Darlene Hatcher
Darlene Hatcher first noticed a mole that had increased in size, changed in color, and started to scab on her right upper abdomen in March of 1999. At 25 years old, Darlene was more concerned with the upcoming summer and swimsuit season than any health implications related to this mole. So she went to have it removed. The dermatologist removed the suspicious mole at the initial visit and sent it off for pathology studies. She assured Darlene that this was standard practice for mole removals and so Darlene wasn’t worried. Four days later, Darlene came home to a message from the dermatologist to call her at her home number. Darlene knew immediately something was wrong and returned the call. It was melanoma. The mole was 1.45mm, right on the edge between Stage 2 and Stage 3 on the Breslow’s depth chart. When she met with the surgeon, Darlene was given the option to remove the primary lymph nodes in her right groin since that was protocol for Stage 3 melanoma. Darlene opted to not have them removed. She underwent surgery for a wide excision at the site of the melanoma in April 1999. The margins were clean and so the follow-up regimen began: blood work and chest CT scan every three months for the first year, blood work and chest CT scan every 6 months for the second year, and blood work once a year for the next 9 years. Darlene also started her lifelong annual dermatology appointments for skin checks following the diagnosis. In 2010, at the conclusion of her follow-up process, Darlene had shown no signs of melanoma.
Fast forward to July 2016. Darlene decided after living all 42 years of her life in Nebraska, she wanted to take a chance and moved to Kansas City, just her and her two dogs. She thought it would be a good first move – close enough to go home if needed, but far enough away to really be on her own. She started her adventure meeting new people and was once again playing volleyball, going golfing, running, and starting to enjoy her new life in KC. This move allowed Darlene the opportunity to take a job in the mathematics department at Johnson County Community College. The semester schedule gave her the opportunity to schedule a long trip over winter break and she chose to visit Australia which fueled her desire to see more of the world.
Just over a year after her move, July 17, 2017, Darlene noticed a lump under her right armpit. With a family history of breast cancer, Darlene knew she should not wait around to have her findings evaluated. Darlene called her gynecologist’s office to set up an appointment. The gynecologist felt the lump and ordered a mammogram and ultrasound for Thursday, July 20, 2017. The ultrasound confirmed three to four enlarged lymph nodes and a biopsy was ordered for Friday, July 21, 2017. Darlene was not immediately concerned as she had experienced an enlarged lymph node in her right groin that had been removed in 2010 and was benign. At the time of the enlarged groin lymph node, she was going through divorce and was told that stress most likely lead to the flare up. Darlene believed moving and starting a new life in KC was most likely the reason for the enlarged nodes she had discovered in her armpit. She was feeling great and had been healthy for years so she had no reason for alarm. It wasn’t until reading the line, “The core specimens obtained appear grossly pigmented, suspicious for involvement by metastatic melanoma” from the impression of the biopsy in her medical record that Darlene became scared. The next day the gynecologist called with the results – metastatic melanoma. Darlene was devastated. She didn’t understand how this could be as she had seen the dermatologist the summer before she left Omaha and she had not noticed any new moles during the previous year. She distinctly recalled what her first melanoma looked like and she was certain there had not been any lesions like this on her skin. It would be at her first appointment with the dermatologist in Kansas that Darlene learned that her immune system most likely attacked the second primary melanoma before she would have had a chance to see it on her skin; however, not before the cells had migrated to her lymphatic system.
Darlene was concerned wondering if the cancer had spread beyond the lymph nodes. Her gynecologist had told her that she would be contacted by an oncologist and they would be scheduling her for appointments to determine the extent of metastasis. Three days went by and her phone calls were not being returned and she had not received any contact from any specialists. Darlene had the next two weeks off between summer school and fall semester and she wanted to get appointments completed so her time away from class would be minimal. She knew there would have to be a surgery and the sooner this could be scheduled, the better.
The frustration of getting a metastatic cancer diagnosis and then hearing nothing for days was mounting. A friend stepped in and made a phone call. Unbeknownst to Darlene, her friend’s connection worked at Siteman Cancer Center in St. Louis and Darlene was immediately scheduled at Siteman on Monday, July 24, 2017 for a brain MRI, PET scan, and a pre-op evaluation. The good news was the cancer was isolated to her lymph nodes and so they scheduled her for surgery on Wednesday, August 9, 2017. Surgery was a success and Darlene was back in KC two days later. The following week, the surgeon called to let Darlene know that 10 of the 24 lymph nodes tested positive for cancer and that based on those results, she was diagnosed as Stage 3C and she would need adjuvant therapy. At the time of her diagnosis, the FDA had not approved Nivolumab for treatment and the only way to receive the drug was participation in a clinical trial. Fortunately, Siteman had recently been selected as a location for a trial and Darlene was a candidate. While driving from KC to St. Louis every other week for the next year was not an ideal situation, there were no options for the immunotherapy medications in Kansas or Nebraska. Darlene knew it was the best decision for her prognosis to participate in the trial and so her new normal began.
Darlene started treatment on Monday, October 16, 2017. She experienced her first side effect, loss of thyroid function, after the first treatment. Considering all of the possible side effects, this diagnosis was relatively minor and treatable with synthetic drugs, so Darlene continued with treatment. She missed only 5 total Monday night Calculus classes all semester. Darlene was fortunate enough to be able to adjust her schedule for the next year to teach all her classes on Tuesdays and Thursdays so she could continue her treatment every other Monday without missing work. Darlene’s final treatment was scheduled for Monday, September 24. Unfortunately, due to joint pain, nausea, and general fatigue that Darlene had been experiencing since Labor Day, she did not receive her final treatment on the 24th but rather was diagnosed with adrenal insufficiency. Doctors immediately started her on steroids and two weeks later, she was healthy enough to receive her final treatment and ring the bell on October 8, 2018.
Darlene is continuing her participation in the clinical trial, however, she is in the follow-up stage and is now able to schedule her remaining appointments in Kansas. She continues to see a dermatologist every 3 months and will continue CT scans and lab work every 3 months for the next two years and then every 6 months for two additional years. The diagnosis has pushed Darlene to pursue some of her dreams. She traveled to Italy for two weeks between treatments in May 2018 and to Hawaii in January 2019. Darlene knows she was fortunate to get 18 years between melanoma diagnoses and that tomorrow is not a guarantee. She plans to travel as much as possible as well as spend time with family, friends and her two dogs.
