Notice a change, get it checked
Randy Bowden noticed a small bump, similar to a pimple, on his jawline under the ear while shaving in November 2017. When it was still there two months later, he decided to visit his doctor. Randy was referred to a dermatologist by his family doctor. At first, it was determined to be a small cosmetic removal, but the dermatologist ordered a biopsy on the growth and lymph nodes. While cancer wasn’t found in the growth itself, cancer was detected in Randy’s lymph nodes, leading to surgery for their removal.
The small bump turned out to be the only symptom Randy experienced before he was diagnosed with stage III melanoma. Melanoma is an aggressive form of skin cancer. Stage III means the cancer has spread to lymph nodes.
In April 2018, Randy and his wife Maria received confirmation of the stage III diagnosis, and were told that Randy would need to start radiation. “When they say you have cancer, your heart drops. Your stress and anxiety is up. When they said stage III, I thought, ‘what does that mean? That can’t be good. What’s going to happen?’” says Randy.
At this point, Dr. John Lenehan, a medical oncologist at the London Regional Cancer Program (LRCP) at London Health Sciences Centre who specializes in treating melanoma, was introduced to Randy and Maria. In general, surgeons aim to provide a cure by cutting out the cancer. The medical oncologist’s role is to increase the chances of a cure by ensuring no cells are left behind – otherwise these cells will multiply and the tumour will come back.
Maria was Randy’s advocate throughout this experience, accompanying him to every appointment, asking questions, taking notes, and keeping a calendar of milestones through his care. “Each appointment can be very overwhelming, and Randy couldn’t remember everything we were told. I was the second set of ears and the note taker so we could make sense of everything later,” explains Maria.
“Melanoma is always serious and Randy’s melanoma had spread to his lymph nodes, which makes it an even higher risk of coming back somewhere else in his body. Melanoma is hard to treat and it is a cancer that can wait out drug treatment and then come back,” explains Dr. Lenehan.
Randy started radiation treatment very soon after surgery. Every weekday he came for treatment in the LRCP. Because the minute-long treatment was focused on his face and neck, Randy had to wear a plastic mask over his face that is screwed to the table to limit his movement and increase accuracy.
A common theme from Randy’s experience is the toll that the side effects of his treatment had on his quality of life. He never felt sick from symptoms of his illness. A few weeks into radiation, Randy noticed that he was losing his sense of taste. Food lost its flavour, and Randy lost his appetite due to this.
“Obviously the treatment was necessary to save my life, but not being able to taste food was surprisingly difficult. I was feeling super depressed. Not knowing whether my taste would return was one of the hardest parts of treatment,” Randy said, and he added with a smile, “I should have been eating Brussels sprouts since I couldn’t taste it.”
During this time, Maria would encourage Randy to drink Ensure to keep his strength up. Said Randy, “I could still smell all the delicious food, but it was as bland as water when I ate it. This was my lowest period during radiation treatment.”
About one month after completing radiation treatment, he experienced some flavor when eating a sausage egg McMuffin. When asked what he most wanted to eat once his taste returned, Randy says “everything”!
The radiation treatment also damaged his face and neck. Almost like a bad sunburn, Randy’s skin peeled along his neckline.
After his skin was healed and his taste returned, Randy began an older type of immunotherapy treatment called Interferon which gave Randy flu-like symptoms.
“Randy has a great sense of humour, and it made a huge difference in how he approached his Interferon treatment. He was getting more and more tired with each month, and he was losing a lot of weight. Most people have trouble staying on the treatment, and if it wasn’t for his easy-going nature, he would not have made it as far as he did,” explains Dr. Lenehan.
Eventually, a newer immunotherapy drug (Nivolumab) became available, which is an intravenous medication that helps the person’s immune system attack and kill the melanoma. It is administered every two weeks in the chemotherapy unit for twelve months.
After switching to the new drug, Randy jokes that he became known as a “boring patient” as many of the side effects subsided. After a year and a half of treatment, Randy finally rang the bell in LRCP to celebrate the end of treatment in November 2019. As he rang the bell, the nurses came out to applaud.
“It was bittersweet because these people worked with me for over a year, and they’re such great people. I will miss the people, but not the place,” explains Randy. “From start to finish, every doctor and nurse that helped me, I never had one case of someone treating me badly, it was unbelievable. You’d think you would find someone having a bad day, but we didn’t.”
Randy has some lasting effects from this experience. He experiences dry mouth, numbness on his jaw and a crooked smile from nerves being cut during surgery, hair doesn’t grow on the side of his face where radiation was focused, and he continues to check in with his medical team every three months for follow up. He is also an avid hat and sunscreen user, and avoids being directly in the sun.
‘It’s important to monitor, and visit the doctor if you notice a difference in your skin. It could have been much worse if I hadn’t got it checked out,” says Randy.