Strength and Determination: Overcoming Distance and Stage IV Melanoma

Before his diagnosis, Paul describes himself as a “picture of health.” A former athlete and long-time business owner, he had worked for nearly three decades in the mining industry, travelling regularly in busy fly-in-fly-out roles as a specialist in plastics engineering.  

One evening, returning from a remote site, he remarked to his brother how great he felt despite days in the field, which could be physically taxing.  Hours later severe pain began to spread through his legs and back. Soon he was struggling to walk, and visited Kalgoorlie Hospital. Initial scans showed little cause for concern, but when the doctor pushed on a spot on his spine, the pain was intense. Further imaging with contrast revealed unexpected shadows on his lungs and spleen. Within days, additional investigations in Perth, confirmed metastatic melanoma. Paul had previously experienced skin cancers that had been removed. Now the disease had spread.  

Paul recalls the early days after diagnosis as surreal, “You don’t process it all at once. One minute I was eating sushi in the waiting room, worried mostly about how hungry I was. The pain has almost completely gone and I felt ready to go home. The next I am being told how serious it is… It took time to sink in.” 

He admits it took prompting from his family and doctors for him to realise the severity of his diagnosis and acknowledge the word ‘cancer’ and the later stage of his melanoma. This in an experience often reported by Melanoma Patients, particularly during the overwhelm of early diagnosis, or where complex or advanced melanoma is involved. Early information and support pathways are crucial.  

Living in a regional centre has shaped Paul’s experience. While Kalgoorlie has local health services, specialist oncology care requires travel to Perth. Telehealth consultations are also an important link between appointments, with local nurses supporting video calls with metropolitan clinicians.   

For imaging and specialist procedures, Paul travelled regularly. The Patient Assisted Travel Scheme provided some support, though navigating eligibility and appointment timing added an additional layer of complexity. Coordinating scans, skin checks and specialist reviews often required careful planning and extensive time away from home, family and work. “It disrupts every part of your life.” 

Paul chose to also continue attending a Perth-based clinician who had been managing his skin checks – widening his professional care team. He speaks about the importance of having access to professional clinicians who instil trust.  

“It’s great to have doctors in your court that you are inclined to listen to, and who know their stuff. I don’t think I would have survived otherwise.” 

Paul commenced combination immunotherapy in March 2022. The treatment, which included ipilimumab and nivolumab, was delivered in cycles several weeks apart. Immunotherapy has transformed outcomes for many people with advanced melanoma, and Paul understood the importance. 

The first cycle was manageable. By the second and third cycles, side effects became more pronounced. He developed significant fatigue, fever and inflammation. At one point, immune related toxicity deranged his liver, requiring hospital admission and close monitoring. Treatment was paused while specialists focused on stabilising his condition with supportive care and medication. 

During one admission, his condition became life-threatening, and he was transferred to Perth for further investigation and acute care. The experience was confronting for Paul and his family. 

“I remember looking at my family members and seeing the fear in their eyes. It still makes me emotional now to think of that. People often underestimate the impacts on family as the bystanders. I on the other hand was feeling so awful, I had no fear. I just wanted relief.”

Managing side effects became the priority in Paul’s treatment. Adverse side effects are a recognised risk of most treatments that can range from mild to serious, but most are treatable. Patients are closely monitored by care teams during treatment. Paul’s medical team did just that, working collaboratively across regional and metropolitan settings to monitor his pathology results and adjust his care plan accordingly.  With time and careful management, his liver function improved.

“I went from thinking I was going to die, to having a better liver than most. The turnaround was amazing.” 

Looking back, Paul acknowledges that although treatment was physically demanding, it was also the intervention that ultimately brought his cancer under control. He is aware that his experience might sound concerning to others, but is mindful of still being encouraging about care plans that save lives.
 

Paul believes his determination and mental strength, along with his lifelong good physical health, were major contributors to his recovery journey.  

“I realised how much I can endure and come back from. There are days that are extremely tough, but you have to decide to keep going. The fact that a human body can bounce back is incredible.” 

Throughout his illness, Paul worked when he was able to, adjusting his commitments around hospital stays and recovery. He also sought peer support and began journalling,  

“Speaking to others who have been through it makes a big difference. You realise you’re not the only one navigating it.” 

Paul joined online support groups through Melanoma Patients Australia and even went on to become a volunteer, moderating online support groups and helping others to connect with the supports they need. Drawing on his own experience of advanced disease and regional care, he hopes to provide practical insight and encouragement. 

Being classified as ‘no evidence of disease’ does not mean Paul can simply return to his former lifestyle. He experiences ongoing pain, discomfort and lingering fatigue. Some days are harder than others. He talks about not being able to use the word ‘remission’ or ‘recovery’ given the advanced stage of his diagnosis.  

“I can’t call myself fully recovered, and I still have to be vigilant and get regular checks. But I am disease free now, and mostly healthy.” 

Paul speaks with measured confidence about the future – conveying his passion for running his own business, and the hope of finding the strength to ride his motorcycle again on a long trip. He even jokes about writing a book about his experience one day, “I kept so many notes in my journal, there is enough in there for it.”  

Paul’s story reflects the complexity of treating advanced stage melanoma, while managing complications, in regional Australia. Support pathways and personal resilience are key.   

“Living the life you want to…it takes time after this level of setback, but you keep working at it.”  

Melanoma Patients Australia thanks Paul for sharing his story of remarkable strength and resolve and wishes him the best for the future.