumor’s size and location, prognosis for radiation is that they might save the eye, but I would almost assuredly lose “substantial” vision in the eye – sooner rather than later. Also, because of the size and location, there is substantial risk of other damaging side effects (such as hemorrhaging and fluid leakage) both near- and long-term. There would be a long regimen of follow-up visits both in Houston and Lubbock. There may be some additional risk of spreading because of the time required to make the radiation patch and for the treatment itself. The primary reason for choosing this course in my circumstance would be cosmetic – to keep the eye.
Removal: This is a drastic course and like radiation, it is not reversible. It also has the side effect of reducing depth perception. Its primary benefits are that it is quick, clean, effectively removes the cancer and can be done on virtually an out-patient basis. At the time of the eye removal, a ball is inserted into the socket, muscles attached to the ball, and a shell placed over the ball. A few weeks after the initial operation, they create a new shell to match the other eye, and they place that over the ball.
Whereto for now?
We are waiting for a new reading on CT scans relative to my liver. There were a couple of abnormalities that Dr. Gombos wants a second opinion on. If the second opinion comes back negative (meaning no cancer in the liver), we believe we will start the process of moving toward eye removal. If the second reading suggests further testing, then I will submit to a liver biopsy for confirmation.
Either way, it appears we are at the beginning of a longer, not shorter, journey.