Calling an all-out blitz on skin cancer
August 13, 2019 / in Cancer / by
When UK defensive lineman Josh Paschal hits the football field in the season’s opening game, he will have some special fans cheering him on. They are the same people who have supported and cared for him at UK HealthCare’s Markey Cancer Center – through three surgeries and months of immunotherapy – after he was diagnosed with melanoma just over a year ago.
Melanoma brings Paschal to Markey
Sharon Martin, RN, remembers the first time she saw the 6’3”, 284-pound Paschal at Markey. “Here was this huge young man wearing a UK sweatshirt. When he told me he played football, it hit me. I said, ‘You’re defensive line. You’re the Josh who’s number 4.’ ” The oncology nurse nicknamed Giggles for her ability to make patients laugh is a Kentucky Wildcat season ticket holder. She and Josh have talked sports ever since.
Josh said Markey staff, from the greeters at the front door to nurses like Martin, have helped him remain upbeat through his cancer treatment because of their compassion and positive attitudes. Just as important has been his support team of family, friends and teammates, and his faith in God.
The college student’s cancer journey began in July 2018 when he noticed a small spot on the bottom of his right foot. He thought it was a blood blister. The football team’s athletic trainer immediately sent him to a dermatologist.
Biopsy results were not good. Josh had a rare and aggressive form of skin cancer, acral lentiginous melanoma (ALM). Two days after the July 16 diagnosis, he was in surgery.
“It was a shock,” Josh said. He had appeared in all 13 football games his freshman year, receiving accolades for his outstanding play. A 19-year-old sophomore, he was in the best physical shape of his life. Now he would be sidelined.
“I kept thinking this can’t be real,” he said. “Nobody talked about skin cancer when I was little. I thought it was something I didn’t have to worry about because I’m African American.”
“Fortunately, Josh, his trainer and his family all focused on the problem and took quick action,” said B. Mark Evers, MD, director of the Markey Cancer Center, who performed Josh’s surgeries and worked with a team of other specialists to develop a treatment plan.
While ALM accounts for just 2 to 3% of all melanoma cases, its incidence is higher in people of color, particularly in blacks, according to research published in the Journal of the American Medical Association. It appears most often in areas unaffected by sun exposure, such as the soles of the feet, palms of the hands and under the nails.
Possibly, because of the misconception that those with dark skin cannot get skin cancer, African Americans have the highest melanoma death rate of any racial group even though Caucasians are 20 times more likely to receive a melanoma diagnosis.
Faith, family provide support
Armed with a notebook full of questions, LaTauna Paschal, Josh’s mother, flew to Kentucky with her husband and other family members from their hometown of Olney, Maryland, before the first surgery.
“When you get a diagnosis like that, you’re numb,” she said. “But before I could ask a single question, Dr. Evers and the entire team answered and explained everything.”
After surgery, tests showed some cancer cells remained at the edge of the tissue that was removed. To get “clean margins,” Josh had a second surgery on August 1.
“You think about Josh being a football player with a possible pro career ahead of him,” Evers said. “But if you start to cut corners, you’re missing the big picture of dealing with the cancer. Everyone was on board with going back to the operating room.”
Leading-edge cancer care
Afterward, with no signs of cancer remaining, a plastic surgeon joined Evers on August 24 and performed a skin graft, taking skin from Josh’s calf to repair and replace the tissue on the sole of his foot.
As the only National Cancer Institute-designated cancer center in Kentucky, Markey offers the most technologically advanced and sophisticated care available.
Five days after his skin graft, Josh began immunotherapy, which boosts the body’s own immune system to fight disease. Once a month he receives an infusion of the drug Opdivo. Approved by the FDA in 2018 for certain patients with melanoma, Opdivo significantly lowers the risk of recurrence. His last infusion takes place in September.
“Immunotherapy has completely changed the treatment of melanoma,” said Peng Wang, MD, the Markey medical oncologist leading Josh’s post-surgical treatment. “Ten years ago it was a sad situation. We had no medications to offer. Now we have multiple options and sometimes have to debate which one to choose first.”
To guide the decision-making process, Josh’s case was brought to Markey’s Melanoma Tumor Board, which consists of medical, surgical and radiation oncologists, as well as pathologists. It meets every other week, bringing the best minds together to discuss how to care for individual patients.
“I’d never heard of immunotherapy,” Josh admitted. Throughout his treatment, he experienced only a few side effects and occasionally missed classes for appointments. The honors athlete, majoring in family sciences, maintained a cumulative GPA of 3.469 and earned a 3.5 last semester.
“Every time I come in,” said Josh, “I’m surrounded by positive people. There is joy in the room. It really lifts me up.”
His mother agrees. “I can’t imagine Josh being treated anywhere else. They made us feel like family. Dr. Evers gave us his cell number and told us to call at any time.” It’s something he does for all of his patients.
The Markey culture is to do everything possible to make patients and their families feel comfortable, said Deb O’Nan, RN, who cared for Josh during his immunotherapy treatment. “We love our patients and we do what we can to reassure them. We work to make this a warm environment. And I always let them know that I may not have the answers, but I know how to find them.”
For Leila Scandrani, RN, seeing a young, active patient like Josh hits home. “That could be my brother, my family,” she said. “Josh is always kind, humble and appreciative. Most of our patients are. It’s the little things we can do, like explaining the plan for their treatment that day, talking to them about their interests, pulling the shades if the room is too bright, that make a difference.”
Back to the game
Throughout his treatment, Josh continued to work out and went through intensive rehabilitation. The entire Markey team was thrilled when he returned to the game on November 17, 2018, where he made a tackle that contributed to the team’s win against Middle Tennessee.
“I was yelling and screaming and jumping,” Martin said. “And when he came in the next time and I told him I saw that hit, he just grinned.”
Josh also played in the last regular season game and in the Citrus Bowl win against Penn State. The Wildcats ended the season 10-3, their best record since 1977.
The football player invited Evers to join his family at UK’s annual CATSPY Awards, where UK athletes are recognized for their achievements. Josh won the Heart of a Wildcat award.
“It was very special,” said Evers, another season ticket holder. “With any cancer diagnosis, we remain hyper vigilant. But with his support, his strong faith, his hard work, and the help of our amazing group at Markey, cancer is just going to be one chapter in the book of Josh Paschal.”