You don't die from skin cancer. That's what Robert Harsh thought when he was diagnosed with the disease about four years ago.
You go to a doctor, have the lesion removed and life goes on.
But there was more to the small spot on Harsh's cheek than met the eye.
It was melanoma.
For several months, Harsh would look in the mirror and see something resembling a pimple.
It wasn't dark, it didn't change shapes. But it wouldn't heal.
Harsh is a flight paramedic with the Maryland State Police and volunteered for years with the Williamsport Ambulance Co.
But even with his medical training, "I didn't have a clue what it was," he said.
At the urging of his wife, Donna, Harsh went to see his primary-care physician.
The results of a biopsy caught him by surprise.
He had basil cell carcinoma.
Harsh said he made an appointment with a plastic surgeon in Frederick, Md., who removed the growth and sent it to a lab for diagnosis.
This time around, Harsh received more serious news.
He had malignant melanoma.
Anyone can get skin cancer
Each year, about 9,000 Americans die from melanoma.
When diagnosed early, the skin cancer is highly curable, reports the Melanoma Research Foundation. But it is the least screened cancer and the more advanced the tumor, the harder it is to treat and cure. It's often fatal once it spreads beyond the skin.
Harsh said he was never an outdoors person.
"I grew up helping my grandfather on his farm. But I wasn't a biker, hiker or boater. I just wouldn't classify myself as the outdoorsy type," he said. "And most of my career has been spent in ambulances or in and out of buildings."
But that didn't prevent the disease from striking an otherwise healthy, active man in the prime of his life.
"When you're young, you think you're invincible. I learned quickly that I'm not," he said.
At the age of 44, Harsh has taken a journey that few would want to travel.
After being diagnosed with melanoma, the Washington County resident underwent a nine-hour surgery.
"At that point, I was cancer free," Harsh said.
But when it comes to melanoma, the deeper the tumor, the greater chance it will return.
"Because of the depth, I knew it would come back," he said.
With the increased chances of the cancer returning, Harsh said he had several options.
He could do nothing. He could do interferon, a therapy drug with unpredictable results that also made you feel terrible, for a year. Or, his oncologist suggested, he could participate in a clinical trial.
Harsh's wife, Donna, said her husband was accepted into a nine-month clinical trial at National Institutes of Health "and we thought the cancer was gone."
"But a CT scan showed that the cancer had spread to his lungs and the medications failed to stop the growth of that cancer, which put him at Stage IV," she said.
High dose IL-2, the next course of treatment, also proved to be ineffective.
Melanoma might start out as skin cancer, Harsh noted, but will metastasize — traveling to other organs, releasing cancer cells that float through the body.
"It travels, sits and waits," Harsh said. "And when it metastasizes, it goes to Stage IV."
Staging is a process of finding out how widespread a cancer is, Harsh explained. This includes its size, whether it has spread to the lymph nodes or other organs and is the result of imaging tests, such as CT or MRI scans and biopsies.
In Harsh's case, when the cancer did return, tests showed it has traveled to his lungs.
"Melanoma ranks right up there with pancreatic cancer," Harsh said. "It doesn't respond to radiation or chemotherapy. And I now had five tumors in my lungs. The doctors figured the way it was spreading, there were probably a lot more."
Harsh said he went through a roller coaster of emotions during this time.
"But I'm a statistics person," he said. "I look at things black and white. I knew I was probably going to die and probably had 4 to 6 months to live."
The father of three children, ages 21, 17 and 15, he said he was up front with them "giving them all the correct information instead of bits and pieces."
But he was soon contacted by his doctor's office saying that he might be eligible for a new clinical trial for Ipilimumab, a new drug from Bristol-Myers Squibb. The drug was approved by the FDA in March and is the first drug approved for malignant melanoma in 13 years.
In August of 2009, Harsh was accepted as one of 10 patients in a new Ipilimumab trial offered at the Carolina's Medical Center in Charlotte, N.C. Before leaving, though, Harsh did something he had always wanted to do. He and his family headed west in their camper to visit some of the country's national parks.
"I had to be eight weeks free of any drugs before I began treatment," he said. "So we just decided to do the trip and wing it."
It was good having a change of scenery, Harsh said. "You can never forget what's going on. But it's not in the forefront."
When he returned home, Harsh became one of 50 participants in the nation-wide clinical trial and began his doses of the drug, which is now called Yervoy.
After several weeks, a set of scans, he said, showed the largest tumor was completely gone.
"I was amazed to see progress so quickly," he said. "It caught the doctors by surprise, as well."
Today, Harsh has returned to work and is back to full-duty flying in Cumberland.
Harsh said he has done presentations for Bristol-Myers Squibb and has told his story in publications including Cure Magazine.
He and his family also have become advocates for sun protection.
"I never wore a hat or sun block," he said. "Now I wear sun block, a hat and long-sleeved shirts."
His daughter recently promoted a campaign at Williamsport High School during prom season, he said, asking students to avoid tanning salons.
Harsh said he continues to be a part of the clinical trial and is coming up on week 96.
"I could stop," he said. "But it's more of a security blanket. I could relapse. Plus, I wouldn't receive the CT scans every 12 weeks — and with melanoma, it can come back fast."
Harsh said some people might not want to share a similar story.
"But I want people to see how well I'm doing and, maybe, it will give them hope that anything is possible."