Tim Dreier

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As many of you know, I had melanoma three and a half years ago. It was fairly deep and classified as stage 2b. The surgery showed clear margins and the cancer had not spread to my lymph nodes. I had skin checks every few months after that, which all were good. One night in June I felt a pea sized nodule on my neck near my surgical scar that seemingly popped up out of nowhere. I set up an appointment right away to get it looked at. The surgical oncologist thought it was a sebaceous cyst. Due to me coming home a couple times for Matt’s bachelor party and wedding, and the surgeon going on vacation, it didn’t get removed until July 21. On July 31 I got the results that the melanoma was back. A PET scan was set up for August 9. The weekend before the PET scan I coughed up blood a few times and my doctor ordered a chest x-ray which I had on August 7. The x-ray showed a large mass in my chest. I met with a medical oncologist on August 8 and we discussed some treatment options and made a tentative treatment plan. On August 9 I had the PET scan. On August 10, I met with the medical oncologist again. He told me the cancer had spread throughout the body (meaning this time it’s stage 4) and based on the amount of disease shown on the PET scan, things in Las Vegas would move too slowly. He referred me to Mayo Clinic to get the best and quickest care possible.

On August 11 I went to the Emergency Department at Mayo Clinic. One thing my doctors in Vegas were worried about was that I might have a clotting issue. This was due to a nasty bruise by my armpit. Luckily, a blood test showed that my platelet levels were right where they were supposed to be. One of my relatives had a connection and I was able to get an appointment with Dr. Markovic of the Melanoma Care Team on August 15. He scheduled several tests that were completed over the next week. He scheduled a chest CT to get a better look at the tumor in the lung. He scheduled a biopsy of the lung tumor. There was some concern that it could be lung cancer because of how much larger it was than most of the other cancer that had metastasized. Fortunately it was melanoma and not a second cancer. He also scheduled an MRI of the head, which thankfully was negative. They also tested to see if the melanoma had a BRAF mutation, which would have meant a different treatment. It did not have the mutation. After getting the results from all these tests, the treatment plan was finalized... Ongoing immunotherapy for at least a year and five treatments of radiation on the lung tumor. The immunotherapy is a combination of Opdivo (nivolumab) and Yervoy (ipilimumab) given intravenously every three weeks for four cycles, and then just one of those drugs given every four weeks for at least a year. I received my first immunotherapy treatment August 24. I received my first radiation treatment August 31, and finished my radiation on September 7. Insurance has been very frustrating to deal with and caused both the immunotherapy and radiation treatments to be pushed back several days. It was going to be weeks before I would receive radiation where the insurance company was demanding I go (University of Southern California), and I decided to start the radiation treatment at Mayo without approval from the insurance company. Thankfully, my appeal was approved twenty minutes before my first treatment! Over the weekend after I finished my radiation, my cough worsened and I had a lot of congestion/phlegm/mucus. The doctors had me come in on September 11 to check if the cough was a complication from the radiation. They determined it was just a virus I had picked up on top of my existing cough. Upon comparing the chest ct I had done that day with the chest ct I had done prior to starting treatment there was some very good news. The large tumor in the lung targeted with radiation had visibly shrunk. More exciting to me was a smaller tumor in the chest not targeted with radiation had also shrunk! Also, a tumor that noticeably stuck out of my left arm has gotten much smaller. At the start of treatment I was told that after 3 months the tumors may be the same size or slightly larger even if it is working. To see results in less than a month was as good of a response to the treatment as I could have hoped for. On September 14 I had my second immunotherapy treatment at USC Norris Comprehensive Cancer Center. I’m scheduled to have my third immunotherapy treatment on October 5. Thank you so much for the continuous thoughts and prayers! 

TL;DR: I have stage 4 metastatic melanoma, but I’m kicking it’s butt!