Skip to Navigation

Melanoma (transcript)
Share This:

CHILD’S VOICE: THERE ONCE WAS A TIME WHEN WE WERE TRULY FREE --

FREE OF WORRY, FREE OF FEAR, FAR FROM DOUBT.  THAT IS STRENGTH.  THAT IS POWER.  THAT IS FEARLESS.  "SECOND OPINION" IS BROUGHT TO YOU BY BlueCross/BlueShield,  ACCEPTED IN ALL 50 STATES.  LIVE FEARLESS.

 

ANNOUNCER: “SECOND OPINION" IS PRODUCED IN ASSOCIATION WITH THE UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.

 

PETER SALGO:

 

THIS IS "SECOND OPINION," AND I'M YOUR HOST, DR. PETER SALGO.  IN THIS WEEK'S "MYTH OR MEDICINE," DOES SUN BLOCK ACTUALLY CAUSE CANCER?

 

SHERIFF IBRAHIM:

 

THIS IS REALLY A UBIQUITOUS PRODUCT.  IT'S CONTAINED IN SO MANY DIFFERENT PERSONAL CARE PRODUCTS THAT ARE OUT THERE.

 

PETER SALGO:

 

AND SPECIAL GUEST ANDREA HEITKER, WHOSE BOUT WITH CANCER HAS BROUGHT HER HERE FOR A SECOND OPINION.

 

ANDREA HEITKER:

 

IT ACTUALLY TOOK A FEW MINUTES FOR IT TO SINK IN WHEN SHE SAID THAT THE ONE ON MY BACK WAS BENIGN...HOWEVER, THE ONE ON MY TORSO WAS MALIGNANT.

 

PETER SALGO:

 

THANKS FOR BEING HERE, ANDREA. NICE OF YOU TO JOIN US.  I KNOW YOU'VE GOT A LOT TO TELL US, SO WE WANT TO GET RIGHT TO WORK. LET ME INTRODUCE YOU TO YOUR "SECOND OPINION" PANEL. THEY'RE HERE TO HELP YOU. AND THEY'RE GOING TO BE HEARING YOUR STORY FOR THE VERY FIRST TIME. THIS IS DR. LISA HARRIS OF THE UNIVERSITY OF ROCHESTER. DR. MARIO SZNOL FROM YALE CANCER CENTER. WELCOME TO YOU BOTH. THANK YOU BOTH FOR JOINING US. ANDREA, I KNOW YOU HAD A PRETTY CAREFREE, IDYLLIC CHILDHOOD. SO YOU TOLD ME. TELL ME A LITTLE BIT ABOUT IT.

 

ANDREA HEITKER:

 

I GREW UP ON COASTAL MASSACHUSETTS, AND SO –

 

PETER SALGO:

 

WHICH, FOR OUR AUDIENCE THAT DOESN'T LIVE ON THE EAST COAST, IS GORGEOUS, IT'S BEAUTIFUL.

 

ANDREA HEITKER:

 

IT IS, IT'S BEAUTIFUL. AND SO, AS A KID, WE SPENT A LOT OF TIME ON THE NUMEROUS BEACHES IN THE NEW ENGLAND AREA, AND I WAS A BEACH BUM FROM A VERY EARLY AGE.

 

PETER SALGO:

 

NOW, YOU TELL ME YOU'RE A BEACH BUM FROM A VERY EARLY AGE, AND I'M LOOKING AT YOUR SKIN. IT'S PALE. NO OFFENSE, BUT YOU HAVE LIGHT SKIN.

ANDREA HEITKER:

 

ABSOLUTELY.

 

PETER SALGO:

 

SO KIDS LAYING OUT IN THE SUN -- SUN BLOCK? NO SUN BLOCK?

 

ANDREA HEITKER:

 

NO, BACK THEN, WE JUST -- SUNSCREEN WAS RARELY PART OF THE EQUATION, AND CERTAINLY NOT AFTER EXCESSIVE SWIMMING, ET CETERA, SO IT -- YES, I HAD QUITE A NUMBER OF SUNBURNS WHEN I WAS YOUNG.

 

PETER SALGO:

 

OH, SO YOU BURNED A LOT? HOW BAD WERE YOUR SUNBURNS?

 

ANDREA HEITKER:

 

I DO REMEMBER ONE TIME I HAD A BLISTERING SUNBURN – IT ACTUALLY BLISTERED.

 

PETER SALGO:

 

OKAY, THAT'S IN ALL THE MEDICAL TEXTBOOKS, BY THE WAY, SERIOUSLY, A BLISTERING SUNBURN, NOT GOOD. SO WHAT HAPPENED AS YOU GOT A LITTLE BIT OLDER, TO YOUR SKIN?

 

ANDREA HEITKER:

 

SO -- SO MY TANNING BEHAVIORS STILL INCREASED AS I GOT OLDER. SO, INTO MY TEENS AND MY 20s, AND EVEN INTO MY EARLY 30s, I WOULD STILL PUT MYSELF OUT THERE IN THE SUN, UNPROTECTED.

 

PETER SALGO:

 

YOU DIDN'T QUIT.

 

ANDREA HEITKER:

 

I DIDN'T.

 

PETER SALGO:

 

ALL RIGHT. AND THEN WHAT HAPPENED TO YOUR SKIN?

 

ANDREA HEITKER:

 

AND THEN -- SO THEN AS I GOT INTO MY 30s, I STARTED TO GET A LITTLE SMARTER AND MAKE BETTER CHOICES, AND I WOULD USE SUNSCREEN PERIODICALLY, AND I WOULD TRY TO REMOVE MYSELF FROM THE SUN IF I FELT THAT IT WAS GETTING A BIT EXCESSIVE.

 

PETER SALGO:

 

IN THE MEANTIME, WHEN YOU LOOKED IN THE MIRROR, WHAT WAS HAPPENING TO YOUR SKIN?

 

ANDREA HEITKER:

 

IT WAS DEFINITELY GETTING MORE WRINKLED. I WAS GETTING A LOT -- LIKE YOU SAID, I HAVE FAIR SKIN, I HAVE AN IRISH HERITAGE, AND SO MY SKIN WAS DEFINITELY BEARING THE BRUNT OF ALL OF THAT DAMAGE.

 

DR. LISA HARRIS:

 

CAN I JUST ASK A QUESTION?

 

ANDREA HEITKER:

 

YEAH, SURE.

 

DR. LISA HARRIS

 

I WAS JUST CURIOUS, WHEN YOU HAD THE BLISTERING SUNBURN, DID YOU SEEK MEDICAL ATTENTION AT THAT TIME? DID YOU EVER SEE A DOCTOR ALONG THE WAY, SOMETHING THAT MADE YOU DECIDE THAT NEEDED --

 

ANDREA HEITKER:

 

WE WERE ON VACATION, I REMEMBER, SO, NO, I DIDN'T SEEK MEDICAL ATTENTION. I THINK THAT MY MOTHER APPLIED, YOU KNOW, THE NECESSARY ALOE VERA AND STUFF LIKE THAT, BUT I DID NOT SEEK MEDICAL ATTENTION AT THAT TIME.

 

PETER SALGO:

 

IS THIS WORRYING YOU AT ALL?

 

DR. MARIO SZNOL:

 

WELL, IT'S ACTUALLY AN EPIDEMIC. PEOPLE GET POSITIVE REINFORCEMENT FROM -- THEY FEEL GOOD WHEN THEY A SUNTAN. AND THAT'S PART OF THE SUN-SEEKING BEHAVIOR. SO IT'S NOT JUST TO LOOK GOOD. THEY ACTUALLY GET SOME SORT OF POSITIVE FEEDBACK FROM IT, AND I THINK THEY KEEP GOING BACK. THAT'S ONE OF THE REASONS WHY PEOPLE KEEP GOING BACK TO TANNING BOOTHS, I THINK.

 

PETER SALGO:

 

WELL, WE'RE NOT EVEN GOING TO GET ON TO TANNING BOOTHS FOR A WHILE, BUT IT WAS ABOUT, I KNOW YOU TOLD ME, SOMETIME AROUND YOUR 37th YEAR THAT SOMETHING HAPPENED. WHAT HAPPENED?

 

ANDREA HEITKER:

 

CORRECT, I WAS 37, AND I NOTICED THAT I HAD A NEW MOLE GROWING ON MY TORSO.

 

PETER SALGO:

 

OKAY. AND SO --WHAT HAPPENED? WHAT DID YOU DO ABOUT THAT?

 

ANDREA HEITKER:

 

NOTHING, INITIALLY. I'M A MOLE-Y AND FRECKLY PERSON, SO IT DIDN'T ALARM ME, TO BE HONEST WITH YOU. I JUST THOUGHT, "OH, LOOK, I HAVE A NEW MOLE." AND IT TOOK ME PROBABLY ABOUT A YEAR TO SEEK OUT A DERMATOLOGIST.

 

 DR. MARIO SZNOL:

 

HOW OLD WERE YOU WHEN YOU FOUND IT?

 

ANDREA HEITKER:

 

37.

 

PETER SALGO:

 

ALL RIGHT, SO YOU HAVE A MOLE, AND IT'S BEGINNING TO GROW. WHAT FINALLY CAUSED YOU TO SAY, "THIS NEEDS ATTENTION"?

 

ANDREA HEITKER:

 

THE FACT THAT IT CONTINUED TO GROW, AND IT WAS GETTING BIGGER, AND IT JUST REALLY ALERTED ME TO THE FACT THAT I HAD NOT BEEN HAVING SKIN CHECKS, AND NOW THAT IT WAS IN MY LATE 30s THAT IT WAS PROBABLY A SMART IDEA TO START GOING TO THE DERMATOLOGIST.

 

PETER SALGO:

 

SO YOU WENT TO THE DERMATOLOGIST.

 

ANDREA HEITKER:

 

I DID.

 

PETER SALGO:

 

AND WHAT DID HE OR SHE DO?

 

ANDREA HEITKER:

 

SHE TOOK A LOOK, WE DID AN OVERALL SKIN CHECK, SHE REMOVED TWO MOLES -- ONE FROM MY BACK, AND THEN THE ONE ON MY TORSO. THE ONE ON MY BACK WAS BENIGN. THE ONE ON MY TORSO DID COME BACK MALIGNANT.

 

PETER SALGO:

 

OKAY, SO WE'RE GOING TO PAUSE THERE FOR A SECOND. SHOULD ANDREA HAVE GONE TO A

DERMATOLOGIST EARLIER?

 

DR. MARIO SZNOL: 

 

I THINK SO. I THINK IT'S IMPORTANT, ESPECIALLY FOR PEOPLE WITH LIGHT SKIN AND EXTENSIVE SUN EXPOSURE, TO BE FOLLOWED BY A DERMATOLOGIST. I THINK THE DERMATOLOGISTS ARE THE BEST GROUP OF PHYSICIANS TO DETECT NEW MELANOMAS. EITHER THAT, OR PRIMARY CARE PHYSICIANS WHO HAVE EXPERIENCE IN LOOKING AT MOLES.

 

PETER SALGO:

 

NOW, YOU USED THE WORD "MELANOMA." WE DON'T KNOW WHAT SHE HAD, BUT YOUR PRESUMPTION WAS, IT WAS A TYPE OF SKIN CANCER CALLED MELANOMA. WE'RE GOING TO GET TO THAT. BUT SHE WAITED A YEAR. NOW, YOU'RE IN PRIMARY CARE.

 

LISA HARRIS:

 

I'M HAVING A FIT OVER HERE.

 

PETER SALGO:

 

IS THAT COMMON? WHAT DID YOU SAY?

 

DR. LISA HARRIS:

 

WELL, I'M HAVING A FIT OVER HERE, BUT UNFORTUNATELY, THE WAY WE FUNCTION TODAY AS FAR AS ROUTINE PHYSICAL EXAMS AND FOLLOW-UPS, IT MAY HAVE BEEN 5 OR 10 YEARS BEFORE SHE WAS SEEN BY HER PRIMARY CARE PHYSICIAN. BUT IT SEEMS TO ME THAT SOMEBODY -- EITHER A GYNECOLOGIST OR HER PCP OR SOME OTHER CLINICIAN -- SHOULD HAVE BEEN DOING SOME SORT OF A GENERAL SKIN SURVEY ALONG THE LINE -- SOMEWHERE BETWEEN THE AGES OF 20 AND 37, IT SEEMS TO ME THAT SOMEBODY SHOULD HAVE LOOKED AND BECAUSE SHE'S FAIR-SKINNED, MADE AN EARLY REFERRAL TO DERMATOLOGY. AND THAT DOESN'T MEAN THAT PEOPLE WHO ARE DARKER-SKINNED ARE SAFE. I THINK ANYONE WHO HAS EXCESSIVE SUN EXPOSURE NEEDS TO BE FOLLOWED BY A DERMATOLOGIST.

 

PETER SALGO:

 

HOW DO YOU KNOW? THE DERMATOLOGIST TOOK ONE LOOK AT THIS THING AND GOT WORRIED, OBVIOUSLY. WE HAVE SOME PICTURES, WHICH WE'RE GOING TO LOOK AT HERE. HOW DO YOU KNOW IF A MOLE IS SUSPICIOUS ENOUGH TO REMOVE? WE CAN REFER TO -- OUR VIEWERS ARE SEEING THIS TOO.

 

DR. MARIO SZNOL:

 

WELL, THE DERMATOLOGISTS ARE THE BEST AT THIS, BUT THERE'S REALLY FIVE THINGS THAT WE LOOK AT. ONE IS ASYMMETRY. SO IF ONE HALF OF THE LESION LOOKS DIFFERENT THAN THE OTHER HALF OF THE LESION, THAT'S AN IMPORTANT SIGN. IRREGULAR BORDERS, AS YOU CAN SEE IN THE ONE ON THE RIGHT-HAND SIDE, IS A SIGN OF MELANOMA. A VARIATION IN COLOR, SO DIFFERENT PIGMENTS OF COLOR, DIFFERENT SHADES OF COLOR WITHIN THE LESION CAN BE IMPORTANT. A DIAMETER OF MORE THAN ABOUT ½ A CENTIMETER IS IMPORTANT. BUT I THINK THE SINGLE MOST IMPORTANT THING IS THAT THE LESION IS EVOLVING. SO MANY TIMES WHEN I TALK TO

PATIENTS, THE SINGLE MOST IMPORTANT THING THAT THEY TELL ME IS, THE LESION WAS CHANGING OVER TIME, AND THAT'S WHAT BRINGS --

 

PETER SALGO:

 

AND THAT WAS ANDREA'S STORY.

 

DR. MARIO SZNOL:

 

EXACTLY, EXACTLY.

 

PETER SALGO:

 

SO IT'S COMMONLY AN "A," "B," "C," "D," "E" KIND OF THING, RIGHT? WHICH IS ASYMMETRY, "B" IS THE BORDER, IT SHOULD BE IRREGULAR IF YOU'RE GOING TO GET WORRIED ABOUT IT, ALTHOUGH NOT NECESSARILY --

 

DR. MARIO SZNOL:

 

CORRECT.

 

PETER SALGO:

 

CHANGE IN COLOR. "D" IS DIAMETER. "E" -- EVOLVING, RIGHT?

 

DR. MARIO SZNOL:

 

THERE'S ONE MORE THING -- "F," WHICH IS A FUNNY-LOOKING LESION. SO IF YOU HAVE ONE LESION THAT LOOKS VERY DIFFERENT THAN THE OTHERS, THAT'S ANOTHER SIGN THAT IT SHOULD BE EXAMINED BY A DERMATOLOGIST.

 

DR. LISA HARRIS:

 

AND IT'S ALSO AN ADVANTAGE OF YOUR PRIMARY CARE PHYSICIAN, BECAUSE THAT'S SOMEONE WHO'S LOOKING AT YOU OVER TIME, THAT CAN SAY, YOU KNOW, "THIS DOESN'T QUITE LOOK THE SAME AS YOUR LAST VISIT. WE SHOULD PROBABLY GET THIS CHECKED OUT.

 

PETER SALGO:

 

AND DO YOU, AS A PRIMARY CARE PHYSICIAN -- I KNOW THE ANSWER, 'CAUSE I KNOW HOW GOOD A CLINICIAN YOU ARE -- DO YOU EXAMINE YOUR PATIENTS' SKIN, TOP TO BOTTOM, EVERY TIME YOU SEE THEM?

 

DR. LISA HARRIS:

 

FOR THE MOST PART. YOU KNOW, THERE MAY BE SOME AREAS THAT WE DON'T GET TO, BUT FOR THE MOST PART, WE TRY TO DO A GOOD SKIN EXAM DURING THE PHYSICAL.

 

PETER SALGO:

 

WHAT PART OF THE SKIN IS MOST SUSCEPTIBLE TO SKIN CANCER?

 

DR. MARIO SZNOL:

 

ANY SUN-EXPOSED SKIN --

 

PETER SALGO:

 

SO SUN-EXPOSED.

 

 

DR. MARIO SZNOL:

 

SUN-EXPOSED SKIN, RIGHT. BUT YOU CAN GET MELANOMAS IN NON-SUN-EXPOSED SKIN. IT'S VERY IMPORTANT FOR PEOPLE TO REMEMBER THAT YOU CAN GET -- MELANOCYTES ARE EVERYWHERE IN THE BODY, AND THAT'S --

 

PETER SALGO:

 

MELANOCYTES ARE THE CELLS IN YOUR BODY THAT MAKE PIGMENT AND GIVE YOU A SUNTAN.

 

DR. MARIO SZNOL:

 

EXACTLY, AND THEY'RE EVERYWHERE IN THE BODY, AND YOU CAN DEVELOP MELANOMA ANYWHERE YOU HAVE MELANOCYTES. YOU CAN DEVELOP IT BEHIND YOUR EYE, YOU CAN DEVELOP IT IN THE MUCOSA OF THE NOSE, YOU CAN DEVELOP IT IN THE ANAL OR VAGINAL AREAS. SO IT CAN START ALMOST ANYWHERE. UNDERNEATH THE FINGERNAILS AND ACTUALLY IN THE BOTTOMS OF THE FEET.

 

PETER SALGO:

 

SO WITH THAT ENCOURAGING NEWS THAT IT CAN POP UP ANYWHERE, BUT SUN-EXPOSED SKIN MORE LIKELY THAN SOME OTHER AREAS.

 

DR. MARIO SZNOL:

 

ABSOLUTELY.

 

PETER SALGO:

 

WAS THIS A SUN-EXPOSED AREA THAT YOU GOT THIS MOLE IN?

 

ANDREA HEITKER:

 

YES, IT WAS.

 

PETER SALGO:

 

OKAY, AND EVERYONE'S BEEN MAKING THE ASSUMPTION HERE THAT WHAT YOU HAD WAS A MELANOMA, A PARTICULARLY AGGRESSIVE KIND, BAD KIND OF SKIN CANCER. TELL ME A LITTLE BIT MORE. YOUR DOCTOR TOOK THIS BIOPSY --

 

ANDREA HEITKER:

 

SHE DID, SHE DID, SHE TOOK THE BIOPSY AND THEN CALLED ME ABOUT 10 DAYS LATER WITH THE RESULTS, WHICH I WAS VERY UNPREPARED FOR.

 

PETER SALGO:

 

AND WHAT WAS IT LIKE TO HEAR THAT YOU HAD CANCER?

 

ANDREA HEITKER:

 

IT WAS OVERWHELMING. IT ACTUALLY TOOK A FEW MINUTES FOR IT TO SINK IN WHEN SHE SAID THAT THE ONE ON MY BACK WAS BENIGN...HOWEVER, THE ONE ON MY TORSO WAS MALIGNANT. IT JUST -- IT TOOK A FEW MINUTES FOR IT TO ACTUALLY REGISTER, AS TO WHAT SHE WAS SAYING.

 

PETER SALGO:

 

BUT I KNOW THERE ARE PEOPLE OUT THERE WHO ARE SAYING, "BUT IT'S SKIN CANCER." DID SHE USE THE WORD "MELANOMA," BY THE WAY?

 

ANDREA HEITKER:

 

SHE DID.

 

PETER SALGO:

 

SHE DID. "IT'S SKIN CANCER. I MEAN, COME ON, YOU TAKE IT OFF THE SKIN. WHAT COULD BE SO BAD?"

 

DR. MARIO SZNOL:

 

THERE -- PEOPLE WHO ARE SUN EXPOSED WILL GET BASAL CELL CARCINOMAS, WHICH GENERALLY CAN BE REMOVED AND CURED, AND SQUAMOUS CELL CARCINOMAS, WHICH ARE GENERALLY BENIGN AND CAN BE REMOVED AND CURED. EVEN THOSE TWO KINDS OF CANCERS CAN BEHAVE, RARELY, IN A VERY MALIGNANT FASHION. BUT MELANOMA IS THE ONE THAT HAS A HIGH PROPENSITY TO GET INTO THE BLOODSTREAM AND TRAVEL TO OTHER ORGANS, ESSENTIALLY FORM METASTASES, AND THAT'S WHAT PEOPLE GET SICK FROM, AND UNFORTUNATELY THAT'S WHAT PEOPLE CAN DIE FROM, IS THE METASTATIC DISEASE. SO MELANOMA REALLY IS THE MOST DANGEROUS SKIN CANCER.

 

PETER SALGO:

 

OKAY, SO YOU GO TO YOUR DOCTOR. YOUR DOCTOR CALLED YOU BACK, SAID TO SEE A SURGEON?

 

ANDREA HEITKER:

 

CORRECT, YES.

 

PETER SALGO:

 

AND WHAT HAPPENED?

 

ANDREA HEITKER:

 

SO SHE REFERRED ME TO A SURGEON, AND SO MY HUSBAND AND I WENT TO MEET WITH HIM, AND THEY WENT AHEAD AND REMOVED THE TUMOR AND ALSO BIOPSIED THE LYMPH NODES UNDER MY LEFT ARM.

 

PETER SALGO:

 

OKAY, THEY WERE DOING THAT, I PRESUME, SO THEY WOULD SEE IF THE CANCER HAD SPREAD. WE CAN DISCUSS THAT IN A MINUTE. WHAT DID THEY FIND?

 

ANDREA HEITKER:

 

THAT THE CANCER HAD SPREAD.

 

PETER SALGO:

 

OKAY, IT WAS IN YOUR LYMPH NODES.

 

ANDREA HEITKER:

 

CORRECT, IT WAS IN MY SENTINEL NODE, WHICH IS THE MAIN LYMPH NODE.

 

PETER SALGO:

 

AND WHAT DID THAT MEAN? THEY STAGED YOU AT THAT PART, RIGHT?

 

ANDREA HEITKER:

 

CORRECT, SO I WAS A STAGE III AT THAT POINT.

 

PETER SALGO:

 

OKAY, NOW, MELANOMA IS STAGED AT I THROUGH IV -- I BEING THE LEAST SEVERE, IV BEING THE MOST. SO III ISN'T SO HOT.

 

DR. MARIO SZNOL:

 

NO, III MEANS YOU ALREADY HAVE LYMPH NODE METASTASES, AND THE REASON WHY WE STAGE MELANOMA IS TO DETERMINE PROGNOSIS, TO DETERMINE THE RISK THAT THE DISEASE WILL SHOW UP IN OTHER PARTS OF THE BODY. WE BASICALLY USE THREE FACTORS. ONE IS THE DEPTH OF THE LESION. THE OTHER IS ULCERATION, WHICH CAN ONLY BE SEEN UNDER THE MICROSCOPE. AND THE THIRD FACTOR THAT WE USE IS WHETHER OR NOT THE LOCAL LYMPH NODES THAT ARE DRAINING, THE SIDE OR THE PRIMARY, ARE INVOLVED. ONCE WE HAVE ALL THAT INFORMATION, WE CAN ASSIGN A STAGE. ONCE YOU HAVE LYMPH NODE INVOLVEMENT, IT'S STAGE III, AND ACTUALLY, THERE'S THREE KINDS OF STAGE III. THERE'S "A," "B," AND "C" -- "A" BEING THE BEST PROGNOSIS, "C" BEING PROBABLY AN 80% CHANCE THAT THE DISEASE WILL RECUR OVER 10 YEARS.

 

PETER SALGO:

 

WELL, YOU KNOW, I WAS ALWAYS TAUGHT THAT MALIGNANT MELANOMA GOES DIFFERENTLY THAN SOME CARCINOMAS, LIKE BREAST -- THAT IT GOES IN THE BLOOD. IT DOESN'T REALLY CARE ABOUT THE LYMPH NODES. WHY ARE WE SUDDENLY CARING ABOUT LYMPH NODES?

 

DR. MARIO SZNOL:

 

LYMPH NODES PROVIDE PROGNOSTIC INFORMATION. TAKING OUT THE LYMPH NODES PROBABLY DOESN'T AFFECT SURVIVAL. IT DOESN'T CURE YOU -- WELL, THERE ARE SOME PEOPLE WHO DON'T RELAPSE AFTER A LYMPH NODE RESECTION, BUT WHAT IT MOSTLY PROVIDES IS PROGNOSTIC INFORMATION, BECAUSE WHEN -- MELANOMA TRAVELS THROUGH THE LYMPHATIC CHANNELS TO THE LOCAL LYMPH NODES, BUT IT CAN ALSO TRAVEL DIRECTLY INTO THE BLOODSTREAM. SO, EVEN BEFORE YOU TAKE OUT THAT -- YOU FIND THAT INITIAL MELANOMA, THOSE CELLS PROBABLY COULD HAVE GOTTEN INTO THE BLOODSTREAM AND TRAVELED TO OTHER PARTS OF THE BODY. WHEN THE MELANOMA CELLS LAND IN OTHER PARTS OF THE BODY, THEY DON'T NECESSARILY GROW AT THAT TIME. THEY'RE DORMANT. WE CAN'T FIND THEM ON A CAT SCAN OR A PET SCAN. BUT THERE'S A CHANCE THAT THEY MIGHT START GROWING IN THE FUTURE, AND THE WAY WE DETERMINE THAT RISK IS BY LOOKING AT THE DEPTH, ULCERATION, AND THE LYMPH NODE INVOLVEMENT, THE STAGE, EXACTLY.

 

PETER SALGO:

 

SO YOU'VE BEEN TOLD YOU'VE GOT STAGE III CANCER. A PARTICULARLY NASTY ONE, MELANOMA. WHEN PATIENTS IN YOUR PRACTICE HEAR THIS KIND OF DIAGNOSIS, ARE THEY REALLY LISTENING TO YOU THE FIRST TIME YOU SAY THAT?

 

DR. LISA HARRIS:

NO, THEY'RE NOT. THEY'RE STILL IN SHOCK THAT THEY'VE BEEN TOLD THEY HAVE CANCER. YOU KNOW, WHAT DOES THIS MEAN? AM I GOING TO DIE TOMORROW? DO I NEED TO QUIT MY JOB? YOU KNOW, WHAT'S HAPPENING TO ME?

 

PETER SALGO:

 

RIGHT, SO HOLD THAT THOUGHT, EVERYBODY STAY RIGHT HERE, BECAUSE WE'RE GOING TO BE RIGHT BACK TO PICK UP OUR STORY AGAIN, BUT FIRST HERE'S THIS WEEK'S "MYTH OR MEDICINE."

 

NARRATOR:

 

SUNSCREEN OR SUN BLOCK PROTECTS YOUR SKIN FROM SUNBURN BY BLOCKING OUT ULTRAVIOLET RADIATION. BUT RECENT CLAIMS STATE THAT THE SUNSCREEN YOU USE MAY ACTUALLY CAUSE CANCER. IS THAT MYTH OR MEDICINE?

 

SHERIFF IBRAHIM

 

"SUNSCREEN CAUSES CANCER" -- THAT IS A MYTH, AND I AM GOING TO TELL YOU WHY. MY NAME IS SHERRIF IBRAHIM. I AM AN ASSISTANT PROFESSOR OF DERMATOLOGY AT THE UNIVERSITY OF ROCHESTER MEDICAL CENTER. THERE ARE A FEW PAPERS AND A WHOLE LOT OF HYPE ABOUT THIS TOPIC, PARTICULARLY IN RELATION TO TWO CHEMICALS -- RETINYL PALMITATE AND OXYBENZONE. SO RETINYL PALMITATE IS ESSENTIALLY VITAMIN A. IT'S THE SAME STUFF THAT MILK IS FORTIFIED WITH, YOU'RE FEEDING IT TO YOUR KIDS ALL THE TIME. THE OTHER IS OXYBENZONE, AND THAT'S THOUGHT TO DISRUPT SOME OF THE HORMONES IN THE BODY AND THEORETICALLY THOUGHT TO DOWNSTREAM -- MAYBE POTENTIALLY CAUSE CANCER THAT WAY, BUT THAT'S REALLY NEVER BEEN SHOWN TO PAN OUT IN ANY MEDICAL STUDY. REALLY, IF YOU'RE CONCERNED ABOUT THESE CHEMICALS, THERE'S SUCH A MYRIAD OF ALTERNATE SUNSCREENS OUT THERE THAT YOU COULD EASILY AVOID USING THEM AND STILL GAIN ADEQUATE ULTRAVIOLET PROTECTION.

 

NARRATOR:

 

SARAH FROM MIDDLETOWN, NEW YORK, ASKS, "I ALWAYS GET A BASE TAN. IS THAT SAFE?"

 

SHERIFF IBRAHIM:

 

THERE IS NO SUCH THING AS A SAFE TAN OR A BASE TAN OR, YOU KNOW, BURNING ONCE AND THEN BEING SAFE FOR THE REST OF THE SEASON. THAT'S REALLY PREPOSTEROUS. THE TAN, MEDICALLY SPEAKING, IS THE BODY'S RESPONSE TO DNA DAMAGE. SO, IN OTHER WORDS, NOBODY GETS A TAN UNLESS THERE'S DNA DAMAGE IN YOUR SKIN CELLS. THAT'S THE SWITCH TO TURN ON THE TANNING MACHINERY. SO, AS LONG AS YOU'RE GETTING A TAN OR MAINTAINING A TAN, THAT IS INDICATIVE OF YOUR BODY REALLY ACCUMULATING MORE DAMAGE TO DNA, AND THAT IS THE ROOT  CAUSE OF ALL OF SKIN CANCER.

 

NARRATOR:

 

NOT SURE IF IT'S MYTH OR MEDICINE? CONNECT WITH US ONLINE. WE WILL GET TO WORK AND GET YOU A SECOND OPINION.

 

PETER SALGO:

 

WE'RE HERE WITH ANDREA. WELCOME BACK. THANK YOU FOR STAYING WITH US ACROSS THE BREAK. YOU'RE 41 YEARS OLD NOW, RIGHT?

 

ANDREA HEITKER:

 

YES.

 

PETER SALGO:

 

NOW, WHEN YOU WERE 37, YOU WERE DIAGNOSED WITH STAGE III MELANOMA -- MELANOMA, STAGE I TO IV, SO III ISN'T A GREAT DIAGNOSIS TO HAVE. BEFORE WE GET TO THE SECOND OPINION YOU'RE HERE TO GET, I WANT TO HEAR MORE OF YOUR STORY. AT YOUR DIAGNOSIS, YOU MUST HAVE HAD SOME SUGGESTIONS FROM YOUR PHYSICIANS AS TO WHAT KIND OF TREATMENT THEY WERE GOING TO OFFER YOU. WHAT DID THEY OFFER YOU?

 

ANDREA HEITKER:

 

YES, AT THAT TIME, FOUR YEARS AGO, THERE WAS ONLY REALLY ONE PROTOCOL, MY UNDERSTANDING, FOR STAGE III MELANOMA, WHICH WAS SURGERY, FOLLOWED BY A YEAR OF IMMUNOTHERAPY.

 

PETER SALGO:

 

OKAY, NOW, STOP RIGHT THERE, BECAUSE IMMUNOTHERAPY IS NOT WHAT PEOPLE ARE USED TO HEARING. THEY'RE USED TO HEARING "CHEMOTHERAPY," AND THEY ASSOCIATE THAT WITH ALL KINDS OF SICKNESS. HOW DOES IMMUNOTHERAPY DIFFER FROM CHEMOTHERAPY?

 

DR. MARIO SZNOL:

 

IMMUNE THERAPY IS DESIGNED TO ACTIVATE THE BODY'S T CELLS, FOR THE MOST PART, TO ATTACK THE CANCER CELLS -- YOUR OWN IMMUNE SYSTEM.

 

PETER SALGO:

 

YOU HAVE T CELLS AND B CELLS IN YOUR BLOOD, AND THEY ARE THERE TO CHEW UP INVADERS AND KEEP YOU HEALTHY.

 

DR. MARIO SZNOL:

 

ESSENTIALLY CORRECT, YEAH.

 

PETER SALGO:

 

SO THE T CELLS IN THIS CIRCUMSTANCE WOULD DO WHAT?

 

DR. MARIO SZNOL:

 

WELL, THE T CELLS ARE ABLE TO ECOGNIZE SPECIFIC MARKERS IN HE MELANOMA CELLS.THEY'RE ABLE TO SPECIFICALLY RECOGNIZE MELANOMA CELLS, ATTACK THEM, AND ELIMINATE THEM. SO THE DRUGS THAT WE USE DON'T ACTIVATE THOSE CELLS SPECIFICALLY, THEY ACTIVATE THE IMMUNE SYSTEM NONSPECIFICALLY, BUT IN DOING THAT, WE ALSO ACTIVATE CELLS THAT CAN RECOGNIZE MELANOMA.

 

PETER SALGO:

 

SO WHAT YOU DO FOR IMMUNOTHERAPY OR IMMUNE THERAPY IS, YOU RING THE FIRE ALARM, AND ALL THE CELLS RESPOND, AND YOU HOPE THAT SOME OF THOSE CELLS EAT THE TUMOR.

 

DR. MARIO SZNOL:

 

THAT'S EXACTLY RIGHT.

 

PETER SALGO:

 

DO YOU HAVE PATIENTS ON THIS THERAPY?

 

DR. LISA HARRIS:

 

I DON'T, CURRENTLY.

 

PETER SALGO:

 

OKAY, BUT YOU HAVE?

 

DR. LIZA HARRIS:

 

YES, IN THE PAST.

 

PETER SALGO:

 

SO I'M NOT EVEN GOING TO ASK YOU WHAT THEY GO THROUGH, SINCE I'VE GOT SOMEONE WHO'S BEEN THROUGH IT. WHAT WAS IT LIKE? TELL ME ABOUT THE WHOLE PROCESS.

 

ANDREA HEITKER:

 

THE WHOLE PROCESS TOOK A YEAR, TOTAL, FOR THE IMMUNOTHERAPY PROTOCOL. SO WE STARTED -- FIRST I HEALED FROM MY SURGERIES, AND THEN --

 

PETER SALGO:

 

THAT'S IMPORTANT. THEY HAVE TO DO THAT FIRST.

 

DR. MARIO SZNOL:

 

YEAH, IT DOESN'T TAKE VERY LONG, BUT --

 

ANDREA HEITKER:

 

YES, SO I HEALED FROM THE SURGERIES, AND THEN MY ONCOLOGIST STARTED ME ON THE IMMUNOTHERAPY DRUG, WHICH AT FIRST WAS ADMINISTERED EVERY DAY FOR A MONTH.

 

PETER SALGO:

 

HOW WAS IT ADMINISTERED?

 

ANDREA HEITKER:

 

THROUGH INTRAVENOUS.

 

PETER SALGO:

 

SO DID YOU HAVE TO GO TO THE HOSPITAL EVERY DAY?

 

ANDREA HEITKER:

 

I DID NOT HAVE TO GO TO THE HOSPITAL, I WENT TO HIS OFFICE.

 

PETER SALGO:

 

BUT YOU WENT TO A FACILITY. YOU WENT TO THEM. AND THEN WHAT?

 

ANDREA HEITKER:

 

SO THEN EVERY DAY, MONDAY THROUGH FRIDAY, I WOULD GO FOR TREATMENT. AND I'D HAVE THE WEEKENDS OFF. SO THAT TOOK A MONTH.

 

PETER SALGO:

 

AND THEN WHAT?

 

ANDREA HEITKER:

 

AND THEN FOLLOWED BY 11 MONTHS OF INJECTIONS. THE SAME DRUG, BUT I INJECTED MYSELF AT HOME.

 

DR. MARIO SZNOL:

 

IT'S IMPORTANT TO REMEMBER THAT THE PURPOSE OF TREATMENT AT THIS POINT IS TO PREVENT THOSE CELLS THAT MAY STILL BE IN THE BODY FROM STARTING TO GROW -- TO ELIMINATE THE RESIDUAL CELLS. YOU CAN'T SEE ANYTHING ON A CAT SCAN OR A PET SCAN AT THAT POINT. THE IMMUNOTHERAPY THAT'S BEING USED IS INTERFERON, AND INTERFERON IS NOT A GREAT DRUG. IT'S AN OKAY DRUG. IT HAS LIMITED EFFICACY. YOU HELP A FEW PEOPLE OUT OF 100 THAT YOU TREAT WITH THE INTERFERON. WE ALSO TRY AND PUT PATIENTS ON CLINICAL TRIALS, BECAUSE WE'RE ALWAYS LOOKING FOR BETTER APPROACHES.

 

PETER SALGO:

 

CLINICAL TRIALS, EXPERIMENTAL THERAPY.

 

DR. MARIO SZNOL:

 

EXPERIMENTAL THERAPIES, BUT THEY'RE -- AT THAT POINT, THOSE ARE EXPERIMENTAL THERAPIES WHICH WE ALREADY KNOW CAN TREAT ADVANCED DISEASE MORE EFFECTIVELY, SO WE'RE ALWAYS LOOKING FOR BETTER WAYS TO TREAT THE DISEASE, AND THEREFORE WE ALMOST ALWAYS TRY AND OFFER A PATIENT LIKE ANDREA A CLINICAL TRIAL THAT COMPARES INTERFERON OR THE STANDARD OF CARE TO SOMETHING BETTER. THERE ARE BETTER IMMUNE THERAPIES. THE RESULTS OF THOSE TRIALS AREN'T AVAILABLE YET, BUT WE HOPE TO IMPROVE THE THERAPY OVER THE NEXT SEVERAL YEARS.

 

PETER SALGO:

 

WELL, HOW DID ALL THIS MAKE YOU FEEL? YOU ALLUDED TO IT. I WANT TO HEAR -- GIVE ME SOME GORY DETAIL. HOW BAD WAS IT?

 

ANDREA HEITKER:

 

IT WAS PRETTY TERRIBLE. I WAS -- I THINK THE MAIN SIDE EFFECT FOR ME WAS EXTREME FATIGUE. AND INITIALLY, I HAD, YOU KNOW, CHILLS AND FEVER, AND THEY DID HAVE TO LOWER MY DOSAGE AMOUNT A COUPLE OF TIMES, BASED ON MY SIDE EFFECTS.

 

PETER SALGO:

 

DID YOU STOP WORKING BECAUSE YOU WERE SO SICK?

 

ANDREA HEITKER:

 

YES.

 

PETER SALGO:

 

SO THIS IS NASTY STUFF.

 

ANDREA HEITKER:

 

YES.

 

PETER SALGO:

 

ON THE OTHER HAND, HOW IS YOUR MELANOMA DOING SINCE MAY OF 2010?

 

ANDREA HEITKER:

 

GREAT. I HAVE NOT HAD A REOCCURRENCE FOR THE MELANOMA.

 

PETER SALGO:

 

ALL RIGHT, NOW, IT SOUNDS LIKE YOU GOT VERY GOOD MEDICAL CARE.

 

ANDREA HEITKER:

 

ABSOLUTELY.

 

PETER SALGO:

 

AND YOU ARE MELANOMA-FREE, YOU THINK. AND YOU ALLUDED TO OTHER TREATMENTS THAT ARE OUT THERE. WHAT OTHER TREATMENTS ARE ON THE HORIZON?

 

DR. MARIO SZNOL:

 

WELL, IT DEPENDS ON WHETHER YOU'RE TALKING ABOUT THE ADJUVANT SETTING, WHICH IS WHERE ANDREA WAS, OR WHETHER YOU'RE TALKING TO PATIENTS WHO ALREADY HAVE METASTATIC DISEASE, BUT THERE ARE OTHER WAYS OF ACTIVATING THE IMMUNE SYSTEM THAT ARE PROBABLY MUCH MORE POWERFUL THAN THE INTERFERON THAT ANDREA GOT. FOR EXAMPLE, THERE'S A DRUG CALLED INTERLEUKIN-2, WHICH WE DON'T USE IN THE ADJUVANT SETTING, BUT CAN CURE A SMALL NUMBER OF PATIENTS WITH METASTATIC DISEASE. THERE WAS A DRUG THAT WAS APPROVED IN 2011 CALLED IPILIMUMAB -- IT'S AN ANTIBODY THAT BASICALLY --

 

PETER SALGO:

 

I'M GLAD YOU HAD TO PRONOUNCE THAT, BY THE WAY.

 

DR. MARIO SZNOL:

 

WE CALL IT "IPI" FOR SHORT. IT'S ALSO CALLED YERVOY, IS THE TRADE NAME. IT TAKES THE BRAKES OFF THE IMMUNE SYSTEM. SO THE IMMUNE SYSTEM TURNS ON AND TURNS OFF. WE WERE ALWAYS TRYING TO TURN ON THE IMMUNE SYSTEM. NOW WE'VE LEARNED THAT TAKING THE BRAKES OFF THE IMMUNE SYSTEM MAY BE A BETTER WAY OF ACTIVATING THE CELLS.

 

PETER SALGO:

 

NOW, LISA, IN YOUR PRACTICE, HOW DO YOU HELP YOUR PATIENTS DEAL WITH THE SICKNESS AND ALL THE PHENOMENA THAT GO ALONG WITH CHEMOTHERAPY AND IMMUNOTHERAPY?

 

DR. LISA HARRIS:

 

THIS IS A PROBLEM. THIS IS TYPICALLY WHERE YOU LOSE CONTACT WITH YOUR PATIENT, BECAUSE ONCOLOGY TAKES OVER, AND YOU DON'T OFTEN SEE THEM. MANY TIMES, YOU DON'T EVEN KNOW WHAT HAPPENED OR WHAT THERAPY THEY'RE ON, SO IT'S IMPORTANT, REALLY, FOR THE PRIMARY CARE PHYSICIAN TO TRY TO REACH OUT TO THE PATIENT AND SAY, YOU KNOW, "I'M HERE FOR YOU FOR SUPPORT -- IF YOU NEED SOMEONE TO TALK TO, IF YOU NEED SOME ADDITIONAL REFERRALS FOR COUNSELING, OTHER TYPES OF SUPPORT." THINGS LIKE GETTING A NURSING AGENCY INTO THE HOME TO HELP YOU, UNDERSTANDING HOW TO GO THROUGH DISABILITY, BECAUSE YOUR SPECIALIST MAY NOT KNOW HOW TO DO THAT. SO IT'S IMPORTANT TO TRY TO MAINTAIN CONTACT WITH YOUR PRIMARY.

 

PETER SALGO:

 

NOW, ANDREA, YOU ARE HERE FOR A SECOND OPINION. THIS IS YOUR SHOT. YOU'VE GOT GREAT DOCS SITTING ACROSS FROM YOU. WHAT KIND OF A SECOND OPINION DO YOU WANT? WHAT WOULD YOU LIKE TO ASK THEM?

 

ANDREA HEITKER:

 

WELL, I WOULD LOVE TO KNOW WHAT BOTH OF THE DOCTORS WOULD RECOMMEND, GOING FORWARD. SO I GUESS MY FIRST QUESTION WOULD BE, WHAT DO YOU THINK MY RISK IS FOR REOCCURRENCE AND/OR FOR PROGRESSION TO STAGE IV? AND THEN, IS THERE ANYTHING THAT I CAN BE DOING TO TRY AND PREVENT THAT AND/OR BE PROACTIVE?

 

DR. MARIO SZNOL:

 

WELL, FIRST --

 

DR. LISA HARRIS:

 

I'LL LET YOU JUMP IN.

 

PETER SALGO:

 

JUMP IN FIRST, AND YOU PICK IT UP.

 

DR. MARIO SZNOL:

 

SO, SO THOSE ARE GOOD QUESTIONS. FIRST OF ALL, DO YOU REMEMBER WHETHER THEY CALLED IT STAGE IIIA OR IIIB OR IIIC?

 

ANDREA HEITKER:

 

I BELIEVE I WAS STAGE IIIA.

 

DR. MARIO SZNOL:

 

OKAY, SO FOR STAGE IIIA, THE RISK OVER 10 YEARS OF DEVELOPING METASTATIC DISEASE IS REALLY NOT -- WELL, IT'S HIGH, BUT IT'S NOT AS HIGH AS YOU WOULD THINK. IT'S ONLY ABOUT SOMEWHERE BETWEEN 40% TO 50%. SO IT'S LESS THAN HALF. I FIND THAT IT'S VERY IMPORTANT -- AND THAT'S THE RISK OVER 10 YEARS. BECAUSE MELANOMA, IF IT COMES BACK, CAN COME BACK AT A YEAR, AT 2 YEARS, AT 5 YEARS, AT 10 YEARS, AT 25 YEARS. WE'VE SEEN PEOPLE WHERE THE MELANOMA HAS COME BACK AT 25 YEARS. BUT THE STANDARD OF CARE WOULD BE TO SEE YOU IN THE CLINIC EVERY THREE MONTHS FOR THE FIRST FIVE YEARS, DO A PHYSICAL EXAM, TAKE A HISTORY, GET BLOOD WORK, A CHEST X-RAY, AND ALTHOUGH IT'S CONTROVERSIAL, IN OUR PRACTICE, FOR SOMEBODY WITH STAGE IIIA, WE WOULD DO A CAT SCAN OF THE CHEST, ABDOMEN, AND PELVIS ONCE A YEAR, AND NOW WE'RE EXTENDING THE FOLLOW-UP BEYOND FIVE YEARS, ALTHOUGH THERE'S NO REAL DATA TO SUGGEST THAT PEOPLE DO BETTER. BUT I WILL SAY THAT, BECAUSE THE TREATMENTS FOR ADVANCED DISEASE ARE GETTING SO MUCH BETTER, THAT I THINK THERE IS AN INDICATION TO SCREEN PEOPLE CAREFULLY FOR METASTATIC DISEASE, BECAUSE WE CAN TREAT THEM SUCCESSFULLY AT THAT POINT.

 

PETER SALGO:

 

LISA LET ME GIVE YOU THE  LAST WORD, ABOUT 15, 20 SECONDS.

 

DR. LISA HARRIS:

 

I THINK YOU NEED TO BE PROACTIVE WITH CONTINUED REDUCTION OF SUN EXPOSURE. MAKE SURE THAT YOU ARE REALLY NOT EXPOSING YOURSELF FOR TRADITIONAL SUN.

 

PETER SALGO:

 

WORDS OF WISDOM, AS USUAL, FROM LISA. ANDREA, THANK YOU SO MUCH --

 

ANDREA HEITKER:

 

THANK YOU VERY MUCH.

 

PETER SALGO:

 

FOR SHARING YOUR STORY TODAY. AND, PANEL, OF COURSE, THANK BOTH OF YOU FOR SHOWING UP HERE NOW, AND FOR THE LAST WORD ON MELANOMA, HERE'S THIS WEEK'S "SECOND OPINION 5."

 

DR. MANASI LADRIGAN:

 

HI, I'M DR. MANASI LADRIGAN, AND I'M HERE TO TELL YOU FIVE THINGS TO KNOW ABOUT PREVENTING SKIN CANCER. THE FIRST IS USING SUNSCREEN PROPERLY. YOU SHOULD SELECT A BROAD-SPECTRUM SUNSCREEN WITH SPF BETWEEN 15 AND 50.

ONE OUNCE, OR ONE SHOT GLASS, WORTH OF SUNSCREEN SHOULD BE APPLIED WHEN WEARING A SHORT-SLEEVED T-SHIRT AND SHORTS. DOUBLE THIS IF YOU'RE WEARING A BATHING SUIT. SUNSCREEN NEEDS TO BE REAPPLIED EVERY TWO HOURS, SO BUY SOMETHING AFFORDABLE THAT YOU WON'T MIND USING LIBERALLY. THE SECOND IS TO USE SUN-PROTECTIVE CLOTHING AND LARGE-RIM HATS. THERE ARE ALSO PRODUCTS AVAILABLE TO WASH ADDITIONAL UV PROTECTION INTO YOUR REGULAR  CLOTHING. THE THIRD IS TO KNOW WHEN UV RAYS ARE AROUND YOU. WHILE THEY ARE AT THEIR HIGHEST DURING THE MIDDAY, UV RAYS REACH THE EARTH EVERY DAY, EVEN ON OVERCAST DAYS AND THE WINTER. HIGH ALTITUDES HAVE THINNER ATMOSPHERE, SO REMEMBER TO PACK YOUR SUNSCREEN FOR YOUR NEXT SKI TRIP. USING SUNSCREEN EVERY DAY PROTECTS YOU EVEN FROM THE SUN THAT COMES IN THROUGH YOUR CAR WINDOW. THE NEXT IS TO AVOID BURNING AND TANNING. TANNING OUTSIDE OR IN A BOOTH IS EQUALLY DANGEROUS. IT IS MUCH SAFER TO OBTAIN VITAMIN D THROUGH D-RICH FOODS OR DIETARY SUPPLEMENTS. THE LAST IS TO EXAMINE YOUR SKIN AND NAILS ONCE A MONTH, USING MIRRORS, LOOKING FOR ANYTHING THAT IS NEW, ASYMMETRICAL, CHANGING, ISN'T HEALING, OR IS ITCHING OR BLEEDING. AND THAT'S YOUR "SECOND OPINION 5."

 

PETER SALGO:

 

THANK YOU SO MUCH FOR WATCHING "SECOND OPINION." WE HOPE YOU CONTINUE THE CONVERSATION ON OUR WEB SITE, WHERE YOU CAN COMMENT ON THIS SHOW, SEND US YOUR SHOW IDEAS, OR SHARE YOUR HEALTH STORY WITH US, AND MAYBE WE'LL EVEN INVITE YOU TO BE ON THE SHOW. THE WEB ADDRESS IS secondopinion-tv.org. I'M DR. PETER SALGO. I'LL SEE YOU NEXT TIME FOR ANOTHER "SECOND OPINION."

 

CHILD:

 

THERE ONCE WAS A TIME WHEN WE WERE TRULY FREE -- FREE OF WORRY, FREE OF FEAR, FAR FROM DOUBT. THAT IS STRENGTH. THAT IS POWER. THAT IS FEARLESS. "SECOND OPINION" IS BROUGHT TO YOU BY BlueCross/BlueShield,ACCEPTED IN ALL 50 STATES. LIVE FEARLESS.

 

NARRATOR:

 

"SECOND OPINION" IS PRODUCED IN ASSOCIATION WITHTHE UNIVERSITY OF ROCHESTER MEDICAL CENTER, ROCHESTER, NEW YORK.