› Forums › General Melanoma Community › Macro vs Micro, IIIa or IIIb?
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Squash.
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- April 15, 2015 at 5:43 am
Hello,
My primary tumor (abdomen) was diagnosed on April 1, I had an axillary SLNB and wide excision on April 7, and have a PET scan tomorrow after the SNLB returned one positive lymph node. I have also been recommended for CLND. I have not met with an oncologist or melanoma specialist to date – I have only dealt with a dermatologist (briefly) and my general surgeon. Supposed to see oncologist on Thursday after the PET scan.
Does anyone know the clinical difference between a macro vs. a micrometastasis, and if there's a size threshold that delineates the two? My one positive node contains a melanoma growth that is "approximately 2mm in the largest dimension". I have seen various descriptions of macro vs micro, most state something about macro being palpable (mine was not) and micro only visible under a microscopic exam. Seems like there's quite a bit of ground between those two. At 2mm, that growth would certainly be visible to the naked eye. But again, it wasn't palpable through the skin.
The reason for my question is because I don't really know what stage I am (IIIa or IIIb) based on the macro/micro distinction. Maybe it doesn't matter? I'm just very detail-oriented and like to have all the facts. This is all only about 2 weeks old to me, and I have been completely healthy up until now.
I'm currently not in an area with a melanoma specialist, but I am Active Duty Navy and will be moving to the DC area in a few weeks, so I hope to get with a specialist soon!
Thanks for any additional info you can offer re: my question.
- Replies
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- April 15, 2015 at 11:58 am
Hi. Sorry to hear of your diagnosis. I have the same understanding of macro vs. micro that you do. The biopsy results will confirm if you are IIIA or IIIB.
Getting the CLD is a wise move. But you need to know that this may affect your ability to do PT. I don't know what you Navy folks do for PT, but you may need to have a discussion with your doctor about getting a profile that exempts you from some activities. I am not trying to talk you out of that CLD, just trying to give you a heads up. A side effect of a CLD is a condition called lymphedema, which is a swelling of a limb when lymph nodes have been removed. It affects everyone differently, but at minimum you would need to be fitted for a compression garment for the affected limb.
Your local surgeon can take care of the CLD. But if it's possible to wait until your transfer to the DC area is complete, I recommend getting an appointment at Johns Hopkins in Baltimore ASAP. Dr. Lisa Jacobs is an excellent surgeon who specializes in melanoma and breast cancer. Both Dr. Scharfmann and Dr. Lipson, who are their melanoma specialists are also excellent.
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- April 16, 2015 at 4:42 am
Linny,
Thanks so much for the detailed reply. My surgeon did advise me of the risks of lymphadema. She stated it's up to 25% for that particular CLND. Also the other good stuff like nerve damage, partial loss of function, etc. We do similar PT in the Navy as the rest of the armed forces – running, pushups, situps, etc. When we have a health issue/injury that prevents us from doing one of those things for a while, we are on "light duty" and are restricted from doing whichver movements aggravate the injury for a prescribed period of time. I would only have an issue if I were permanently unable to do pushups, because those are part of our twice a year physical fitness test. I only have to do 11 to pass, though…I think I can probably keep up enough of a standard to perform that many twice a year! I'm in the 40-50 range now. I'm going to talk to our battalion doctor tomorrow to find out if there are any risks of being medically discharged with a partial loss of limb, inability to do pushups, etc.
I am really torn on the CLND decision…I already have a numb spot about the size of a baseball on the back of my armpit from the two lymphn nodes that were removed during the SLNB! I am very active and love lifting weights, so I am wary of losing that ability.
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- April 17, 2015 at 12:59 am
It's not likely that you will be discharged based on you not being able to do pushups. If need be, you will be put on a permanent profile that exempts you from them and will have no bearing on your military career.
I did a little research on weightlifting and lymphedema and the good news is that it is possible for you to continue doing that activity. It actually may decrease your risk of developing lymphedema. I would work with a physical therapist who specializes in that condition because that individual would be the best one to guide you through the process. You'll also need to be measured for a compression garment. They make them close to your skin color, so unless your commanding officer is a real pain in the butt, you should be able to wear one with your Class B's and BDU's with rolled sleeves. BDU's with sleeves down and Class A's definitely. Initially you'll want to have one on hand in the event you have to fly anywhere because the cabin pressure changes can increase your risk of lymphedema.
That numb spot is normal and will go away when your nerves are done healing. Consider it built in pain control. LOL. It will take awhile for those nerves to heal, though — like a year or two. I think that those who lose function in an arm as a result of a CLND are in the minority.
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- April 17, 2015 at 12:59 am
It's not likely that you will be discharged based on you not being able to do pushups. If need be, you will be put on a permanent profile that exempts you from them and will have no bearing on your military career.
I did a little research on weightlifting and lymphedema and the good news is that it is possible for you to continue doing that activity. It actually may decrease your risk of developing lymphedema. I would work with a physical therapist who specializes in that condition because that individual would be the best one to guide you through the process. You'll also need to be measured for a compression garment. They make them close to your skin color, so unless your commanding officer is a real pain in the butt, you should be able to wear one with your Class B's and BDU's with rolled sleeves. BDU's with sleeves down and Class A's definitely. Initially you'll want to have one on hand in the event you have to fly anywhere because the cabin pressure changes can increase your risk of lymphedema.
That numb spot is normal and will go away when your nerves are done healing. Consider it built in pain control. LOL. It will take awhile for those nerves to heal, though — like a year or two. I think that those who lose function in an arm as a result of a CLND are in the minority.
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- April 17, 2015 at 12:59 am
It's not likely that you will be discharged based on you not being able to do pushups. If need be, you will be put on a permanent profile that exempts you from them and will have no bearing on your military career.
I did a little research on weightlifting and lymphedema and the good news is that it is possible for you to continue doing that activity. It actually may decrease your risk of developing lymphedema. I would work with a physical therapist who specializes in that condition because that individual would be the best one to guide you through the process. You'll also need to be measured for a compression garment. They make them close to your skin color, so unless your commanding officer is a real pain in the butt, you should be able to wear one with your Class B's and BDU's with rolled sleeves. BDU's with sleeves down and Class A's definitely. Initially you'll want to have one on hand in the event you have to fly anywhere because the cabin pressure changes can increase your risk of lymphedema.
That numb spot is normal and will go away when your nerves are done healing. Consider it built in pain control. LOL. It will take awhile for those nerves to heal, though — like a year or two. I think that those who lose function in an arm as a result of a CLND are in the minority.
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- April 17, 2015 at 1:40 am
You know you dont have to do a CLND. You can decide to monitor by ultrasound and if anything shows up then get it out.
The standard treatment is to do a CLND if any melanoma is found in even very small amounts in one lymph node but it is not clinical proven whether this has any significant advantage over a wait and see approach.
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- April 17, 2015 at 1:40 am
You know you dont have to do a CLND. You can decide to monitor by ultrasound and if anything shows up then get it out.
The standard treatment is to do a CLND if any melanoma is found in even very small amounts in one lymph node but it is not clinical proven whether this has any significant advantage over a wait and see approach.
-
- April 17, 2015 at 1:40 am
You know you dont have to do a CLND. You can decide to monitor by ultrasound and if anything shows up then get it out.
The standard treatment is to do a CLND if any melanoma is found in even very small amounts in one lymph node but it is not clinical proven whether this has any significant advantage over a wait and see approach.
-
- April 17, 2015 at 1:42 am
You know you dont have to do a CLND. You can decide to monitor by ultrasound and if anything shows up then get it out.
The standard treatment is to do a CLND if any melanoma is found in even very small amounts in one lymph node but it is not clinical proven whether this has any significant advantage over a wait and see approach.
-
- April 17, 2015 at 1:42 am
You know you dont have to do a CLND. You can decide to monitor by ultrasound and if anything shows up then get it out.
The standard treatment is to do a CLND if any melanoma is found in even very small amounts in one lymph node but it is not clinical proven whether this has any significant advantage over a wait and see approach.
-
- April 17, 2015 at 1:42 am
You know you dont have to do a CLND. You can decide to monitor by ultrasound and if anything shows up then get it out.
The standard treatment is to do a CLND if any melanoma is found in even very small amounts in one lymph node but it is not clinical proven whether this has any significant advantage over a wait and see approach.
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- April 16, 2015 at 4:42 am
Linny,
Thanks so much for the detailed reply. My surgeon did advise me of the risks of lymphadema. She stated it's up to 25% for that particular CLND. Also the other good stuff like nerve damage, partial loss of function, etc. We do similar PT in the Navy as the rest of the armed forces – running, pushups, situps, etc. When we have a health issue/injury that prevents us from doing one of those things for a while, we are on "light duty" and are restricted from doing whichver movements aggravate the injury for a prescribed period of time. I would only have an issue if I were permanently unable to do pushups, because those are part of our twice a year physical fitness test. I only have to do 11 to pass, though…I think I can probably keep up enough of a standard to perform that many twice a year! I'm in the 40-50 range now. I'm going to talk to our battalion doctor tomorrow to find out if there are any risks of being medically discharged with a partial loss of limb, inability to do pushups, etc.
I am really torn on the CLND decision…I already have a numb spot about the size of a baseball on the back of my armpit from the two lymphn nodes that were removed during the SLNB! I am very active and love lifting weights, so I am wary of losing that ability.
-
- April 16, 2015 at 4:42 am
Linny,
Thanks so much for the detailed reply. My surgeon did advise me of the risks of lymphadema. She stated it's up to 25% for that particular CLND. Also the other good stuff like nerve damage, partial loss of function, etc. We do similar PT in the Navy as the rest of the armed forces – running, pushups, situps, etc. When we have a health issue/injury that prevents us from doing one of those things for a while, we are on "light duty" and are restricted from doing whichver movements aggravate the injury for a prescribed period of time. I would only have an issue if I were permanently unable to do pushups, because those are part of our twice a year physical fitness test. I only have to do 11 to pass, though…I think I can probably keep up enough of a standard to perform that many twice a year! I'm in the 40-50 range now. I'm going to talk to our battalion doctor tomorrow to find out if there are any risks of being medically discharged with a partial loss of limb, inability to do pushups, etc.
I am really torn on the CLND decision…I already have a numb spot about the size of a baseball on the back of my armpit from the two lymphn nodes that were removed during the SLNB! I am very active and love lifting weights, so I am wary of losing that ability.
-
- April 15, 2015 at 11:58 am
Hi. Sorry to hear of your diagnosis. I have the same understanding of macro vs. micro that you do. The biopsy results will confirm if you are IIIA or IIIB.
Getting the CLD is a wise move. But you need to know that this may affect your ability to do PT. I don't know what you Navy folks do for PT, but you may need to have a discussion with your doctor about getting a profile that exempts you from some activities. I am not trying to talk you out of that CLD, just trying to give you a heads up. A side effect of a CLD is a condition called lymphedema, which is a swelling of a limb when lymph nodes have been removed. It affects everyone differently, but at minimum you would need to be fitted for a compression garment for the affected limb.
Your local surgeon can take care of the CLD. But if it's possible to wait until your transfer to the DC area is complete, I recommend getting an appointment at Johns Hopkins in Baltimore ASAP. Dr. Lisa Jacobs is an excellent surgeon who specializes in melanoma and breast cancer. Both Dr. Scharfmann and Dr. Lipson, who are their melanoma specialists are also excellent.
-
- April 15, 2015 at 11:58 am
Hi. Sorry to hear of your diagnosis. I have the same understanding of macro vs. micro that you do. The biopsy results will confirm if you are IIIA or IIIB.
Getting the CLD is a wise move. But you need to know that this may affect your ability to do PT. I don't know what you Navy folks do for PT, but you may need to have a discussion with your doctor about getting a profile that exempts you from some activities. I am not trying to talk you out of that CLD, just trying to give you a heads up. A side effect of a CLD is a condition called lymphedema, which is a swelling of a limb when lymph nodes have been removed. It affects everyone differently, but at minimum you would need to be fitted for a compression garment for the affected limb.
Your local surgeon can take care of the CLD. But if it's possible to wait until your transfer to the DC area is complete, I recommend getting an appointment at Johns Hopkins in Baltimore ASAP. Dr. Lisa Jacobs is an excellent surgeon who specializes in melanoma and breast cancer. Both Dr. Scharfmann and Dr. Lipson, who are their melanoma specialists are also excellent.
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- April 15, 2015 at 12:59 pm
Hi Guinnessgirl7, just to add a little to what Linny said about exercise, I had both arms done (CLND) and it takes a while before you can do intense exercise again. I get swelling after doing weights and I probably don't do as much because of this. I used to teach Phys-Ed but switched out to the regular class room after the CLND. The second thing that you should consider is that if you do progress to stage 4 like I did one year after complete lymph node removal that the new Immunotherapy treatments are using your bodies ( T-Cells ) to fight the Melanoma. Your Lymphatic system is so important in this fight. I have heard a couple of leading Immunotherapy Oncologist talk about the importance of having the Lymph nodes intact. The standard of care in the past that a general surgeon would follow is in my opinion a little out dated due to advances in the Immunotherapy drug advances like Ipi and Pd-1. There isn't a lot of research on survival advantages for complete Lymph node removal vs leaving them intact. If I knew then, what I do today about the disease I would have not done the CLND. I think getting to see a Melanoma specialist is probably the most important thing you can do at this point. Wishing you the best of luck in the journey!!! Ed
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- April 15, 2015 at 1:21 pm
You are stage IIIb. -
- April 15, 2015 at 1:21 pm
You are stage IIIb. -
- April 15, 2015 at 1:21 pm
You are stage IIIb. -
- April 16, 2015 at 5:08 am
Ed,
Thanks for your reply and the details about your CLND post-op situation. With the swelling and not working out as much, does it hurt or is it just that you don't want to aggravate the condition? I found a few studies about lifting after CLND that suggest it CAN or MAY BE helpful towards fewer flare-ups, but nothing definitive. They were mostly for breast cancer patients, too.
I love lifting and I would be crushed if I couldn't do it any more. I also need to maintain a decent standard of fitness to stay in the military (long-term). This is really a tough choice, and I appreciate your advice and sharing your experience. Thanks.
-
- April 16, 2015 at 5:08 am
Ed,
Thanks for your reply and the details about your CLND post-op situation. With the swelling and not working out as much, does it hurt or is it just that you don't want to aggravate the condition? I found a few studies about lifting after CLND that suggest it CAN or MAY BE helpful towards fewer flare-ups, but nothing definitive. They were mostly for breast cancer patients, too.
I love lifting and I would be crushed if I couldn't do it any more. I also need to maintain a decent standard of fitness to stay in the military (long-term). This is really a tough choice, and I appreciate your advice and sharing your experience. Thanks.
-
- April 16, 2015 at 5:08 am
Ed,
Thanks for your reply and the details about your CLND post-op situation. With the swelling and not working out as much, does it hurt or is it just that you don't want to aggravate the condition? I found a few studies about lifting after CLND that suggest it CAN or MAY BE helpful towards fewer flare-ups, but nothing definitive. They were mostly for breast cancer patients, too.
I love lifting and I would be crushed if I couldn't do it any more. I also need to maintain a decent standard of fitness to stay in the military (long-term). This is really a tough choice, and I appreciate your advice and sharing your experience. Thanks.
-
- April 15, 2015 at 12:59 pm
Hi Guinnessgirl7, just to add a little to what Linny said about exercise, I had both arms done (CLND) and it takes a while before you can do intense exercise again. I get swelling after doing weights and I probably don't do as much because of this. I used to teach Phys-Ed but switched out to the regular class room after the CLND. The second thing that you should consider is that if you do progress to stage 4 like I did one year after complete lymph node removal that the new Immunotherapy treatments are using your bodies ( T-Cells ) to fight the Melanoma. Your Lymphatic system is so important in this fight. I have heard a couple of leading Immunotherapy Oncologist talk about the importance of having the Lymph nodes intact. The standard of care in the past that a general surgeon would follow is in my opinion a little out dated due to advances in the Immunotherapy drug advances like Ipi and Pd-1. There isn't a lot of research on survival advantages for complete Lymph node removal vs leaving them intact. If I knew then, what I do today about the disease I would have not done the CLND. I think getting to see a Melanoma specialist is probably the most important thing you can do at this point. Wishing you the best of luck in the journey!!! Ed
-
- April 15, 2015 at 12:59 pm
Hi Guinnessgirl7, just to add a little to what Linny said about exercise, I had both arms done (CLND) and it takes a while before you can do intense exercise again. I get swelling after doing weights and I probably don't do as much because of this. I used to teach Phys-Ed but switched out to the regular class room after the CLND. The second thing that you should consider is that if you do progress to stage 4 like I did one year after complete lymph node removal that the new Immunotherapy treatments are using your bodies ( T-Cells ) to fight the Melanoma. Your Lymphatic system is so important in this fight. I have heard a couple of leading Immunotherapy Oncologist talk about the importance of having the Lymph nodes intact. The standard of care in the past that a general surgeon would follow is in my opinion a little out dated due to advances in the Immunotherapy drug advances like Ipi and Pd-1. There isn't a lot of research on survival advantages for complete Lymph node removal vs leaving them intact. If I knew then, what I do today about the disease I would have not done the CLND. I think getting to see a Melanoma specialist is probably the most important thing you can do at this point. Wishing you the best of luck in the journey!!! Ed
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- April 15, 2015 at 3:20 pm
Another thing to keep in mind is at stage 3 there is now a trial that you either get yervoy or pd1. Something to think about.
Artie
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- April 15, 2015 at 3:20 pm
Another thing to keep in mind is at stage 3 there is now a trial that you either get yervoy or pd1. Something to think about.
Artie
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- April 15, 2015 at 3:20 pm
Another thing to keep in mind is at stage 3 there is now a trial that you either get yervoy or pd1. Something to think about.
Artie
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