In June 2004 I was asked to examine a 22-year-old woman who had just graduated from college and was engaged to be married. During the months leading up to her graduation, Shirley (not her real name) had been plagued by a nagging cough. Eventually a computed tomographic (CT) scan revealed multiple masses in and around her lungs. A biopsy indicated metastatic melanoma that had spread from a skin cancer Shirley did not know she had. She immediately began chemotherapy treatments timed around a hastily rescheduled wedding.