I learned a lot today during our appointment with Dr. Lipson at Johns Hopkins – so much that I can’t absorb the information and turn it around into a day-one story. I’ll write more in the next week about melanoma, but for today I’ll write about the biopsy.

Dr. Lipson seemed pleased with the chunk of tissue he took out of Robert’s leg. To explain why, he started talking about apples. This one, he said, was “not this soft, mealy, mushy thing you bite into. It’s crispy and firm.” Sometimes, he said, “you get an apple that’s like a four-day-old pear.” This one was more like a Honey Crisp apple: when you bite into it, “it comes off in one satisfying bite – you get a bite that’s self-contained.”

The good thing about a crisp biopsy is that you only need one stitch to close the wound. So, that’s all Robert got – one stitch!

We also took note that Robert’s injection sites are less reactive this time than they have been after the previous GVAX injections. This is not out of the mainstream of other patients who have completed the cycle of four injections in the trial.

Dr. Lipson likened this vaccine therapy to getting a series of allergy shots. The first time the vaccine is injected, the immune system recognizes it as a foreign substance and reacts at the injection sites, making them red. The reaction creates an army of T-cells and antibodies to fight the foreign substance if it comes along again. With the second injections, the immune system goes nuts because it knows what it’s looking for now, and hence, the swelling and itching are much worse.

Over time, the immune system gets used to the foreign substance, and with each additional injection, it cares less and less. That’s what we want to bring about with allergy shots, which generally are given over a much longer period of time.

With the GVAX, now it’s time to stop. We hope those T-cells and antibodies have done a job on any micrometastases left in Robert’s body after the surgery. Now, it’s time to get on with our lives ...

That doesn’t mean we’re done at Johns Hopkins, however. We have two more follow-up visits, and the one in April will include scans to make sure there are no active tumors in Robert’s body. After that, we will watch and wait – and hope.

All for now. Call or email if you have questions.