When her dermatologist removed a small mole from Michele Yerger’s face, next to the top of her nose, neither woman was particularly concerned. Michele was 49-years old, had no family history of skin cancer, and figured the mole had recently started bleeding because it rubbed the nose pads on her glasses.
Then Michele’s dermatologist called with biopsy results.
“She asked me if it was a good time to talk,” Michele recalls. “When I said yes, she said, ‘The biopsy shows that you have malignant melanoma at a depth of .9 millimeters, which is considered a deep melanoma. I scheduled an appointment for you with Dr. Miller at Penn Medicine. He is expecting you tomorrow at 8am.”
Michele and her husband Mark were both shocked.
“I was like, ‘Huh?’ It was just a tiny mole. I had always wrongly believed that being half Italian meant I was immune to skin cancer.”
Less than 24 hours later, Michele and Mark were at the Penn Medicine Perelman Center for Advanced Medicine, meeting with Dr. Christopher J. Miller, MD. From the get go, the experience was better than Michele expected.
“When my mother went through cancer years ago, I never got the sense that her doctors truly cared. Right away, my experience with Dr. Miller ran counter to those memories. He was kind, authentic, and sympathetic. A calmness washed over me.”
Dr. Miller explained that Michele needed another biopsy to ensure the accuracy of the first one. Melanoma, after all, can be tricky to diagnose. When results came back days later, they were even more sobering: Michele’s cancer had reached a depth of 1.38 millimeters.”
Within days, she would need to undergo a procedure to remove the cancer, as well as skin surrounding it. Dr. Miller was tasked with getting a clean circumference extending from the location of the melanoma.
“I learned that when doctors perform this removal, they need to go as far out from the cancer as necessary to get a clean edge,” Michele says. “Patients can’t go under full anesthesia because they need to be awake to respond to directions from the doctor to smile or move their face as needed.”
When her procedure was over, Michele had 150 stitches in her face, on the dermal surface and below.
“As jarring as it was seeing all of those stitches, it was also quickly apparent that Dr. Miller had done an amazing job. I’d read that these surgeries can deform patients when doctors are only thinking clinically - focused on removing cancer, but not on how the patient will look. Dr. Miller carefully cut along my laugh lines. Once my face healed, you never would have known the amount of cutting and stitches it incurred.”
From there, Michele needed a sentinel lymph node biopsy, a procedure that injects radioactive tracing material into the cancerous area to see which lymph node the area drains to first. If cancer has spread, the sentinel lymph node (“sentinel” means “first”) is generally where it’s found.
This was the case for Michele.
With cancer in at least one lymph node, her malignant melanoma diagnosis was considered stage 3.
Michele started doing research.
All Roads Led to Penn Medicine
“I hadn’t chosen Penn Medicine. My dermatologist had chosen it for me. I knew Penn’s great reputation, and knew it was the best option for specialties like breast cancer and lung cancer. But melanoma is tricky, and a niche. I wanted to make sure I was at the right place.”
Michele visited other nearby healthcare systems to get second opinions, but wasn’t impressed. In her research, she also talked with a skin cancer survivor who works at a nationally recognized melanoma research center. The woman supported Michele’s decision to stay at Penn Medicine, and added, “Since you’re at Penn, talk to Dr. Schuchter.”
“I tucked that name in the back of my mind,” Michele remembers.
Michele underwent a partial neck dissection to remove the cancerous lymph node and to see whether the cancer had spread further – to any tissue, to her other lymph node, or to the glands in her neck. Thankfully, it hadn’t. But given melanoma’s high reoccurrence rate, Michele hoped for an aggressive plan to keep it at bay.
That’s when Dr. Miller referred Michele to Dr. Lynn Schuchter, MD.
“The fact that I had just heard Dr. Schuchter’s name weeks prior, from a trusted contact who was also a survivor…I just felt like the stars had aligned.”
Dr. Schuchter and Michele met in October 2015, two months after Michele’s diagnosis. Michele remembers it clearly.
“I had looked her up online and read her reviews. They were all positive. But I still didn’t anticipate her kindness. I just remember seeing Dr. Schuchter’s face and recognizing a real compassion.”
Michele had done enough research to know that traditional chemotherapy isn’t a very effective treatment option for melanoma.
“I had already braced myself for what Dr. Schuchter told me: That, because I was relatively young and healthy, the best treatment was vigilant observation. ‘Watch and wait.’ It made sense once she explained the ineffectiveness of other treatment options. Still, I was devastated.”
A plan was set. Michele would undergo skin checks, blood work, and scans every three months. She resigned herself to a wait and see reality.
Until a week later, when her phone rang once again.
A Big Opportunity – and Big Decisions
“It was Dr. Schuchter. I could hear the excitement in her voice,” Michele remembers. “The FDA had just approved a clinical trial for a new treatment for stage 3 melanoma. It was a really big deal; the entire melanoma world was talking about it.”
Candidates had to have had cancer removed in the past month. Amazingly, Michele’s timeline met this requirement.
But the trial had drawbacks. The highly effective treatment was also very toxic. Some trial patients had died as a result when their colons ruptured. If she moved forward, Michele’s colon would have to be monitored carefully over the course of the four infusions, which would be administered at 3 to 4 week intervals.
“I had been told that, without treatment, I had a 70 percent chance of being alive in five years. I wanted to increase my chances. I talked to Mark, our two kids, and my extended family. We looked at the side effects profile and asked ourselves whether the possible benefits outweighed the risks. We all agreed, yes.”
Michele’s first infusion treatment was in early December of 2015. She developed a rash afterward, which was successfully treated with steroids. But by the second infusion treatment a few weeks later, the toxins were getting the best of Michele’s body. She had to be hospitalized for colitis – an inflammation of the colon - which doctors treated with another round of high dose steroids.
“The terror and anxiety were unbelievable,” she remembers.
Dr. Schuchter advised Michele not to continue with the clinical trial.
“I was crestfallen. I remember Dr. Schuchter gave me her phone number, and told me to call or text her if I needed to talk at any time. She encouraged me to meet with a psychologist, and she told me about Penn Medicine’s mindfulness offerings.”
But focus on Michele’s mindset took a backseat to her serious physical issues. Because Michele’s immune system had been altered by the treatments, the debilitating colitis returned each time doctors tried to wean her off of the steroid treatments.
“It was the most terrible cycle. Dr. Schuchter was so concerned. I remember her saying, ‘We have to get you off these steroids.’ The steroids were treating the colitis but killing me slowly. I started having pancreatic complications.”
Despite doctors’ best efforts, Michele continued to require steroids to keep the colitis at bay. Then she experienced a patient’s worst nightmare: Steroid-induced psychosis.
Side Effects Spiral
Steroid-induced psychosis is a well-documented phenomenon that can result from psychological changes caused by steroid treatments administered in high doses.
Michele was hospitalized again – this time for psychiatric care.
She vaguely remembers Dr. Schuchter coming to her house in the midst of the episode.
“My memories are blurry. I don’t remember the interaction, but I remember her being there, and it just meant so much to me. She was so loving and kind, as always.”
In the weeks and months following, Michele received psychiatric care, and doctors were finally able to get her colitis under control. The whole time, Dr. Schuchter stayed in close touch with Michele and her family.
“Beyond being my doctor, Dr. Schuchter was a person caring for another person. When I went to an appointment at her office for the first time after the psychosis, I literally felt like I was going home.”
Ongoing Treatment Benefits
Even though she wasn’t able to complete four infusion treatments as hoped, data shows that Michele likely benefited from the two she did receive.
She has been NED – a medical acronym for no evidence of disease - since her cancerous lymph node was removed in September 2015. For two years following the infusions, she underwent scans and blood work every three months. The intervals increased gradually. Earlier this year, Michele graduated from scans every nine months to check-ins just once a year.
“When I saw Dr. Schuchter this past February, I asked her, ‘What do you do to fill your spirit?’” Michele says. “For years, there were so few treatment options for patients with melanoma. Only in the last decade have there been serious strides. I truly wanted to understand how she had emotionally withstood work in such a tough specialty, and so gracefully. She said to me, ‘Michele, it’s all about the connections with my patients.’”
Tuned Into Today – and Tomorrow
Today, Michele’s days are filled with a lot of gratitude - and sunscreen. Following her diagnosis in 2015, she was tested for DNA breaks that would indicate a genetic predisposition toward skin cancer. None existed. Michele had a lot of sun exposure before the age of 25, meaning her cancer likely stemmed from overexposure. She works hard now to protect her skin, and encourage others to do the same.
She looks forward to her future and appreciates every day more than ever before.
“Cancer has made me much more present and much more grateful. I am just so grateful to be on the downside of my illness, no longer actively in treatment – though I actively look forward to my appointments with Dr. Schuchter!”
Michele attends Penn Medicine’s annual Focus on Melanoma conference – an opportunity to connect with Dr. Schuchter, her larger care team, and fellow survivors. If she needs them, she also has constant access to her Penn Medicine care team through the patient portal.
“Penn is at the helm of treatment, and understands the power of personal care. I couldn’t be more grateful. Life is good.”