Saving Molly's Skin
Stricken with Melanoma, a Young Woman Beats the Odds on Two Fronts: Becoming Cancer-Free and Starting a Family
Growing up in a large family in Tulsa, Oklahoma, Molly Cesarz had always loved the idea of living in New York City. So at the age of 26, she took a job teaching Spanish at Regis High School in Manhattan. “I jumped right in,” she says. That was just before 9/11—a cauldron that forged her identity as a New Yorker. Before long, though, she met and fell in love with a financial analyst named John.
In 2002, Cesarz noticed that a mole on her upper left arm kept bleeding. At the urging of her mother, a physician, she consulted a dermatologist, who had the mole biopsied. The mole turned out to be just the tip of the iceberg: melanoma, a potentially fatal form of skin cancer that metastasizes rapidly, threatening vital organs. When detected and properly treated in its early stages, melanoma has a cure rate of greater than 90%, but once it has metastasized, this aggressive cancer can claim its victim in a matter of months. According to the National Cancer Institute, 76,690 new cases of melanoma were diagnosed in the U.S. in 2013, resulting in 9,480 deaths.
Cesarz was referred to Richard L. Shapiro, MD, associate professor of surgery, director of surgical oncology operations, and a member of NYU Langone Medical Center’s Interdisciplinary Melanoma Cooperative Group, a nationally renowned center at the forefront of melanoma research and treatment. Nearly 30 years ago, dermatologists at NYU Langone developed the criteria for detecting melanoma, encapsulated in the mnemonic ABCDE. A is for asymmetry, where half the mole is unlike the other. B is for border, where the mole is irregularly shaped, scalloped, or poorly defined. C is for color, where there is variation from one area to another or different shades of tan, brown, black, and sometimes white, red, or blue. D is for diameter, where a mole is wider than a pencil eraser, and E is for evolving, where a mole changes in size, shape, or color over time.
Dr. Shapiro made a wide, deep excision to remove the cancerous tissue, and also removed a nearby lymph node. The news just got worse. Analysis of the lymph node revealed that the cancer had spread, requiring another operation. “It was pretty bleak,” recalls Cesarz. “Dr. Shapiro said that the chances of it spreading further were at least 50%, which would have substantially increased my risk of dying. I really did go through all those steps of grief—denial, anger, whatever. My mother said, ‘You have a fighting chance,’ and I said, ‘But I don’t want a fighting chance!’ I finally did get to the point where I accepted that I might die.”
Dr. Shapiro explained to Cesarz that battling melanoma is a lifelong process. Even years of postsurgical treatment with interferon, a protein that blocks viral cell replication, can’t guarantee that there won’t be a recurrence. “With melanoma,” says Dr. Shapiro, “you’re never out of the woods.”
After the second surgery, Cesarz continued teaching, but many days she struggled to cope with flulike symptoms caused by interferon. In the summer of 2003, soon after her treatment concluded, she and John became engaged. “He never flinched,” says Cesarz. “He’s been my rock throughout this whole thing.” They married in 2004.
The couple wanted children, but Dr. Shapiro suggested holding off for a few years. “There’s a theoretical action between melanoma and reproductive hormones,” he explains, “so we do worry that pregnancy can reactivate the cancer.” Moreover, he says, melanoma is a type of cancer that can reach the placenta and fetus. Despite a new melanoma on her right calf during her first pregnancy in 2008 (it was successfully excised and had not spread), their first child was born healthy in 2009. The Cesarzes now have three boys, and their mother remains cancer-free.
In 2011, Cesarz posed with one of her sons for a book featuring successfully treated NYU Langone melanoma patients (soon after, the book became the basis for a Medical Center exhibition on skin cancer survivors). Her portrait, with others, now hangs in the Laura and Isaac Perlmutter Cancer Center. For the photo shoot, survivors wore T-shirts adorned with images of supermodels and celebrities who posed in the nude for a skin cancer awareness campaign called “Protect the Skin You’re In.” Marc Jacobs International, the shirts’ designer and manufacturer, donates the entire proceeds from their sales to skin cancer research at NYU Langone. The company’s president, Robert Duffy, is himself a former patient of Dr. Shapiro.
The incidence of melanoma in younger women is on the rise, notes Dr. Shapiro, due in part to the popularity of tanning salons (not the case with Cesarz), so he’s pleased to see fashion models taking a stand against the bronze look. Moreover, ongoing financial support from Marc Jacobs International funds a large portion of NYU Langone’s melanoma research program.
“We’re identifying gene mutations we can target with a whole new arsenal of drugs, with very few side effects,” Dr. Shapiro explains. “Marc Jacobs International enables us to focus on treating patients and developing new treatments, rather than constantly scrambling for funding.”
Cesarz has her own reason to be grateful to Marc Jacobs International. “It’s nice to be able to thank someone— other than God and the doctors,” she says.