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Lymph Node Dissection or NOT ???
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Lymph Node Dissection or NOT ???

› Forums › General Melanoma Community › Lymph Node Dissection or NOT ???

  • Post
    • June 24, 2017 at 8:36 pm
    Sam33
    Participant

      Hi everyone,

      10 months after learning one of the sentinel lymph nodes contained micro metastasis of 0.03 mm.(no dissection of lymph nodes) and 14 doses of mono Keytruda (minimal side effects), I had malign melanoma metastasis on one lymph node (positive Pet CT scan and positive fine needle biopsy), yesterday.

      What should i do? Two options to choose from my oncologist.

      1) To add Yervoy to Keytruda and watch around 2 months if it will work on the lymph node (to understand the effectiveness of combination therapy) and remove the lymph node after 2 months.

      2) Make a partial lymph node dissection (2 or 3 levels) of neck and adding Yervoy to Keytruda.  

      I appreciate your recommendations..

      Best,

      Sam  

       

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    • Replies
        • June 24, 2017 at 10:39 pm
        ed williams
        Participant

          I have two articles for you from this years ASCO's reports. First one  https://am.asco.org/treatment-options-patients-localized-metastatic-melanoma and then a second article based on MSLT-2 final results in new England journal of medicine. http://www.ascopost.com/News/56731  Best Wishes!!!Ed

            • June 25, 2017 at 8:43 am
            Sam33
            Participant

              Thank you so much Ed. Perfect articles..(but when you read them, even doctors can not decide what to do, so many variables and lack of long time studies). 

              • June 25, 2017 at 3:49 pm
              jennunicorn
              Participant

                After reading all you can about the pros and cons of a node dissection, it really comes down to your gut feeling. For myself I would be thinking about the fact that there's more recovery time and complications involved with a dissection rather than just removing the affected lymph nodes after treatment. I'm in a similar situation as you, when I had my sentinel lymph node biopsy, 3 were positive for micro mets, they were removed. Went on Ipi and then 6 months later melanoma was back in 1 groin lymph node and 1 armpit lymph node. I then started Ipi/Nivo and it has taken care of the groin lymph node completely and the armpit one is half the size as before, so I've chosen to continue to do Nivo maintanence and see what the affected lymph node looks like in 3 months.. if it doesn't shrink down anymore then I'll have it taken out, but wouldn't go so far as to do a dissection.

                Melanoma decisions are the hardest, but I've found that by not overthinking and overanalyzing things, just getting some facts and then sitting with it for a moment, my gut always leads me to where it wants to go and I go with it.

                • June 25, 2017 at 10:18 pm
                Sam33
                Participant

                  Thank you very much for your comments, Jenn. My positive lymph node under my ear is so big and uncomfortable that it is annoying to keep it 2 or 3 extra months. I am wondering if you are PDL-1 positive (primary)..  Are you NRAS or wild type?

                  • June 26, 2017 at 3:35 am
                  jennunicorn
                  Participant

                    I have never been tested for PDL-1. I am BRAF positive.

                    • June 26, 2017 at 4:43 pm
                    Sam33
                    Participant

                      I am NRAS, by the way. Did you use 1 mg/kg Ipi with Nivo combination?

                      • June 26, 2017 at 4:53 pm
                      jennunicorn
                      Participant

                        I did the standard Ipi/Nivo combo. Ipi at 3mg/kg combined with Nivo for 4 doses. Been on Nivo alone maintanence since February.

                        • June 27, 2017 at 10:36 am
                        Sam33
                        Participant

                          Thank you so much Jenn.. 

                          • June 27, 2017 at 3:39 pm
                          jennunicorn
                          Participant

                            No problem. Wishing you the best in whatever decision you make.

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