Surgery a sensible choice?

Hello everyone,

After reading on this board for quite some time I find myself in the position of asking for some advice about an upcoming decision I have to make concerning an unsuspected proposition in changing my therapy plan.

I'm a 50 year old male from The Netherlands first diagnosed in 2005. A 9mm ulcerating (I suspect nodular) melanoma tumor was removed from my left calf. Both sentinel nodes harboured a 2mm tumor each. Both superficial and deep lymph node station in left groin where dissected. No further metastasis where detected in these nodes.

In 2011 the first single in transit metastasis was discovered about 8cm from the primary tumor location.

In 2013 a single metastasis was found in the scar tissue from the 2011 surgery. A full body PET/CT scan showed 7 smaller tumors in what is believed to be the abandoned lymph vessel(s) connecting primary and sentinel nodes. Further examination of the image showed a lesion deep within the abdomen between a large blood vessel and the bladder. 22mm in diameter most probably a lymph node. Surgery at that time was considered too risky. Stage IIIx became stage IV. A biopsy of that lesion confirmed it was melanoma and luckily it turned out to be BRAF positive.

Systemic therapy started with Tafinlar\Mekinist which reduced the diameter from 22mm at baseline to 14mm in about four months. Since then the tumor burden has been labeled stable. At about the median PFS for this combo therapy my oncologist suggested to switch over to Yervoy given the fact she had no real clue on how long this stable fase would last. Moreover my excellent fysical fitness would be no deal breaker in regard of the more serious adverse effects associated with Yervoy.

Apart from some major fatigue the Yervoy therapy was completed in December of 2014 without any troublesome side effects. After completion of the Yervoy treatment the 2 week scan showed growth to 23mm diameter, 4 weeks later grown to 25mm. Current size and rate of growth makes it difficult to say whether Yervoy has failed or not at this point in time. A pre Yervoy MRI scan showed no evidence of brain tumors.

Given the fact that since the tumor burden hasn’t increased in number and only at a moderate rate in size over the past 16 months – even after quitting the inhibitors – the proposition is to remove the tumor in the abdomen by surgery, dealing with eventual problems coming from the leg tumors if and when they arise. Radiation surgery would be no option considering the delicate nature of surrounding tissues and toxicity. Some – believed to be – nodes in the immediate surroundings of the target lesion are labeled suspect.

At the moment I can appreciate the rationale behind this – at least to me – unusual move. It sounds promising given the fact that a major source of potential melanoma settlers is physically and radically removed from a critical location within my body. As usual I’m fully aware there aren’t only upsides associated with this plan.

What are the downsides that have to be taken into account to come to an intelligent decision?

Many thanks in advance,

Ben