It was 2009. Nan DeGraw, a recently divorced mother of three, had just returned to work after twelve years as a stay-at-home mom when she noticed a pink growth above her left breast.
“It sort of resembled a wart. I went to my local dermatologist, who said it was nothing. He told me, ‘Just wear a turtleneck.’”
When it kept getting bigger, Nan went back. This time, the doctor removed the growth and sent it off to be biopsied.
“Later that day, I got the call I’ll never forget,” Nan remembers. “The dermatologist said, ‘Come back here with a family member, and make an appointment at a cancer center right away.’”
Nan had malignant melanoma.
Within a week, she underwent surgery at a Philadelphia area cancer center. She learned that melanoma that presents as pink is uncommon.
“Doctors told me that melanoma shows up pink only about two percent of the time. It’s very rare.”
Two subsequent PT scans showed that the cancerous cells had all been removed. Still, Nan was surprised when doctors chose not to perform topical radiation at the incision site on her chest to kill any cancer cells that might still remain – a step she’d read about in her own research. “I remember feeling unsettled by that, but trying to trust my doctors’ judgment.”
Nan shifted her focus back to raising her three young children, teaching dozens more at a K-8 school, and trying to find her footing as a single mom.
“To be honest, life was so busy that I almost forgot I’d had cancer.”
The Calm Before the Storm
Fast-forward almost a decade.
Nan had undergone annual checkups at the cancer center in the eight years since the melanoma had been removed, and saw her dermatologist several times a year. Results always came back clear.
“Then, on New Years Day 2017, I did a self breast exam in bed and felt a lump on the side of my breast, about the size of a pea.”
Nan went to her gynecologist, who recommended a 3D mammogram and an ultrasound. At the ultrasound, the radiologist brushed off Nan’s mention of her melanoma history.
“She more or less said to me, ‘The two aren’t related.’”
Nan would need a referral for additional scans. She made an appointment with her primary care provider, where she was seen by a young physician assistant.
“The physician assistant asked how I was feeling. I said mostly fine – and that anytime I didn’t feel okay, it was probably the stress of raising three kids on my own and working full-time. That’s when she told me my white blood cell count was high.”
At that point, Nan remembered one strange sensation she’d been experiencing: A feeling in her chest she could only describe as a rubber band being pulled.
“The physician assistant said to me, ‘Here’s your referral, and you should make sure to get a chest x-ray.’ In hindsight, I think that young woman was the first person who helped save my life.”
Unexpected News
Nan’s chest x-ray and a subsequent CT scan delivered shocking news: There was an 8-centimeter mass the size of a tangerine on Nan’s lung. Doctors assumed it was lung cancer.
“I was shocked. I’d never smoked. I’d grown up in an old house – I thought maybe I’d breathed asbestos or something else toxic.”
Nan decided not to return to the cancer center where she had been treated eight years earlier.
“The cancer center only had only one lung specialist on staff, which didn’t sit well with me. I decided to finally listen to my friends and my co-workers and more or less everyone I knew who had been urging me to go to Penn Medicine.”
Nan made an appointment with Dr. Kucharczuk, MD, a thoracic surgeon at Penn Medicine. During an early examination, he made the critical discovery.
“Dr. Kucharczuk had me lift my shirt so he could show me where he’d operate to remove the lung mass,” she remembers, “When I did, he noticed a lump on the left side of my chest. He asked, ‘What is that?’ I said, ‘A benign cyst.’ He wasn’t convinced, and ordered a biopsy.”
The biopsy confirmed Dr. Kucharczuk’s fear: Nan’s “cyst” was malignant melanoma. Her skin cancer had come back - and metastasized.
“Dr. Kucharczuk said, ‘If you can be here tomorrow at 11am you’ll meet the best doctor on the east coast for melanoma.’”
Then he added something Nan will never forget.
“He pointed to my heart and then to my head and said, ‘If this doesn’t work with this, the medicine won’t, either.’ He was telling me that if I wanted to get better, I had to really want it – emotionally and rationally. It stuck with me.”
At Long Last, Answers – and a Plan
At 11am the next morning, Nan met Dr. Lynn Schuchter, MD.
“I adored her from the second she walked through the door. So did my two best friends, who came to every single appointment with me. Beyond her kindness, Dr. Schuchter’s intelligence was obvious right away.”
Tests ordered by Dr. Schuchter showed that Nan’s melanoma, which had begun externally, had spread. In addition to metastasizing in her lung, it had traveled through her blood to her hip, shoulder, and adrenal glands.
It was serious.
Treatment options were limited.
“Dr. Schuchter said to me, ‘There are two treatment drugs that, if combined, give you a sixty percent chance of survival. If you opt for only one of them, that outlook is closer to forty percent.’”
Both drugs carried the risk of serious side effects. With nowhere else to turn, Nan decided to move forward regardless.
“Me, my family, my friends – we were all terrified of those risks, especially during those first four combined treatments when I was receiving both drugs.”
An immune system-stimulating antibody called ipilimumab was administered through four infusions a few weeks apart. It was coupled with nivolumab (Opdivo), also administered intravenously, which Nan would continue indefinitely.
Amazingly, Nan was one of the few fortunate patients who experienced minimal side effects.
“The only discomfort I felt was mild headaches and extreme sensitivity in my teeth.”
Still, just because Nan felt good didn’t necessarily mean the drugs were working – even though, by all indications, they were.
“I’m such a worrywart, and at my appointments, Dr. Schuchter always did such a great job of reassuring me that progress was being made. At the same time, though, she never let me forget that this was a fight for my life.”
Nan’s Opdivo treatments continued for a year, then two, then a third – with her friends by her side every time.
Through it all, Nan kept working at St. Andrew’s School in Bucks County, where her youngest daughter was still a student. The school that had hired her just before her initial diagnosis ended up being Nan’s saving grace.
“My community – the amazing people I work with – did so many things for me that blew my mind, from paying for my daughter’s lunch everyday to encouraging me to take time off to covering my rent one month. One day, a rosary group gathered to pray for me. That same day, a rainbow appeared over the school.”
Nan’s symptom-free response to the treatment continued. The cancer shrank steadily.
Endings and New Beginnings
All in all, Nan underwent 58 treatments at Penn Medicine between January 2017 and 2020, when she finally got the long-awaited news: Her final infusion treatment was scheduled for early March.
When Nan walked to the school parking lot after work to meet her two closest friends and drive to her last treatment, they weren’t the only ones waiting.
“My two sisters were there - one had flown in that morning from Ohio, and the other came down from New York, just to join me at my last treatment. And my friends had basket after basket of thank you gifts in their cars for my nurses and doctors.”
Family members and friends went out to dinner with Nan that night after her last infusion treatment at Penn Medicine – which she wrapped up by ringing the victory bell reserved for patients whose treatment is complete.
“It was a more powerful day than I ever expected.”
Moving forward, Nan will head to Penn Medicine every three months for a CT scan and every six months for a PT scan.
She says there isn’t one thing she’d change about her experience at Penn Medicine.
“At that last appointment, just last week, Dr. Schuchter hugged me and said, ‘You are loved because you love so many people. That’s what I see.’ It’s just so neat to have a doctor talk to you like that. It was like she could see into my heart, because my cancer really did remind me how loved I am, and how important relationships are. I am so thankful.”