Sylvester Comprehensive Cancer Center

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Darleen Fenster, Melanoma

Darleen Fenster, Melanoma

"Life is short; every day is a gift. You have to enjoy every moment and make the most out of every single year."

Friendships Forged: One Survivor’s Bittersweet Journey

Darleen Fenster is a pastry chef, which might explain why she has such a sweet outlook on life, this even despite her cancer diagnosis 33 years ago. Fenster, in fact, would become the first patient to be seen at the University of Miami Sylvester Comprehensive Cancer Center. Her success story is truly inspirational.

In the spring of 1974, when Darleen Fenster was pregnant with her first son, she noticed a mole on the upper part of her right arm. “Strange things happen when you’re pregnant,” she thought. Not overly concerned, Fenster’s obstetrician removed the mole after the birth of her first son and reported back that it was benign. Then during her second pregnancy two years later, a new mole, a little larger than the size of a pencil eraser, grew through the scar. Fenster’s new obstetrician insisted she see a dermatologist.

“Life is short; every day is a gift. You have to enjoy every moment and make the most out of every single year.”“I thought to myself, I’ll go when I have time.’ I had a toddler and a brand new baby so it was difficult for me to take time away from them to go see a doctor,” she recalls. Months later, when visiting her child’s pediatrician, he too, noticed the growth, and asked her, “What’s that on your arm?” He urged her to get it checked out. So Fenster went to see a local dermatologist who removed the growth. The doctor called the next morning, and Fenster went to see him that same day. He told her it was melanoma and advised her to see a specialist to make sure the cancer had not spread.

Without delay, her husband, Sandy, started making phone calls to find the best doctor to treat his wife. That person turned out to be Alfred Ketcham, M.D., who would later become chief of surgical oncology at Sylvester. Ketcham, who was a faculty member at the University of Miami since 1974, first treated Fenster at Jackson Memorial Hospital. After examining the microscopic slide prepared from her biopsied tissue, reviewing her history, and checking the wound, Ketcham told her a wider area of the scar and skin had to be re-excised in order to remove any cancer cells that may have remained. “His motto was, ‘When in doubt, take it out’—when dealing with cancer,” recalls Fenster. When Ketcham reviewed the original microscopic slide from her first mole, he discovered she had been misdiagnosed the first time; it was indeed cancer. Ketcham’s supportive demeanor helped ease the young mother’s fears. “He treated me like his daughter. I was 28 and really scared; I was a brand new mom dealing with cancer,” she says.

Ketcham, who at 83 has been retired for ten years, vividly remembers the visit of this alarmed and anxious young couple. “Having had a history of this cancer growing back in the same area suggested she may have “fingers” and “feelers” of cancer cells extending into the tissue around the scar,” says Ketcham. He therefore re-operated and removed an area of tissue and underlying muscle and used a skin graft to cover the baseball-sized area on the arm. In addition to the surgery on her arm, lymph nodes from her armpit were surgically removed to ensure the cancer hadn’t spread through her bloodstream. It hadn’t. “She had a minimal invasion, but we got the cancer before it became a problem.”

This year, it is estimated that more than 8,000 people will die from melanoma, according to the American Cancer Society. The good news is, if diagnosed and treated early, melanoma is curable. Fenster is one of those success stories. She says Ketcham was very compassionate with her. “He always walked in telling a joke and was never rushed. He’s such a wonderful man,” she says.

At the time Fenster was treated, Sylvester hadn’t been built yet, but Fenster saw Ketcham at Jackson Memorial Hospital for follow-up visits weekly, then monthly, and then every three months, followed by every six months, and finally once a year. During those visits, Ketcham would examine her from head to toe, looking for anything suspicious, and also run blood tests. “I followed her carefully, and when the cancer center was ready to open its doors, I asked her to be the first patient seen at Sylvester,” says Ketcham, who was named chief of surgical oncology at the newly created cancer center. In 1992, when the dedication took place, Fenster became the first patient ever seen at Sylvester.

Fenster still visits Sylvester for her yearly check-ups with Frederick L. Moffat Jr., M.D., professor of surgical oncology in the DeWitt Daughtry Family Department of Surgery at the University of Miami Leonard M. Miller School of Medicine, and a member of the Breast Cancer Site Disease Group at Sylvester. Moffat had been one of Ketcham’s surgical fellows, undergoing several years of extra training in order to become a cancer specialist.

During the time Ketcham treated Fenster, the two became fast friends, staying in touch throughout the years. Darleen and Sandy would join Ketcham and his wife for dinner, frequent the theater, and even go out on family boat trips together. In fact, Ketcham attended both of Fenster’s sons’ bar mitzvahs—Brian, who is 33 today, in 1987, and Adam, who is 31 now, in 1989. Three years ago, Darleen and Sandy attended Ketcham’s 80th birthday.

Many surgical advances have been made at Sylvester since Fenster was first treated. “We now have better management of how much tissue from around the area to take,” Moffat says. “We also have the option of a sentinel lymph node (SLN) biopsy, a new procedure that can be used on patients with early stage melanoma to find out if it has spread to the nodes.” Cancer usually spreads from the tumor to the sentinel lymph node before invading the other lymph nodes. Through a SLN biopsy, doctors remove the sentinel lymph node and analyze it to see if cancer cells are present.

“This is a major change,” says Moffat. “When Mrs. Fenster was treated [in the late 1970s], we didn’t have this technique. Radical lymph node surgery or simple observation of the lymph nodes were the only options available.”

Another advance is immune stimulation, which involves administering a vaccine to “immunize” against cancer. This type of therapy holds special promise for melanoma patients. Researchers are experimenting with synthetic vaccines that when administered have shown to evoke an immune response in some patients.

Since treating Fenster, Sylvester has witnessed phenomenal growth due to its ongoing recruitment effort. Fenster is proud to be part of that. Last February, she and Sandy hosted “A Sweet Celebration in Search for a Cure” in their home, which attracted more than 80 guests and netted $20,000 for surgical oncology research at Sylvester.
For Fenster, finding a cancer cure has been a very personal mission. Sadly, Sandy battled esophageal cancer for four years, losing his fight earlier this year. “It’s a fallacy that only old people get cancer,” she says. “Life is short; every day is a gift. You have to enjoy every moment and make the most out of every single year. My husband and I lived that way every day of our lives.” It’s a motto she hopes others will follow. “That’s what having cancer at 28 does to you. You realize life is not a dress rehearsal. Enjoy it while you’re here!”

Fenster is currently pursuing her passion for cooking and has set her sights on traveling abroad. She recently spent one week in the Tuscany region of Italy to attend culinary classes. “Baking is my passion—what you do in life has to be your passion,” she says. Her job as a pastry chef, along with her sweet culinary creations, allows her to share happiness with others. “There’s no better feeling than making others happy on joyous occasions by creating something that tastes as good as it looks.”

Today, Fenster is glad to be healthy and is thankful to Sylvester, a place where she developed strong bonds over the years. She just celebrated her 59th birthday with her beautiful family; her son Brian and his wife Shelevah; their daughters Telem and Keren; and her son Adam and his wife Goldie. “I love birthdays. I’m just so happy to be here,” she says.

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