UP CLOSE: Lung Nodule Program Offers Faster Diagnosis, Emphasizes Care









When Kristina Alvarez started coughing up blood in April, she knew something was wrong. It wasn’t until she was seen at the UCSF Fresno and Community Regional Medical Center Lung Nodule Program that Kristina and her husband Randy had answers. She was referred to the program by her primary care physician.

The Lung Nodule Program relies on a team of specialists to provide faster diagnosis and treatment for people with lung cancer. Started by UCSF Fresno Associate Dean and pulmonologist Michael Peterson, MD, it is the only program of its kind in central California and one of only a few in the United States.

Under the leadership of medical director Daya Upadhyay, MD, the lung nodule team regularly reviews patients’ charts to identify the most critical cases. After reviewing her file, Mohamed Fayed, MD, a pulmonary and critical care faculty member at UCSF Fresno, determined Kristina should be seen immediately.

Kristina saw Dr. Fayed on a Tuesday. He ordered a CT scan that day. Fayed sat with her while she waited for the results to review the images with multiple radiologists. On Thursday, she had a bronchoscopy, which revealed an abnormal area in her right lung. Samples were taken and provided to pathology. On Friday, the diagnosis came – metastatic melanoma.

Metastatic melanoma is when the cancer has spread to other parts of the body and is generally very difficult to cure. Fortunately, in Kristina’s case, it was an isolated nodule. 

Kristina had a history of melanoma, a type of skin cancer. She was first diagnosed (a mole on her back) in 1997. In 2015, she was diagnosed with melanoma on her left arm.

She was scheduled for surgery two weeks later and the nodule was removed. She underwent a few more surgeries and was started on immunotherapy. She will continue immunotherapy for the next year and possibly a clinical trial to help her immune system fight the cancer. Right now, she is on the mend and recently returned to work.

“We believe what we did was a cure,” said Fayed. “There is no other indication of any other metastasis at this time. Having a team that is committed to the same goal, providing the very best patient care possible, is crucial.”

Kristina is thankful for the care she received and gives credit to the entire team of specialists.

“I have never had someone so involved in my care along the way like Dr. Fayed. Everyone involved really made me feel taken care of,” she said. “I am sharing my story because the more people who know about melanoma and lung cancer and the care available locally, the better.”

Skin cancer is the most common of all cancers, according to the American Cancer Society. Melanoma accounts for just one percent of skin cancers, but causes the majority of skin cancer deaths. The cause of all melanomas is unclear. However, exposure to ultraviolet light and other factors such as fair skin increases the risk for developing it. The Skin Cancer Foundation recommends always using a sunscreen of 15 SPF or higher.