› Forums › General Melanoma Community › 2nd opinion?
- This topic has 30 replies, 6 voices, and was last updated 9 years, 9 months ago by
mjanssentx.
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- November 19, 2015 at 5:21 pm
Hi all – my husband was diagnosed with a stage 1b melanoma on his ear in September and had a wide excision and SLNB earlier this month. The surgeon took two lymph nodes as he said the signal was fairly high for both. We got the path report last night, and the doctor said that the second/father away lymph node was clear, but the first had some cancer cells – but such a small amount that further treatment isn't indicated. He's still being staged as T1b, N0, M0. (I believe. I haven't seen the path report, we got the results by phone.)
Y'all, my dad died from a melanoma on his ear in 2002, so needless to say, even a small amount of cancer cells makes me nervous. My husband is being treated at Dana-Farber (we live in Boston) but I'm wondering if we should seek a second opinion.
Thanks for your wise advice!
Jen
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- November 19, 2015 at 7:41 pm
I would go for a second opinion if your unsure. Was there any signs of physical cancer in the nodes? It sounds like micromets to me. I had the same and the doctor told me it’s a very tiny amount. Then I asked him how much and he said there was no way of telling how many cells. My question is how does he know just a few cancer cells? Either way micro is better then macro. I think they only say micro because they can’t feel it and use special stains to see it. I would also request a pet. I’m not sure how likely it is to spread to organs with micromets in blood. Anyone know the probability. Be strong and remember the doctor works for you so don’t be afraid to say I want a pet and question him on stuff. Greg -
- November 19, 2015 at 7:41 pm
I would go for a second opinion if your unsure. Was there any signs of physical cancer in the nodes? It sounds like micromets to me. I had the same and the doctor told me it’s a very tiny amount. Then I asked him how much and he said there was no way of telling how many cells. My question is how does he know just a few cancer cells? Either way micro is better then macro. I think they only say micro because they can’t feel it and use special stains to see it. I would also request a pet. I’m not sure how likely it is to spread to organs with micromets in blood. Anyone know the probability. Be strong and remember the doctor works for you so don’t be afraid to say I want a pet and question him on stuff. Greg -
- November 19, 2015 at 7:41 pm
I would go for a second opinion if your unsure. Was there any signs of physical cancer in the nodes? It sounds like micromets to me. I had the same and the doctor told me it’s a very tiny amount. Then I asked him how much and he said there was no way of telling how many cells. My question is how does he know just a few cancer cells? Either way micro is better then macro. I think they only say micro because they can’t feel it and use special stains to see it. I would also request a pet. I’m not sure how likely it is to spread to organs with micromets in blood. Anyone know the probability. Be strong and remember the doctor works for you so don’t be afraid to say I want a pet and question him on stuff. Greg -
- November 19, 2015 at 9:45 pm
If the first lymph node had any signs of cancer, he is now stage 3, not stage 1b. Once the melanoma leaves the original site, he has regional disease. There aren't a ton of treatment options for someone in your husbands position but a complete lymph node dissection would be a common next step. If that wasn't even discussed, I'd definitely be asking for another opinion. There is controversy about the CLND, but it should at least be discussed. There may also be clinical trials available. Maybe the doc would discuss this at a follow up appointment?
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- November 19, 2015 at 9:45 pm
If the first lymph node had any signs of cancer, he is now stage 3, not stage 1b. Once the melanoma leaves the original site, he has regional disease. There aren't a ton of treatment options for someone in your husbands position but a complete lymph node dissection would be a common next step. If that wasn't even discussed, I'd definitely be asking for another opinion. There is controversy about the CLND, but it should at least be discussed. There may also be clinical trials available. Maybe the doc would discuss this at a follow up appointment?
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- November 19, 2015 at 9:45 pm
If the first lymph node had any signs of cancer, he is now stage 3, not stage 1b. Once the melanoma leaves the original site, he has regional disease. There aren't a ton of treatment options for someone in your husbands position but a complete lymph node dissection would be a common next step. If that wasn't even discussed, I'd definitely be asking for another opinion. There is controversy about the CLND, but it should at least be discussed. There may also be clinical trials available. Maybe the doc would discuss this at a follow up appointment?
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- November 20, 2015 at 5:02 pm
Is this the newer way of staging? I thought lymph node involvement always meant Stage 3.
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- November 20, 2015 at 5:02 pm
Is this the newer way of staging? I thought lymph node involvement always meant Stage 3.
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- November 20, 2015 at 5:02 pm
Is this the newer way of staging? I thought lymph node involvement always meant Stage 3.
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- November 20, 2015 at 5:24 pm
It's all the same, see explanation here:
http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-staging
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- November 20, 2015 at 5:24 pm
It's all the same, see explanation here:
http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-staging
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- November 20, 2015 at 5:24 pm
It's all the same, see explanation here:
http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-staging
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- November 20, 2015 at 6:23 pm
This is my concern. I don't understand how ANY melanoma cells in a lymph node mean he can still be classified as Stage 1, but that's what the doctor said – no additional treatment warranted, based on some study that showed if there are fewer than 20 cancer cells in a lymph node, survival rates are the same as for Stage 1.
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- November 20, 2015 at 6:23 pm
This is my concern. I don't understand how ANY melanoma cells in a lymph node mean he can still be classified as Stage 1, but that's what the doctor said – no additional treatment warranted, based on some study that showed if there are fewer than 20 cancer cells in a lymph node, survival rates are the same as for Stage 1.
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- November 20, 2015 at 6:23 pm
This is my concern. I don't understand how ANY melanoma cells in a lymph node mean he can still be classified as Stage 1, but that's what the doctor said – no additional treatment warranted, based on some study that showed if there are fewer than 20 cancer cells in a lymph node, survival rates are the same as for Stage 1.
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- November 20, 2015 at 6:44 pm
Not sure about the study – but even if survival rates are similar, he is still stage 3. It's obviously good that there are only a few cells in the lymph node, but the melanoma still traveled there somehow and that is now considered "regional" disease, not local to the original primary. I'd ask for a copy of the study the doctor is referencing, check the results and see how many people participated in it. THEN you can make your own informed opinion. Even so, there isn't a lot in the way of treatment for stage 3A (and none for stage 1b) besides surgery and a possible lymph node dissection.
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- November 20, 2015 at 6:44 pm
Not sure about the study – but even if survival rates are similar, he is still stage 3. It's obviously good that there are only a few cells in the lymph node, but the melanoma still traveled there somehow and that is now considered "regional" disease, not local to the original primary. I'd ask for a copy of the study the doctor is referencing, check the results and see how many people participated in it. THEN you can make your own informed opinion. Even so, there isn't a lot in the way of treatment for stage 3A (and none for stage 1b) besides surgery and a possible lymph node dissection.
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- November 20, 2015 at 6:44 pm
Not sure about the study – but even if survival rates are similar, he is still stage 3. It's obviously good that there are only a few cells in the lymph node, but the melanoma still traveled there somehow and that is now considered "regional" disease, not local to the original primary. I'd ask for a copy of the study the doctor is referencing, check the results and see how many people participated in it. THEN you can make your own informed opinion. Even so, there isn't a lot in the way of treatment for stage 3A (and none for stage 1b) besides surgery and a possible lymph node dissection.
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- November 20, 2015 at 2:12 pm
If you have reservations or want another opinion on surgery and treatment options, get a second opinion. It's not always easy to know how to go about asking for one or getting on, so I would check out information from Cancer(dot)net about getting a 2nd opinion. The Patient Advocate Foundation has good resources as do the Center for Advancing Health. Google those organizations names + "second opinion" and the articles should pop up (can't link here).
-M
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- November 20, 2015 at 2:12 pm
If you have reservations or want another opinion on surgery and treatment options, get a second opinion. It's not always easy to know how to go about asking for one or getting on, so I would check out information from Cancer(dot)net about getting a 2nd opinion. The Patient Advocate Foundation has good resources as do the Center for Advancing Health. Google those organizations names + "second opinion" and the articles should pop up (can't link here).
-M
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- November 20, 2015 at 2:12 pm
If you have reservations or want another opinion on surgery and treatment options, get a second opinion. It's not always easy to know how to go about asking for one or getting on, so I would check out information from Cancer(dot)net about getting a 2nd opinion. The Patient Advocate Foundation has good resources as do the Center for Advancing Health. Google those organizations names + "second opinion" and the articles should pop up (can't link here).
-M
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- November 20, 2015 at 6:24 pm
Thanks everyone for your wisdom. We are getting a copy of the path report and will go from there. Husband is not so interested in a second opinion, not as worried as I am. But we have a contact at NIH who looked at his original path report from his mole, so hopefully we can get him to look at this one, too.
Jen
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- November 20, 2015 at 6:24 pm
Thanks everyone for your wisdom. We are getting a copy of the path report and will go from there. Husband is not so interested in a second opinion, not as worried as I am. But we have a contact at NIH who looked at his original path report from his mole, so hopefully we can get him to look at this one, too.
Jen
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- November 20, 2015 at 6:24 pm
Thanks everyone for your wisdom. We are getting a copy of the path report and will go from there. Husband is not so interested in a second opinion, not as worried as I am. But we have a contact at NIH who looked at his original path report from his mole, so hopefully we can get him to look at this one, too.
Jen
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- November 20, 2015 at 7:34 pm
Jen – I am a 3A….get a second opinion.
If you have any lymph node involvement it is 3A and he is considered "high" risk for reoccurrence. Even if you don't do any adjunctive therapies, you certainly wanted to be monintored very closely so that IF it does come back as a Stage 4 that you are able to get quick and diligent treatment. As you will read on this board, melanoma treatments have advanced significantly so that it is not an automatic death sentence…but you have to do your part.
And make sure that second opinion is from a Melanoma specialist. (dermatologists and oncologists do NOT count in this recommendation).
Best wishes
Michel
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- November 20, 2015 at 7:34 pm
Jen – I am a 3A….get a second opinion.
If you have any lymph node involvement it is 3A and he is considered "high" risk for reoccurrence. Even if you don't do any adjunctive therapies, you certainly wanted to be monintored very closely so that IF it does come back as a Stage 4 that you are able to get quick and diligent treatment. As you will read on this board, melanoma treatments have advanced significantly so that it is not an automatic death sentence…but you have to do your part.
And make sure that second opinion is from a Melanoma specialist. (dermatologists and oncologists do NOT count in this recommendation).
Best wishes
Michel
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- November 20, 2015 at 7:34 pm
Jen – I am a 3A….get a second opinion.
If you have any lymph node involvement it is 3A and he is considered "high" risk for reoccurrence. Even if you don't do any adjunctive therapies, you certainly wanted to be monintored very closely so that IF it does come back as a Stage 4 that you are able to get quick and diligent treatment. As you will read on this board, melanoma treatments have advanced significantly so that it is not an automatic death sentence…but you have to do your part.
And make sure that second opinion is from a Melanoma specialist. (dermatologists and oncologists do NOT count in this recommendation).
Best wishes
Michel
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