Case Report: Amelanotic Melanoma in a Dog

Case Report: Amelanotic Melanoma in a Dog

Author: Daniela Capellari, DVM, Austria/Monday, April 1, 2013/Categories: Student Case Reports, TCVM Newsletter, 2013 Spring Issue

Mayday, a 12 year old, neutered female Cocker Spaniel was presented with a tumor mass (1.5cm) at the right maxilla near the last molar. The surgically removed neoplasm was histologically diagnosed as an amelanotic Melanoma. Because of the poor prognosis of oral melanoma and the dog’s old age, additional treatment options, which included radiation, chemotherapy, and cancer vaccine, were refused by the owner.

A physical examination in December 2011 indicated that the complete blood cell count and biochemical profile and urine were unremarkable. Chest X-ray showed no lung metastasis, but abdominal ultrasound revealed multiple small neoplasms in the liver.  No biopsy was performed.A TCVM examination showed a friendly, outgoing dog with a Fire constitution and a good Shen with normal body weight. She had a one-year history of very chronic sneeze attacks with nasal discharge and tended to have chronic recurrent otitis. The owner reported intermittent and slight tremoring at the fore- and hindlimbs, but no muscle weakness. Ears and nose were warm and the coat was dull but had very little dandruff. Water intake was normal. Food intake was restricted by the owner. Tongue was pale and purple with a very thin white coating, a little sticky saliva and many cracks. The tip of the tongue and the sides were more red than purple. Pulses were deep, fast and floating with the right pulse weaker than the left, especially at the Lung and Spleen position. The patient was very sensitive upon palpation of Bl-16 and BL-18 (the dog tried to escape palpation in general, so that the Back Shu and Front Mu points did not help with the diagnostic outcome in this case).

A TCVM diagnosis of Phlegm Stagnation in the Lung, Qi/Blood Stagnation at the Stomach meridian, Spleen Qi and Lung Qi/Yin Deficiency was made based on the patient’s history and findings from the tongue, pulse and physical examination.

Dry needle acupuncture was performed at LIV-3 (resolve Blood Stagnation, very good point for cancer) BL-20 (Back Shu association point for Spleen; Damp), GV-14 (strengthen immunity, clears Heat, Yin Deficiency), LI-4 (master point for face and mouth, Yuan source point for the Stomach channel  and also for nasal discharge), LI-20 (local point for nasal discharge), ST-36 (for Qi Deficiency), BL-17 (influential point for Blood), SP-10 (Sea of Blood), and ST-40 (to resolve Phlegm).

Herbal formulas administered were Stasis Breaker (breaks down Blood Stasis) and Wei Qi Booster (tonifies Qi and Blood, and boosts Wei Qi, and inhibits mutations). Both formulas were dosed at 1.3 grams orally twice daily. Stasis Breaker was used to resolve post operative Blood Stagnation while Wei Qi Booster should enhance the immune functions, and inhibit further mutations. Diet was duck (Yin tonic, Cold food) with potatoes.On reexamination three weeks later, in January 2012, Mayday was doing fine, there was no tumor regrowing, but nasal congestion started getting worse again. Tongue was pale with little white coating. Pulses were forceful, fast and wiry. Dry needle acupuncture was performed at LIV-3, BL-20 (bilateral), GV-14, LI-4 (bilateral), ST-36, ST-40, LI-20, Bi-tong (nasal congestion), and Long-hui (nasal congestion). Herbal formulas continued in same dosage.Four weeks later, the dog showed up with gastro-intestinal upset. Tongue was pale-red but not purple anymore. Pulse was fast, deep and weak. Mayday showed no recurrent melanoma and also the chronic nasal discharge improved a little again. Dry needle acupoints were the same as the examination before, but Stasis Breaker was discontinued while Wei Qi Booster was continued at the same dosage.

Another four weeks later, the owner complained that the gastrointestinal problems did not resolve completely, even though she tried to change the amount of herbs by herself. In addition, the dog’s acceptance of the herbs decreased with time and she started to look for cooler places. Because of the overall healthy condition of the dog, we decided to wean her off the Wei Qi Booster. Dry needle acupuncture was performed at LIV-3 (bilateral), GV-14, ST-36, BL-20 (bilateral), BL-13 (back Shu Point for the Lung), LU-9 (Yuan source point for the Lung), SP-3 (Yuan source point for the Spleen), and SP-6 (three Yin crossing). Wei Qi Booster, was replaced with Ling Zhi (Ganoderma lucidum) with a dose of 1g given once daily.

At the next examination, 4 weeks later in April 2012, the nasal congestion declined again and light coughing was present. Chest x-rays showed no metastatic problem. At this time dry needle acupuncture was performed at LIV-3, LI-4, LU-9, Ding-Chuan (stops cough) bilateral, Fei-men and Fei-pan (pulmonary disorders, nasal congestion), LU-5 (acute cough), BL-13 (bilateral), and ST-36.

Four weeks later, Mayday was doing very well. The owner reported that the nasal congestion improved tremendously after the last acupuncture and that her sneezing attacks with nasal discharge are very seldom. In February 2013, the nasal discharge and the sneezing have further improved and is no longer a big issue for the owner. Ling Zhi will be continued to improve the patient’s general condition and inhibit new tumor growing. 13 months after the initial diagnosis, the dog behaves like a young pup, plays a lot and shows no signs of tumor recurrence.

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