Canine Melanoma (Mostly Non-Oral)

Head straight to the Links! 

June 24, 2001

On June 18th, 2001, I got the biopsy results back that Leilah the Wonderpuppy had a "Benign Melanoma".  I have also found that this can be especially tricky to pigeonhole as benign or malignant, and that in our case, benign is not a firm diagnosis.  We are not home free just yet.

There is an amazing amount of info out there online to sort through, much of it is not helpful since it pertains mostly to oral melanoma or blurbs about experimental gene therapy.  If Oral Melanoma is the diagnosis on your dog, you can find lots of info by searching using the words "Canine Oral Melanoma".  Leilah had it on her anus, not in her mouth, and location is apparently very important for the prognosis. While oral melanoma info may have descriptions of the progression of malignancy, I haven't checked that out yet. While I have found almost no info on anal melanoma so far, but I have found some good reading. I was warned at my vet's office to be careful about finding info on canines, not humans. 

So, even though it's only been a few days since I got the biopsy results, I want to start this page and share the links and info I found helpful, as well as organize this info for myself (my "class notes" so to speak). Plus doing this is better than sitting and worrying, and not keeping busy building a webpage! If you know me, then you know I build webpages at the drop of a hat and am a serious linkaholic. This is going to be a work in progress for quite a while, I think, maybe changing from day to day for now at least. 

The Links

Facts I've learned about Melanoma

Or, keep reading for the blow by blow....

Background
Leilah is a 4 year old, Vizsla X probably Beagle mix, female. She takes strongly after the Vizsla side of her family physically and mentally. Existing health problems include very mild luxated patellas (trick knees), mild laxity in hips (looseness), and a tendency towards colitis if she doesn't get enough fiber in her diet. While I feed my dogs commercial kibble, I have been careful to find high quality kibbles for them that suit their individual needs. Leilah is free fed, the bowl is down with food in it whenever I'm home. I supplement her with a glucosoamine/vitamin C tablet twice daily, and feed her a couple of granola bars weekly to help her colitis.  She also gets a daily multivitamin, mostly because the other dog needs one, I don't feel she really needs it. I found out from Dr. Jean Dodds, at a lecture, that Vizslas have a higher incidence of autoimmune disorders than many other breeds. I've been using the University of Colorado Protocol for vaccinations and minimally vaccinate only every 3 years, for rabies, parvo, distemper, hepatitis and parainfluenza (which means at this age she's only been vaccinated once since her 1 year old boosters). 

She's been to many public places, trials and matches, charity dog walks, and dog parks, and has been around hundreds of dogs, and except for a kennel cough running rampant around the neighborhood a few years ago (one not there was a vaccine for), she has never so much as a runny nose or drippy eye. I've believed her immune system to be overall pretty strong (and if it wasn't, this cancer could be worse maybe?).  Her titers (tests that measure immune response to certain diseases, I get them done in the years I don't vaccinate) have always come back good.  I do know Leilah's mother, a purebred Vizsla, had uterine and skin tumors. I also assumed that they were probably hereditary. The uterine tumors were extra reason for me to spay Leilah before her first heat.  But, I've always tried to make sure that I keep close watch for anything suspicious on Leilah because of her mother's history. 

Tumor
This tumor was in about the ONE place I did not look at real close and real often!  Not something I'm gonna find with belly rubs either.  I found it because she was licking her little backside more than usual, and her automatic sits in obedience had deteriorated (which I initially thought was a training issue, and it still might be).  I at first thought that this tiny smooth, dark lump, just under the anal opening, was a blood blister or a bug bite.  Could my other dog have snagged her with a tooth while playing? Did she sit on a spider? So, I watched it carefully for a week or two. 

After about a week and a half, I noticed a darkish spot to the right of the anal opening, not a lump, more like an irritation. Enough is enough, so off to the vet.  While it turns out that the licking and second spot (it was an irritation) was because of full anal glands, he was suspicious about the lump, and did a needle biopsy right then and there. I do appreciate the coincidence that led me to find this lump, it is the only time in Leilah's life she's ever needed help with the anal glands, and it was not related to the lump. 

The needle biopsy was a very very small sample, the pathologist was not able to see any cancer cells and could not identify it, probably because it was so small.  My vet thought it was probably hemangioma, a benign tumor of the blood vessels. Since it had not increased in size at all, my vet wanted to wait another week or two before removing it on the chance that breaking it with the biopsy needle might get it to shrivel and reduce a bit. 

On June 14, the tumor was removed.  My vet let me be present for the entire surgery and recovery, it was wonderful for my psyche to be there.  He removed the tumor plus a good margin of skin around it, and sent it off to the pathologist for identification. 

Pathology Report
Here's what the pathology report looked like:

This first pathology report on the tumor said:
Source:
1) Tissue less than 1 cm. All tissue processed. Pedunculated growth on anus.

2) Two Tissue(s) less than 1 cm.  All tissue processed. Additional upper margin of tissue near the mass?

Ok, cool, it's small! But, small enough? Hmmm, gotta start looking up words here (like what's pedunuclated?). And, yes, the additional sample was the upper margin, I was there when the vet removed it. Gotta realize that the pathologist was not there and hasn't seen the whole dog, he's only looking at her cells in a microscope. 

Diagnoses:
1) Benign Melanoma
2) No Neoplastic Tissue Seen

So far so good!!! It went on to say....

These benign tumors are common in dogs, especially heavily pigmented breeds.  They are found anywhere on the body, but are unexpectedly common in sites such as haired skin of the eyelids or lips that are not commonly affected by other benign neoplasms.  These tumors are benign and in some dogs, histologically benign melanomas may develop in multiple intraepidermal sites. 

Ok..... that's all well and good I think, but then....

However, if this neoplasm was at the mucocutaneous junction, this tumor could be considered malignant.  It has been reported that melanomas of mucocutaneous junction are invariably malignant.

Huh??  It's benign but maybe not, based on where it is? And, is the anus considered a "mucocutaneous junction"? "Invariably malignant" sounds REAL scary. 

Borders: Clean

Well, I know that's good news! 

My vet had talked to the pathologist and the oncologist at the lab before he even called me and left a message on my answering machine. They had told him it had a low mitotic rate (rate of cell division), was not aggressive. Talking to him the next day after I had looked up a few definitions and other things, it seems the pathologist thought the sample was from haired skin, but I know there was no hair where the tumor was. It was not "staged" (stage 0 through 4, 4 being worst) because it is considered benign. All this actually left me with more questions, like exactly what kind of skin is involved here, is this on the mucocutaneous junction or not, is this really benign or not, and now what? 

Pinning it down
First I hadda start searching online for word definitions, info on cancer and canine melanoma, etc. etc..... (Terminology link). I thought I was done with studying biology in 11th grade!!  Most of the info I found was about oral melanoma, and most info on "mucocutaneous junction" was about human circumcision, not dog anuses.  One dear friend did find a good link about it, here (Thanks Barby!). It would seem to be the fine line between skin and mucus membrane, but how wide a border is included by the pathologist's reference? Leilah's tumor was maybe 1/4" below the mucus membrane line, in the smooth skin around the anal opening. 

My vet was wondering about this too, were there hair follicles definitely in the sample or something? So, we asked the sample to be re-evaluated again.  Preliminary results of that show that the borders are quite clean, she could not find any dividing cells, which is what is measured as "mitotic rate". (Turns out that benign melanoma is considered to have a mitotic rate of under 2, so this is great news!). Bad news is that this apparently is on the mucocutaneous junction. We think the haired follicles were from the wide margins the vet removed, but can't get a confirmation on this either way.  The addendum from the re-evaluation does go on to say that there is a "concern for malignancy" because of the location.

So, we have mixed results, some criteria (mitotic rate, encapsulation, clean margins) saying it's benign, at least one saying it's "invariably malignant" (the location of where it was). Nothing real concrete, grrrrr. 

Now What?
In the meantime, I have found a local veterinary oncologist and made an appointment for Leilah for further evaluation.  I found it's important to verify that the oncologist is board certified (link here).  Next week, Leilah will get her stitches removed, have more xrays taken to check what they can for lymph nodes, and we'll see the oncologist later that day.  The surgery may have been completely curative, but I am cutting NO corners here with my precious girl!  I will be asking for further testing, probably scans or blood work, whatever can help further diagnose this, find out if it's been cured already or not, and ensure Leilah's safety as much as possible. 

Healing from the surgery
For now she has to live in the dreaded elizabethan collar so she doesn't annoy her sutures.  I bought one from Petco and modified it to fit her using self stick velcro which may not stick until the sutures are out at this rate, we'll see. I'll use extra glue if it doesn't. She doesn't try to remove it, and my other dog doesn't bother it either. She's got a medium diameter neck, but an extra large neck and nose length, so I made the extra large narrower at the neck. Side effect is it's also narrower at the front opening too, which makes it easier for her to negotiate this crowded place. It seems more comfortable for her then the one the vet gave us. As far as she's concerned, we are messing with her for no reason, I don't think she ever knew she had a lump to begin with. I keep lifting her tail to check sutures, she doesn't like that much either. 

She is not on any restricted activity, it's not like when she was spayed and not allowed to run and jump, movement will not bother these sutures. The vet told me that if I take her around other dogs, the usual butt sniffing should not be a problem. Until at least the sutures are out, we have stopped all training, we needed a training break anyway. Plus I think it's just plain rude to ask her to sit on the sutures, even though she can with apparently no problem. But I'm not gonna ASK her for it. She can go without the collar if carefully supervised (she has a good "leave it" command") so I still took her to the dog park the second weekend after the surgery and she had a great time. She also gets supervised time without the collar every evening, so she can eat in her accustomed "roman dog" style - laying down. But if she wants to eat with the collar, she just has to stand up. At first she only wore the collar when I was asleep and when not home, I thought I could supervise her enough, but by the third day the suture area was a bit swollen and it looked like she may have been sneaking at them to lick them. So, the collar became almost full time and the next day the sutures were looking much better. 

Recovery at this anal surgery location was not the problem it may seem to be. I don't have to follow her around with disinfectant when she poops. The vet used silk sutures so they're as soft as possible and less chance of bothering her than other types, and she's got 6 stitches.  She got a short course of antibiotics for a week. I needed to check the sutures at least or twice once a day, but I do check them much more often, especially after she poops. For the first couple of  days, it bothered for her to squat, but that improved quickly. 

I do need to clean any fecal material with a paper towel and water if there is any. It's pretty tender to do that, so I kind of blot it gently and checked the towel for brown marks, until there's no more marks.  She cooperates with this though she does not like it. She is already well trained and gets high octane goodies for her cooperation. There has been very little catching of fecal material on the cut ends of the sutures, but that's what seems to happen if anything at all. I've only had to do clean them twice so far in a bit over a week. It's harder to tell than you would think, looking for dark fecal material on dark stitches on a dark butt, you need good light. I suggest if you have an obedience trial dog, that you do NOT used the stand command much, since it can create a negative association with the command and could cause training problems later. The "command" I've used here is to touch her abdomen at the tuck up and I often need to keep my hand or arm there to prevent her from sitting down. For cleaning, I have my arm reaching under her and that hand holding up tail while other hand works with paper towel. She's not a big dog. The antibiotics did not give her diarrhea thank goodness. 

So....
Melanoma really is a tricky cancer, it's not black and white.  It also can be a  deadly one if not caught early, or in the wrong place, completely cured if caught early in a good place. Finding the differences between benign and malignant has been the tough part here so far because we don't have a complete picture yet. Leilah's surgery may have been totally curative even if it is malignant, but if not we'll deal with it when we know more.  I was very lucky to have caught it early.  I'll keep you posted!

As I have been telling my friends, the moral of this story is to check your dogs for any lumps and bumps, and have them looked at. Lift those tails, take a good look, and tell them you love them! 

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We went to the oncologist on Thursday (today's tuesday).  Here's what I posted on a friend's message board on June 28:

~~~~~~~
Went to oncologist today.....and the damn jury is STILL out!  Onco is getting second opinion on tumor samples, this time from a dermatopathologist - a pathologist who specializes in skin.  If it comes back that the skin involved is just regular skin, without certain properties, then we probably will be fully home free with this one, have a nice life unless something else comes up, etc etc.   But, that will take a couple of weeks, the samples have to be transferred, and so on.

In the meantime, we're not sitting around. Leilah is scheduled for an ultrasound check up of her lymph nodes next Thursday, as well as a urinalysis from a sterile sample. This is not pie plate time, they'll go in and get it with a needle.  That makes me cringe thinking about it. I'm gonna ask about why not use a catheter. They gonna shave her funny for the ultrasound, and as slow as her hair grows back (took many many months, most of a year, for spay shave to disappear), I'm guess I'm gonna have to convince her she's just trendy and ahead of the pack LOL.  I need to find out if she'll need sun protection for a while and maybe make her a light weight shirt. Sunscreen is out of the question, she likes the taste way too much, it's all I can do to make her leave it on me. 

If they cannot resolve after all this that it really is benign, the onco is talking about immune system boosting drugs and chemotherapy, possibly even if we don't have firm confirmation that's it's metastasized.  She has also referred me to a holistic vet for nutritional and supportive information.  He's well known around here, I know lots of his patients, wish us luck we'll even get in. 

Leilah is to no longer get ANY vaccines, ever, including rabies. She says they will get me a waiver for that so city of LA will still give me the dog license.  She got the rabies in early december and her 4 way a bit later, so I have a long while before I have to deal with that anyway - she'll be 7 (she's 4 now). Just I am worried about the ramifications after that if she ever had even an accidental bite claim against her, there is no titer for rabies yet.

Of course I will research like hell and try my best to make the most informed decisions I can.  My vet apparently did an excellent job with the surgery, got good borders, even if it is eventually malignant he apparently bought us the time to do these diagnostics before committing to anything. Even though the 6 sutures were only removed about 5 hours earlier, the oncologist could not see where they had been, it's healed so well!  The xrays my regular vet took this morning show everything is great, no swollen lymph nodes pushing on anything, lungs nice and clear.  Onco felt out lymph nodes that she could feel and did rectal check, everything ok there too. 

In the meantime, we are all thrilled with the banishment of the elizabethan collar, and Leilah is snoozing in my lap as usual. It's tearing me up what this is doing to my beautiful sweet girl, I really REALLY hated it that she even had to tolerate removing the tumor and the e collar, let alone the rest of this! I think I hated it more than her. I want her life to always be sunshine and roses, laps and nylabones.  But, we know that some rain must fall, and hopefully it will only be a little for her.
~~~~~~~~

Well, I have since done a bit of research on the drugs that the oncologist thinks we may use. Carboplatin is a drug that is apparently recommended for human ovarian cancer. I have found some references to it being used for canine melanoma, but haven't been able to see the studies yet. The big problem with this treatment is it suppressed bone marrow, leaving Leilah at higher risk of passing infections.  While the oncologist says it's not as severe in dogs and goes to quality of life issues, so I don't have to really isolate her.  But, when I first lost my husband, we went many months without going out at all, she's been semi isolated for long periods before and didn't seem to have a problem with it. My paranoia would keep her out of trials and dog park anyway, the biggest sources of infection she's exposed to. She would still have my other dog and my trainer's dog to play with, as well as me, all on private property where these dogs are the only ones ever there. I still have a LOT more research to do on all this. 

Piroxicam is an NSAID (Non steroidal anti inflammatory drug) that apparently boosts interleuken 2 production - kind of a natural immuno/chemotherapy. Of course that runs the GI tract risks that comes with all NSAIDs. I've learned that often antacids are giving with this drug (which is always given with food) and need to find out if Tagamet will fill this bill. The oncologist said there is one anecdotal incident of a horse with melanoma improving with Tagamet. Of course since I've learned some cancers can go into remission on their own, this doesn't necessarily mean a whole lot, but if it's appropriate I might as well use it. 

We see the holistic vet on July 19th. He has an excellent reputation, I've known many of his clients. I am hoping I can leave Leilah on her current kibble, Canidae, it's agreed with her quite well and is highly rated for being "natural"  and high quality for a processed food. I can hardly prepare food for myself at all, I live out of fast food places and the microwave oven. I've honestly made exactly one full meal from scratch in my life, that was in 1983 and was a disaster. So preparing home made meals for Leilah will be difficult for me. But, if it's gonna be critical, I'll manage! We'll see. Hopefully I can use just supplements to boost her immune system and help with chemo if she gets it.

Tomorrow's 4th of July, my best friend is bringing some reference materials for me when she comes over, info on how to interpret blood tests, etc.  She is currently a nursing teacher (has her masters), but also has her undergrad degree in animal science and was a licensed animal health technician for many years before she went into human nursing. We're gonna go to the local parade with her kids and my Leilah, and I'm gonna try to  pretend nothing could be wrong.  Leilah loves going, she gets so much attention and is convinced when people clap that the applause is for her! 
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1. Is this pathology report acceptable? 
       Before I could even ask, the oncologist said we need a second opinion and more info

2. Don't we need to know:
   Actual tumor size in mm?
   Type of skin involved?
   Depth of skin involved?
   Types of cell makeup?
   SSM (superficial spreading), NM (nodular), etc 
   Staging info?
   Anything else missing?
       Some of this isn't really necessary in this case,  but the type of skin info is important

3. Do we need 2nd pathologist opinion?
       yes

4. Do we need cytologist vs. histopathologist?
       Second opinion will be done by a dermatopathologist, who specializes in skin pathology.

5. Does this even need to be staged?
       won't be staged if it hasn't metastasized

6. Other diagnostics for staging?
       Not for staging, but will run urinalysis and check lymph nodes with ultrasound

7. Is this considered “well differentiated”?
       extremely

8. Does that make it harder or easier for her to fight it?
      I think she said easier, but don't remember, didn't write it down

9. Have you ever seen anal melanoma? Smooth skin melanoma?
      Probably (I guess this means she doesn't remember off the top of her head)

10. Can you find any info on anal melanoma in dogs? What does it say? May I see?
        No handouts or anything like that.

11. How dangerous is this, being on the mucocutaneous junction. 
12.  Will it spread?
        it might

13.  Has it spread?
         don't know yet

14. Where did it spread to? 
15. Where is this most likely to show up next? How do we tell? 
16. How quickly can it spread? 
17. What is likely to happen next? (cancer behavior – disease progression)
18. Side effects of the cancer – such as hormones causing problems or not eating?
19. Does she need biopsy on lymph nodes? Which lymph nodes?
        Ultrasound tests

20. What further testing can be done to confirm malignancy?
21. Other methods to check for possible metastasis?
           A urinalysis. this isn't to check for metastasis, but to check for a sub-clinical urinary tract infection since it's common in dogs with cancer. 

22. Blood tests? Ki67 Tumor marker?
23.  Do any of these tests hurt afterwards?
24. Exactly what will each test tell us?
25. Why is any test (whatever recommended) better than others? (do them all?)
26. What is the time frame to be considered fairly safe from secondary tumors or metastasis? (when can I breathe again?)
        Hopefully dermatopathologist will find no muciod tissue, then we probably home free for this one.

27. How often does she need to be rechecked assuming she's ok now?
         Probably every 3 months, depending on findings.

28.  Does metastasis have to be confirmed or are there things we should do now to prevent it?
         If it's not positively benign and the new path report is inconclusive, chemo with Carboplatin is something to consider. Also Piroxicam.

29.  What should I watch for?
30.  Changes in diet? Supplements? (bring current kibble label and supplements)
          referred to holistic vet

31.  Recommended reading?
32.  What about melanocytoma? (it does run in vizslas)
            I think I remember asking this, but didn't note or remember the answer. 

33.  Treatments – what kind 
         chemo w/ Carboplatin, 4 treatments 3 weeks apart. She then explained some of the risks such as bone marrow suppression. Also possibly Piroxicam which might boost interleuken 2 production. That is an NSAID and she explained the usual risks associated with that. 

34.  why that kind?
         because it's a systemic treatment and if it has spread we don't know to where.  Nothing to aim at with radiation since initial tumor is completely removed. 

35. How long will it hurt her?
36. how long will it help her?
37. how do I know if it's helping or not?
38. what if that doesn’t work? Then what?
39.  What about the vaccine studies (texas A&M, U of Wisconsin, etc..)?
     they wouldn't accept her, not proven metastasized and they mostly looking for oral melanomas anyway.

THE BIG QUESTION: WILL SHE BE OK????
no one knows that one yet
 

Whew! she's pretty patient, thank goodness!
 

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Leilah got the ultrasound and urinalysis yesterday.  Results of both were good WHEW!!!!!  Everything they looked at was normal, so if this thing is spreading, it's not spread far at all yet. We are still waiting on the results of the second pathologist's report, the samples arrived at his office today. That's the BIGGIE. But, with these ultrasound results, I'm considering breathing again!

The ultrasound shave wasn't as severe as I thought, it's like a spay shave gone bonkers. I do have to protect her from sunburn on her belly and sides until her hair grows back enough to protect her. The UV index here is maxed out at 10 for most of the summer and her fur grows back very very slowly. It took most of a year for her spay shave to grow back. And, she loves to lay out in the sun before I wake up ( I work nights so I sleep until late morning). So she can still head out the dog door before I get up and be the "sundog", I will first try sunscreen on her.  Problem with that is she likes the taste of many sunscreens, she barely lets me wear them sometimes! Hopefully I can find one that is safe, will stay on and lasts long enough. The oncologist recommended Bullfrog because it's waterproof. Problem is that it is a bit greasy and Leilah does sleep in my bed. But, I'm gonna try it. If it doesn't work for us, I got some cheap tshirts I can modify, and found an extra large (great dane size! Leilah's only 33 lbs) dog tshirt that does cover her whole back. With a little elastic belt around her waist and a tail loop, that might work. It's a Harley Davison shirt too, "Hog Dog" and my husband would be so proud!  On the 4th of July, my friend brought over some shirts her kids outgrew. Locking her inside in the mornings will be a last resort. 

I've been doing a lot more reading, including some basic holistic stuff. I sure hope the holistic vet makes more sense than that little book I got, some of this just doesn't make sense.  Found out that there are places that will do rabies titers too, but don't need that for a long time anyway. Still looking up more stuff about the drugs too and finally invested in a new medical dictionary (one I had been using was from 1962!). My friend is loaning me a copy of Mosby's Manual of Diagnostic and Laboratory tests. That's for humans, so the values aren't applicable, but the generalizations pretty much apply. 

Now, all we gotta do is wait a few more days for the pathologist's report. The oncologist said that if he finds no muciod tissue, we might be home free with this one!  But, if it's bad news, I hope I have a start on the info I need to handle it. Prepare for the worst and hope for the best.

I got the BEST wakeup call from the oncologist this morning. The results came in from the dermatopathologist. LEILAH'S OK and she's recommending NO further treatment!  We will need a followup visit in 3 months. I haven't seen the pathology report yet, but there's no muciod tissue involved, everything looks good. That was the big worry. I've been practically shouting it from the roof tops! 

Leilah will not be undergoing any chemo or other procedures, assuming she gets no more tumors. But, for this melanoma tumor, and this page, this is the happy ending!  Of course that means I will not have much more to add to this page, but I will finish adding the links I've collected and organize them a bit more, and maybe info from the report when I get it. 

In the meantime, we're gonna go out an PLAY!

WHEW!!!!

The final diagnosis from the dermatopathologist is "benign compound Melanocytoma".  I'll include some links on it below. Compound means that more than one skin layer was involved, both the epidermis and dermis. Vizslas are at higher risk for it than other breeds, and she is half Vizsla.  Melanocytoma is a benign tumor,  basically a type of mole and they may be precancerous.  It may be that Leilah cannot be considered to have had cancer at all, so I don't know if the oncologist still wants to give us a rabies waiver, we'll see. I'm not gonna sweat it for now anyway. 

In the meantime, Leilah's only remaining "treatment" is the application of Bullfrog sunscreen, spf 45,  2x day. Surprisingly, we've made that work though I sure doubted it at first. Just where she was shaved for the ultrasound, until her hair grows back. She sure doesn't mind THAT at all, it's all just a belly rub for her. I got advice from a sun sensitive friend that the first half hour after putting on a sunscreen is the most important for it's effectiveness (Thanks Jo-anne!), and hopefully I can prevent her from licking for at least that first half hour. Not that hard actually, I rub it in with one hand  for 15 - 30 mins, and play a computer game with the other hand. Then I don't have long to supervise her so closely after that especially if I distract her afterwards for a little while. Her hair is starting to grow a bit thank goodness, it will be interesting to see if the color changes at all (since her colors change anyway as she matures). 

I am finishing up the links and organizing them a bit, but after this I hope to not have to add to this page at all  (other than link updates).

I feel like we missed a bullet, and am so overjoyed she's ok!  My regular vet, who I saw today with my other dog, is pretty overjoyed too. He had a non stop ear to ear grin about it! Pretty much how I've been too!

Visiting the Holisitic Vet was real interesting. Here's a post I wrote about it:

Still plenty hot, maybe mid 80s, not 90 like my mom said. But, with the cool coat,
        Leilah didn't even pant, though I sweated buckets in the hot car on a slow freeway.
        I only got into 3rd gear a few times LOL. Took over an hour to get home! 

        I saw his wife actually, not him, and she's real sweet. They all fussed over her too
        LOL, she sucked it right up. Leilah has never been so relaxed at a vet's office, they
        said it's probably because it smells different. Blew me away when she just took off
        the leash and let Leilah just hang out in the exam room while we discussed diet
        and supplements. Leilah curled up on the floor and took a nap LOL. Leilah only
        shook while on the exam table, and then only barely. She was head butting her for
        pats a few times too. 

        when I mentioned that maybe I should toss her an occasional chicken wing since I
        can't deal with full on BARF, she tells me she's NOT a big believer in raw feeding, I
        sure didn't expect that. She says she's had food handling training and implied she
        "knows too much" about it to feed raw. NO problem for me though LOL. We
        discussed supplements and additional food ideas that would not infringe on my
        current feeding (canidae kibble, free fed). If I can't keep up with it, no harm, no foul
        type of thing, Leilah will just eat more or less Canidae. 

        She is not sure if the Canidae is good enough for her, and it does have a couple
        of the ingredients on the no no list, like animal fat. I had forgotten the label with the
        morning rush to the other vet, grrr. (At least I did remember to bring copies of all of
        Leilah's recent lab tests!) The glucosamine I'm using is ok, just hadda check that
        there's no sugar in it (there's not). Got to get rid of all the sugar in her life that I can,
        this is gonna be a real probelem for training treats! Gave me a replacement
        multivitamin powder for both dogs (just my luck, I just bought 2 bottles of the old
        stuff LOL). Also some "black fish" omega oil capsules. Not sure how I'm gonna
        feed that yet if Leilah won't take it straight, it's not appropriate to put on the kibble
        since she's free fed - it could go rancid before she finishes it all. 

        She gave me acidophilus for Leilah to take with the other vet's antibiotics for the
        vaginitis. This is EXACTLY the kind of thing I'd hoped for overall, support for
        conventional medicine, not trying to replace it! Also told me to use warm
        compresses on her. She offered no cause for it, there's so many suspects for the
        cause (prev antibiotics, sunscreen, urine sampling, etc) other than licking probably
        had something to do with it (which points to sunscreen). 

        Of course I gotta try to replace the bowls, the stainless steel I'm using is not human
        grade and glass is better anyway. The plastic water bucket (a horse bucket) has
        gotta go too, as well as the unfiltered water in it. I did some looking around online
        for pyrex, found pyrex lab equipment that might work, but MAN, can't afford over
        $400 for a water bucket that's probably too heavy for me to lift! Went to smart and
        final to look for a stainless pot or bucket (better than plastic), but all they had was
        evil aluminum. Not supposed to nuke stuff for them either if I do cook for them, but I
        don't think I'm gonna worry about that. I have some education in radio and radar, I
        thought about it for a while last night, and I don't think how nuking food modifies it
        is something I need to be concerned about. 

        Just DANG, with my set up and MO, all this is going to be tough to settle in to what
        I'll do with all this, between my time and space problems here, and I still don't think
        straight a lot and fighting depression. I'll do what I can. She said to take it slow,
        don't have to do anything drastic all at once. I'm still real worried about what I can
        replace our current training treats with, stuff that need refigeration has caused me
        lots of headaches in the past. Of course I tried not to give any excuses, but it was
        funny when she told me that while she's practiced in other states, not until she
        came to CA did she find people who don't cook for themselves, let alone their
        dogs LOL. 

        She checked Leilah's pulse and tongue and she thinks Leilah has "damp" or
        "dampness" in chinese medicine. usually more of a lab quality, LOL. But, the
      associated characteristics with that, basically being a leaky dog, with discharges,
        drool, generally lots of water, doesn't fit her overall, I've thought of Leilah as a much
        more "dry" dog than others. This vaginitis doesn't even have a discharge, and
        she's never had it before, nothing like that in life. She doesn't drool unless
        something's wrong, doesn't drink a whole lot, doens't pant a lot without good
        cause, is a total water wuss, etc. I see her again in 6 weeks, wonder if this
        "dampness" characteristic will change then. 

~~~~~~

Another post about cooking for her:

Ok, I honestly don't cook, really really, other than pasta and an occasionally
        quesadilla, I only nuke boxed stuff, I live out of Subway sandwiches and Burger
        King. Nick was the cook most all my adult life, I've NEVER had to do this stuff
        before. 

        The vet says to try to give her at least SOME home cooking if I can. I look at this
        little dog, love of my life, joy of my heart, and figure I can at least try something to
        supplement the kibble. Even if the kitchen is a completely alien environment! 

        She gaves me a basic recipe, which I modified for my convience. Instead of rice
        or pasta, I decided to try to put it in mini pita pockets, to make it easier to feed to
        her when I'm in a bleary eyed rush (most days lately). Found "safe" ones from
        trader joes, and the ingredients are about the same as pasta. 

        Of course first, I hadda go buy it all. Got lucky, found a bagged, chopped salad mix
        of carrots, cauliflower and broccoli which are exactly the stuff she recommended.
        Also got garlic, olive oil, parsely and ground chicken as recommended. Adding
        quaker oats too to help replace the granola fiber supplement. Hadda get stuff to
        keep it in too, for freezing (more plastics!). 

        Get it all home, along with glass food and water bowls, and glass storage
        containers. Now what??? Mind you that all this shopping, which took HOURS at
        several stores, is after a "double back" at work (get off 11:30 pm, back at 8am
        next morning) and I'm already exhausted. Took a nap, got up about 11pm, started
        working in the kitchen. At least Copper's new pyrex casserole food bowl will
        double for the cooking, he won't mind. 

        After looking up how to do it in the cookbooks and on the 'net, I decide to nuke the
        stuff. Yeah, it's a holistic no no, but I honestly think it's safe (got some radar and
        radio education beyond the average person) and heck, I'm new at this! Figure just
        buying and washing the veggies and chopping and mixing and figuring amounts,
        etc, that's all enough new territory for this first time at least. I really AM that green in
        the kitchen!  I'm already tired, cranky and frustrated, don't need this! 

        So, first night ends with the veggies all cooked (vet said to cook them!).  Tonight, after another long day
        and a long  nap, am now cooking the chicken, mixing it all up, and stuffing the pita pockets,
        about half done and taking a break here. I can put about 2 or 3 heaping teaspoons
        in each pita. So far I've spent hours preparing all this stuff, learning as I go, and I
        can't imagine how long it would be if I used the regular stove!!! 

        I've thrown away a LOT of food too, had way more parsely, garlic, and spinach
        than I needed (bought the smallest amounts I could, and am not going to be using
        it otherwise). I have to figure out freezing it, only half done and the freezer is so tiny
        that it's gonna take almost half of it w/ two or three tupperwares! I don't know how
        long stuff will be good in the fridge, how often I have to thaw stuff, etc. This is all
        turning into the horror I thought it might be. 

        HOPEFULLY, I'll get the fridge stuff figured out, then I can just add the vitamin and
        fish oil stuff just before I toss a pita to her every day! What I'm making should last
        maybe 6 weeks. 

~~~~~
I have since found out that there IS a food processor in the house (gift to my mom from my uncle, but she's never used it), and gotten info on how to steam the veggies, etc.  So, for next time, I'll hopefully have an easier time. I'm probably not going to use the pita next time and will substitute rice or pasta as originallly suggested , since I bagged the leftovers and have found that feeding those isn't so hard. She's getting maybe 1/4 cup of this every night (big spoonful with a large serving spoon or 2 pitas) with a fatty acid capsule and vitamin powder ( both from Merritt Naturals). Don't have to break open the capsule either, she just eats it whole while wolfing down her mix, especially if my other (more dominant) dog is present. If he comes in (he often doesn't because he's afraid of most kitchen noises), I hold him back, and she still eats twice as fast, gone in seconds. I don't have to be real accurate measuring the mix either, since she'll just eat more or less kibble to compensate. At least she's not critizing my first ever effort in the kitchen, she LOVES this stuff!  Time will tell how well this works for us. 

Found that using carrots for a training treat is too difficult to keep them fresh for when the training impulse strikes (I don't have a routine these days). So, using Charley Bears from Trader Joe's and a natural puffed corn cereal I found at the market (no sugar, no preservatives). She has no real problem with corn, I don't want it to be in her regular diet if I can help it, but I think it's ok for treats. Also natural bread sticks, though those are a bit too crumbly. Got through training yesterday with a minimum of old treats. I'm still probably gonna use the junk food when I need REAL high octane treats, or at trials (that's only about a half dozen times a year) but now that will be minimal. 

For a glass water bucket I ended up putting a glass cookie jar inside the bucket I'm already using. Now they're drinking out of glass, but I still have all the convience of the bucket! I can still tie it to the closet so they don't knock it over, easier on my back to pick it up, too high for them to step in easily, etc... Filling it with a Brita Pitcher that now lives in the bathroom. 

This cancer scare has put the fear into me, I'm gonna do what I can to make it less likely to happen again. As the vet said, that I can take this slow, and work it in over time, after all, any of these changes is better than none. 

Leilah had her first 3 month follow up with the oncologist last Thursday, all is well!  We'll see her again in another 3 months. 

Leilah also saw the holistic vet for a followup a few weeks ago. We saw the other vet in the practice, the husband. He changed the vitamins for her. He also started her on 1 oz Noni Juice every day. This stuff IS bucks and hard to get. I researched it, and found that guy who supposedly studied it may have had ethics problems, hadda leave a university over it,  and at least one lawsuit over falsified claims of other products. So, I figure that this study is not something to consider. But, there is a lot of ancedotal evidence that it may help her immune system, including from the vet himself, he gives it to his own dogs. He has no other info to give me about any studies, I did ask. I can find no info that it will harm her or hurt in any way other than my wallet, so gonna try to keep it up for her. 

I apparently have messed up the supplement recipe, but Leilah seems ok in spite of my (lack of) cooking skills. She was getting about 1/2 cup a day, not 1/4 as I thought (am measuring portions using a big serving spoon).  I guess I got pounds and quarts messed up, and was thinking 32 oz in a pound!  Her supplements have actually been 2/3 veggies and 1/3 meat, but I think they werre supposed to be  1/2 and 1/2. Fortunately, I figure it's only accounted for about 50% of her diet, she's still free fed Canidae kibble. I can't find the original recipe and will try to call the vet on Monday and find out more, and if I should thaw out the 6 weeks worth that I just made and add more meat, or if it's ok for now. I've been giving her these proportions the whole time, argh! 

Her diet now consists of:
Canidae Kibble, available at all times when I'm home and can make sure my other dog doesn't get at it. 

Morning:Tahitian Noni Juice, 2 Tablespoons with a pinch of natural puffed rice.

Evening: 
About 1/2 c. supplement mix, consisting of broccoli, cauliflower, carrots, spinach, ground chicken or turkey coked with olive oil and parsely, and a bit of pasta and oatmeal. I'll put more exact amounts on here once I get them straight myself.

2 fish oil/omega acid caps, "black fish", from Merrit Naturals.

1 teaspoon vitamin powder from Merrit Naturals (only until I run out, vet said to give it concurrently with other vitamins and use it up)

1 tablespoon Nupro vitamin powder. 

1/2 teaspoon Barley Dog powder.

Except for initially with the Noni juice, Leilah just scarfs all this stuff right up! Adding a small bit of rice to the Noni, which should be given on an empty stomach, helped a lot. Now she laps it up pretty quickly.She usually doesn't eat her kibble in the mornings, so that's a good time to catch her on an empty stomach. The Nupro must stick to her mouth like peanut butter, lots of licking the roof of her mouth type maneuvers since I started adding it. . 

She's still at high risk, and I'm gonna do whatever I can for her!

Facts I've learned about Canine Melanoma

First, be aware that I am NOT in the medical field. I am just a scared dog mom who's now spent many hours trying to find info on this. My focus is on non-oral canine melanoma, since my Wonderpuppy was affected on her anus. 

It happens more to dark dogs than light dogs, unlike humans. It is probably not sun related in these cases (which is good, because if I tried to put sunscreen on that little butt, she'd try to lick it off - she's got a taste for sunscreen). 

Bad places for it to occur is in the mouth, on the toes, or anyplace there's mucus membrane, or transition areas between skin and mucus membrane. Happens on eyelids too, but I got the impression that's not so dangerous.

Haired skin a better place to get this.

If the tumor is encapsulated (in a fibrous package and not messy with cells in surrounding skin), it's good news. 

It's possible to have mixed criteria for benign vs malignant on the same tumor. 

Surgery is the first line of defense and is often completely curative.

Getting mixed info whether chemo or radiation would be appropriate if more help is needed. I'm seeing more references to radiation.

Benign melanoma and melanocytoma may be the same thing. My vet says they're interchangeable terms, but I have not found much about it.  The references to melanocytoma I'm finding are mostly about ocular melanocytoma, in the eye. 

Schnauzers are more predisposed to Melanoma, along with Doberman Pinschers, Scottish Terriers, Irish and Gordon Setters, and Golden Retrievers.  This suggests that sometimes it may be hereditary.  Miniature and Standard Schnauzers, Doberman Pinschers, Golden Retrievers, Irish Setters, and Vizslas are more predisposed to melanocytoma. 

In humans, prognosis for ano-rectal melanoma is poor. This may not hold for dogs.

One of the best indicators for a melanoma being benign is a mitotic rate (cell division measurement)  of under 2.  The next best indicator is apparently location. And, those indicators can conflict. 

It looks like there is no apparently blood yet test to directly detect canine cancer or if it's spreading  (like the PSA test for humans to detect prostate cancer). 

While melanoma can metastisize to almost anywhere (per human info), it is dispersed via blood and lymphatic system and one of the most common progressions is into "regional" lymph nodes (local to primary tumor) first.  Most common organs affected are liver and lungs are common sites. It can cross the blood-brain barrier and metastasize there too. 

There may be melanoma risk in light dogs which might be sun-related. It might be a good idea to put sunscreen on the tips of their ears to help prevent burning and exposure. 

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Leilah's Cancer and Melanoma Links

*  are links that weren't working on the last update, hopefully they'll come back.

Please note if I posted a warning about photos on some links. I am a wuss and it's possible some of you are too. Most are photos of surgery or cancers on animals. If it made me cringe, I put a warning on it. 

Some of these links have reference to research papers that could be helpful but are not online where I have access to them.  Ask your vet about how to get copies of them.  Some are "abstracts", just a short article about a study. 
 

General Cancer Info and Helpful Links

Robin's Canine Cancer Files
Because I have been webmaster for Robin's Canine Cancerfiles for over 2 years, of course that's where I started first. Never thought I'd be using it for my own animals! Most of the links here will not be on the Cancerfiles page, except some of the more generalized links, but Cancerfiles is gonna have new links not specific to melanoma because of this!

CancerWeb Online Medical Dictionary
I found it VERY helpful to keep this open in a separate browser window while reading things online. I used it to look up the words in the pathology report too.

Veterinary Abbreviations and Acronyms 
Based on Merck Veterinary Manual and supplemented from other sources

Cancer Resources Search Engine

Cancer in the Canine
Best of the overviews I've found! Written by a cancer researcher who also loves dogs, it's the Wing and Waves Labs' site. Doesn't cover melanoma specifically, but there's lots of great basic info for someone just starting to learn about cancer in dogs.  A "must read" link.

American College of Veterinary Internal Medicine - Specialty of Oncology

Histovet Surgical Pathology - What Can You Realistically Expect from Biopsies

Oncolink: So Your Pet Has Cancer
Short Overview including some info on diagnostic tests - not specific to melanoma

Three rules for Managing the Cancer Patient
From Dr. Hahn. The basic steps in treating a pet with cancer, including diagnostics. Not specific to melanoma.

Texas A&M Oncosite
I think this is a new site, and it's where I got the next couple of links

How is Cancer Diagnosed?
Another breakout from Texas A&M Oncosite. WARNING, some photos might be disturbing to some. Overview of various diagnostic testing techniques. Not specific to melanoma.

What are the steps in a workup for pets....?
I broke this out of it's frame for easier reading, it's from the Texas A&M Oncosite. What is done and  taken into consideration during the workup. Not specific to melanoma.

Cancer Message Board
Part of the Canines in Crisis site. Not a high traffic board at this time, but there seems to be a few knowledgeable regulars.

Dog Owner's Guide - Canine Skin
A description of canine skin, characteristics and structure. 

Skin, Hair and Nail Anatomy in Dogs and Cats A short description of canine skin

Puppy Tracks Newsletter (skin diagram)
If you scroll down, maybe 3/4 of the way,  there's a diagram of some of the skin structures. (I'm still in search of a more complete diagram of K9 skin). This site has music, so if you're at work you may want to turn down the sound. (Thanks FF!)

All About Fatty Acids
People started telling me to give Leilah extra Omega 3 to help fight her cancer, but they gave me puzzled looks when I asked them about the balance with Omega 6. You can't just throw supplements at your dog without some research.  Here's a bit of info if you want to think about going that route. 

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Melanoma Links

American Miniature Schnauzer Club - Canine Melanoma
A short overview 

Melanoma in Dogs
Ask Dr. Mike

Example of Ano-Rectal Junction
Microscopic photo showing some of the geography involved. 

Nikon Microscopy - James E. Hayden - Infiltrating Melanoma in Canine Dermis
Microscopic Photograph - scroll about half way down

The Variable Cytological Appearance of Melanoma in Dogs
Info and Microscopic photos

Oncolink: Melanoma - General Information
While these articles seem to be written for humans, it's what I've found from the Veterinary Oncolink site. 

Oncolink - NCI/PDQ Patient Statement: Melanoma
Includes info on staging melanoma in humans and treatment for each stage.

Oncolink -  NCI/PDQ Physician Statement: Melanoma
More detailed info, for human melanoma

National Cancer Institute -  Melanoma .

Selected Skin Tumors in Domestic Mammals - Canine Skin Tumors
An Overview of various canine skin cancers. This is where I got the fact that mitotic rate under 2 is usually considered benign for melanoma. 

Cytology of Mesenchymal Tumors *
Scroll down for cellular info about melanoma. WARNING, some photos might be disturbing to some. 

The molecular basis of canine melanoma: pathogenesis and trends in diagnosis and therapy
Texas A&M Study

National Cancer Institute - Melanoma Treatment
Written for humans. 

Cancer Control Journal - Melanoma Metastasis
Based on mice studies, a description on what melanoma does and how it does it.

National Institutes of Health - Diagnosis and Treatment of Early Melanoma
Written for humans. Info on diagnosis and staging, also info on "atypical moles".

Small Animal Oncology Into the New Millennium
This is in .pdf format. If you do not have Adobe Acrobat Reader, you can download it free at www.adobe.com.   Overview of other skin cancers and oral melanomas

Flat-Coated Retriever Health Manual
Another Overview..

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Carboplatin, Piroxicam, and other chemotherapy Links
These are the drugs my oncologist talked about using on Leilah

Bristol-Myers Squibb - Paraplatin
Manufacturer's site for Carboplatin

Chemotherapy Tidbits
From Dr. Hahn, basic info about chemotherapy and specific drugs

Leslie Elizabeth Fox, DVM, MS
Reference to : Fox LE. Carboplatin. J Amer. Anim Hosp 36:13-14, 2000.

Bladder Cancer
Reference to: Mechanisms of Synergistic Antitumor Activity of Piroxicam and Cisplatin in Canine Cancer," Dr. Knapp.  I don't even know where this was published, but I'm sure it can be found. 

Archive of Oncology
Point 6 suggests that carboplatin may increase risk of leukemia in women with ovarian cancer. 

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Melanocytoma
Also referred to as Melanotic Nevus. Some of these are duplicate links from he Melanoma section.

Persus Foundation - Common Cancers
Where I first ran into a reference of Melanocytoma. "Tumors of Melanocytic Origin" is a bit more than halfway down the page.

Melanocytoma - benign
Ask Dr. Mike - scroll down

Melaoma Histopathological Variants
Info for humans

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Books
References I used (though many didn't have the details I needed). Links are to Amazon.com, but most of these were borrowed or I already had. 

Taber's Clyclopedic Medical Dictionary
F A Davis Co; ISBN: 0803606540
 I started by using my mom's old 9th edition from 1962, but finally bought a current 19th edition

The Merck Veterinary Manual
Merck & Co; ISBN: 091191029

The Merck Manual is now online at: http://www.merckvetmanual.com/mvm/index.jsp though I don't know if all of it is there. 

The Dog Owners Home Veterinary Handbook - Carlson and Griffin
Hungry Minds, Inc; ISBN: 0876052014 

UC Davis Book of Dogs - Edited by Mordecai Seigal
Harpercollins; ISBN: 0062701363

Skin and Haircoat Problems in Dogs - Lowell Ackerman, DVM
Alpine Pubns; ISBN: 0931866650 
Not much about melanoma, no mention of melanocytoma or moles. But some good general skin info.

Physician's Desk Reference
Medical Economics Company; ISBN: 1563633752
I used a 1992 version that my mom found  at a library sale way back when. 

Mosby's Manual of Diagnostic and Laboratory Tests - Kathleen D. and Timothy J. Pagana
Mosby, Inc.; ISBN: 0815155867
Written for humans, so test values mentioned don't mean so much when applied to dogs. Some of the generalities of high and low values are appropriate. Also explains many of the test procedures.

The Pill Book Guide to Medication for Your Dog and Cat 
Bantam Books; ISBN: 0553579894

The Essential Guide to Natural Pet Care for Cats and Dogs - Cancer - Cal Orey
Bowtie Pr; ISBN: 1889540358
Be sure you check with your veterinarian before making any changes in treatment or diet.

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Cancer Studies and Research
I never did get my hands on most of these papers, but I'm gonna put references I found to them here, in case you want to try and find them.

Taking Part in a Clinical Trial - What Pet Owners need to know \
pdf

Significance of Tumor Suppressor Genes in Canine Cancer

University of Wisconsin Current Oncology Trials 

Canine Times
Scroll down for info on what they're doing at U of Wisconsin
 

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Copyright© 2001-2009 Leilah's Laughs
Last updated 5/27/09