› Forums › General Melanoma Community › Radical vs. Partial Lymph Node Dissection
- This topic has 18 replies, 5 voices, and was last updated 10 years, 7 months ago by
CarolS.
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- July 9, 2014 at 4:39 am
My father had a melanoma on his leg that was removed by wide excision in October 2013. He was staged at IIa and was told he needed no further treatment because his sentinel nodes were clear. In late April he noticed three new lesions near the surgical site. They were all three melanoma and he was referred to a melanoma group in SF. In June he had another wide excision around the three lesions and three MORE brand new lesions. He had sentinel node mapping again and three nodes were identified – two superficial and one deep. His melanoma surgeon chose to only remove the two superficial nodes. One of the two came back positive with melanoma and he was re-staged to IIIc.
His oncologist told him the group was recommending radical lymph node dissection of the groin – taking all nodes superficial and deep. When he consulted with the surgeon, the surgeon wanted only to remove the superficial nodes. He now has to decide whether to to the radical or superficial with not much information.
One concern I have are that there's still a deep node that hasn't been examined with potential for cells. The second concern is that the surgeon wants to rely on PET scans for evidence of metastasis. My father has had several clear PET scans but has active disease in his leg and inguinal nodes so I'm not sure how reliable they are for catching movement early.
Following the surgery (either surgery) he will join the clinical trial for Yervoy vs. Interferon. If anyone has advice or experience about opting for radical or partial lymph node dissection we welcome input.
Thanks,
Stephanie
- Replies
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- July 9, 2014 at 7:30 am
Yes you have every right to be concerned. If the sentinal node that lit up was indeed deep and not tested and he became IIIC then that node could have mets as well. His disease seems particularly aggressive in spite of surgery.
You are asking the right questions. Get a second opinion with an explination of why your docs think the way they do. As far as I see it, full dissection would be the standard of care +/- radiation to the nodal basin. All that can have significant and long term effects.
Considering how aggressive his disease seems to be, it may be better to forget the dissection, do radiation of the area, then Ipi (excellent papers were recently written on the greater effectiveness / synergy of using radiation prior to Ipi).
The other option is to assume he is on his way to stage IV, again forget the nodal basin due to the side effects and do systemic treatment on or off trial. Either way I would personally do something systemic. I am NOT a big fan of interferon. It helps some, but marginally so. IL-2 is the same however if you DO completely respond, there is a high likelyhood of a durable remission or at least life extension. INF doesn't have that significant prolonged survival. At least IL-2's side effects stop almost immediately after treatment.
No, IL-2 isn't typically done for stage IIIc.
Yervoy or combination therapy is better. Try to find a trial that has that scheme for the trial arms, or have your onc start meds off trial all together.
Inhibitors – Braf, MEK, PD=1, EAP (not sure of the abbreviaton)
Immune modulators – GMCSF (contriversial some help, others not)
Vaccines haven't faired well consistantly.
As scary as it seems, for me knowing what I now know about current melanoma research, I would avoid the radical dissection unless nodes causing pain / getting large, and instead radiate the area and start ipi. As to when to add the inhibitors, I would probably save that for later and let Ipi work if I had a low burden of disease. They are still trying to crack that nut – when to use what drug(s) and should they be pulsed to avoid resistance.
Best of luck, whatever you decide, you need to buy into it and never look back. If you aren't on the same page as your doctors, tell them and work together to come up with a plan. Or get a second opinion.
Sorry long, but that was the frustrations I had when first diagnosed so many years ago. It isn't as cookie cutter as breast cancer treatments are for the majority of those cases.
KK
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- July 9, 2014 at 6:19 pm
Thanks for your thoughtful reply, KK. This is indeed a confusing and difficult time. It's tough to make these decisions in such a short period of time with with limited information. I appreciate your advice about standing behind our decisions. I want my dad to be able to feel confident in his choices. His family will back him no matter what. I guess we're feeling a time crunch pressure. He's scheduled for lymph node dissection surgery next Wednesday (one week) so a second opinion may be difficult to come by without halting the entire process. You've given us some things to consider. Thanks again.
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- July 10, 2014 at 1:15 am
My husband had a "superficial" groin dissection. He had 2 lymph nodes with melanoma, 1 was 3 cm(palpable). He was concerned about lymphadena. He was almost done with neurosurgery residency and was determined to finish even with his diagnosis. From the research I did in 2011, the cloquets node is the node that divides deep nodes from superficial nodes. If the cloquets node has cancer then it most likely had moved to your deep nodes. During, the surgery the surgeon will test some nodes. In our situation the cloquets node was not easily identifiable. Anyway, my husband is over 3 years NED(no evidence of disease). Yes we were scared that we didn't make the right choice at that time, but we made based on our personal situation. Neurosurgery is everything to him and lymphadena scared him. He also didn't have radiation to the sight. He does get some swelling, but wrapped his leg and treated lymphadena aggressively after the surgery. We also have compression stockings that were fitted before the surgery so that he could wear those while he recovered. He even wore tight fitting biker shorts during recovery. We also did the massage to control swelling. Our insurance also paid for a neumatic whole leg compression (loved it). Doctors have told us that deep versus superficial doesn't change outcome. However, if you have cancer in deep nodes you do want them out so that you could be become NED. In our situation, it wasn't clear; we couldn't isolate and test the cloquets node; and we took the chance. Scary. We are over 3 years NED and lymphadena is not an issue. My husband operates all day. Whatever you decide-don't second guess. It will drive you insane. Realize that you can help your outcome with lymphadena by being aggressive treating/preventing it from the beginning. There is light at the end-just need time.
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- July 10, 2014 at 3:59 am
My husband was in the ipi vs interferon trial for stage iiic. My understanding was that you must have a complete lymph node dissection to participate in the trial. Good luck!
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- July 10, 2014 at 3:59 am
My husband was in the ipi vs interferon trial for stage iiic. My understanding was that you must have a complete lymph node dissection to participate in the trial. Good luck!
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- July 10, 2014 at 3:59 am
My husband was in the ipi vs interferon trial for stage iiic. My understanding was that you must have a complete lymph node dissection to participate in the trial. Good luck!
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- July 10, 2014 at 1:15 am
My husband had a "superficial" groin dissection. He had 2 lymph nodes with melanoma, 1 was 3 cm(palpable). He was concerned about lymphadena. He was almost done with neurosurgery residency and was determined to finish even with his diagnosis. From the research I did in 2011, the cloquets node is the node that divides deep nodes from superficial nodes. If the cloquets node has cancer then it most likely had moved to your deep nodes. During, the surgery the surgeon will test some nodes. In our situation the cloquets node was not easily identifiable. Anyway, my husband is over 3 years NED(no evidence of disease). Yes we were scared that we didn't make the right choice at that time, but we made based on our personal situation. Neurosurgery is everything to him and lymphadena scared him. He also didn't have radiation to the sight. He does get some swelling, but wrapped his leg and treated lymphadena aggressively after the surgery. We also have compression stockings that were fitted before the surgery so that he could wear those while he recovered. He even wore tight fitting biker shorts during recovery. We also did the massage to control swelling. Our insurance also paid for a neumatic whole leg compression (loved it). Doctors have told us that deep versus superficial doesn't change outcome. However, if you have cancer in deep nodes you do want them out so that you could be become NED. In our situation, it wasn't clear; we couldn't isolate and test the cloquets node; and we took the chance. Scary. We are over 3 years NED and lymphadena is not an issue. My husband operates all day. Whatever you decide-don't second guess. It will drive you insane. Realize that you can help your outcome with lymphadena by being aggressive treating/preventing it from the beginning. There is light at the end-just need time.
-
- July 10, 2014 at 1:15 am
My husband had a "superficial" groin dissection. He had 2 lymph nodes with melanoma, 1 was 3 cm(palpable). He was concerned about lymphadena. He was almost done with neurosurgery residency and was determined to finish even with his diagnosis. From the research I did in 2011, the cloquets node is the node that divides deep nodes from superficial nodes. If the cloquets node has cancer then it most likely had moved to your deep nodes. During, the surgery the surgeon will test some nodes. In our situation the cloquets node was not easily identifiable. Anyway, my husband is over 3 years NED(no evidence of disease). Yes we were scared that we didn't make the right choice at that time, but we made based on our personal situation. Neurosurgery is everything to him and lymphadena scared him. He also didn't have radiation to the sight. He does get some swelling, but wrapped his leg and treated lymphadena aggressively after the surgery. We also have compression stockings that were fitted before the surgery so that he could wear those while he recovered. He even wore tight fitting biker shorts during recovery. We also did the massage to control swelling. Our insurance also paid for a neumatic whole leg compression (loved it). Doctors have told us that deep versus superficial doesn't change outcome. However, if you have cancer in deep nodes you do want them out so that you could be become NED. In our situation, it wasn't clear; we couldn't isolate and test the cloquets node; and we took the chance. Scary. We are over 3 years NED and lymphadena is not an issue. My husband operates all day. Whatever you decide-don't second guess. It will drive you insane. Realize that you can help your outcome with lymphadena by being aggressive treating/preventing it from the beginning. There is light at the end-just need time.
-
- July 9, 2014 at 6:19 pm
Thanks for your thoughtful reply, KK. This is indeed a confusing and difficult time. It's tough to make these decisions in such a short period of time with with limited information. I appreciate your advice about standing behind our decisions. I want my dad to be able to feel confident in his choices. His family will back him no matter what. I guess we're feeling a time crunch pressure. He's scheduled for lymph node dissection surgery next Wednesday (one week) so a second opinion may be difficult to come by without halting the entire process. You've given us some things to consider. Thanks again.
-
- July 9, 2014 at 6:19 pm
Thanks for your thoughtful reply, KK. This is indeed a confusing and difficult time. It's tough to make these decisions in such a short period of time with with limited information. I appreciate your advice about standing behind our decisions. I want my dad to be able to feel confident in his choices. His family will back him no matter what. I guess we're feeling a time crunch pressure. He's scheduled for lymph node dissection surgery next Wednesday (one week) so a second opinion may be difficult to come by without halting the entire process. You've given us some things to consider. Thanks again.
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- October 19, 2014 at 4:37 pm
We are newcomers to this site as it and your post was recommended. My husband was diagnosed IIIb with a needle aspiration of a lymph node on Thursday at his first visit to a Melonoma Center in SF. Quite a shock since it was only recently that he recieved a confirmation of a melanoma, which seems to be fast and aggressiive) following excision on his forearm. Pending an negative PET and brain CT, the doctors there are pushing for a radical lymph node dissection ASAP. Being a nurse, I have many concerns about that, especially given what we have learned in recent years about breast cancer management.
I am interested in the recent papers on radiation that you mentioned. Can you give me some reference for those articles/papers? We are wanting to explore the cyber knife option which is available closer to our home before we make a final decision (knowing that the next scheduled tests may make that decision for us).
Thank you and I am trying to believe your statements that, " nothing is ever 100% bad and there is a reason and silver lining in everything. " But I do agree that cancer sucks! CarolS
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- October 19, 2014 at 4:37 pm
We are newcomers to this site as it and your post was recommended. My husband was diagnosed IIIb with a needle aspiration of a lymph node on Thursday at his first visit to a Melonoma Center in SF. Quite a shock since it was only recently that he recieved a confirmation of a melanoma, which seems to be fast and aggressiive) following excision on his forearm. Pending an negative PET and brain CT, the doctors there are pushing for a radical lymph node dissection ASAP. Being a nurse, I have many concerns about that, especially given what we have learned in recent years about breast cancer management.
I am interested in the recent papers on radiation that you mentioned. Can you give me some reference for those articles/papers? We are wanting to explore the cyber knife option which is available closer to our home before we make a final decision (knowing that the next scheduled tests may make that decision for us).
Thank you and I am trying to believe your statements that, " nothing is ever 100% bad and there is a reason and silver lining in everything. " But I do agree that cancer sucks! CarolS
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- October 19, 2014 at 4:37 pm
We are newcomers to this site as it and your post was recommended. My husband was diagnosed IIIb with a needle aspiration of a lymph node on Thursday at his first visit to a Melonoma Center in SF. Quite a shock since it was only recently that he recieved a confirmation of a melanoma, which seems to be fast and aggressiive) following excision on his forearm. Pending an negative PET and brain CT, the doctors there are pushing for a radical lymph node dissection ASAP. Being a nurse, I have many concerns about that, especially given what we have learned in recent years about breast cancer management.
I am interested in the recent papers on radiation that you mentioned. Can you give me some reference for those articles/papers? We are wanting to explore the cyber knife option which is available closer to our home before we make a final decision (knowing that the next scheduled tests may make that decision for us).
Thank you and I am trying to believe your statements that, " nothing is ever 100% bad and there is a reason and silver lining in everything. " But I do agree that cancer sucks! CarolS
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- July 9, 2014 at 7:30 am
Yes you have every right to be concerned. If the sentinal node that lit up was indeed deep and not tested and he became IIIC then that node could have mets as well. His disease seems particularly aggressive in spite of surgery.
You are asking the right questions. Get a second opinion with an explination of why your docs think the way they do. As far as I see it, full dissection would be the standard of care +/- radiation to the nodal basin. All that can have significant and long term effects.
Considering how aggressive his disease seems to be, it may be better to forget the dissection, do radiation of the area, then Ipi (excellent papers were recently written on the greater effectiveness / synergy of using radiation prior to Ipi).
The other option is to assume he is on his way to stage IV, again forget the nodal basin due to the side effects and do systemic treatment on or off trial. Either way I would personally do something systemic. I am NOT a big fan of interferon. It helps some, but marginally so. IL-2 is the same however if you DO completely respond, there is a high likelyhood of a durable remission or at least life extension. INF doesn't have that significant prolonged survival. At least IL-2's side effects stop almost immediately after treatment.
No, IL-2 isn't typically done for stage IIIc.
Yervoy or combination therapy is better. Try to find a trial that has that scheme for the trial arms, or have your onc start meds off trial all together.
Inhibitors – Braf, MEK, PD=1, EAP (not sure of the abbreviaton)
Immune modulators – GMCSF (contriversial some help, others not)
Vaccines haven't faired well consistantly.
As scary as it seems, for me knowing what I now know about current melanoma research, I would avoid the radical dissection unless nodes causing pain / getting large, and instead radiate the area and start ipi. As to when to add the inhibitors, I would probably save that for later and let Ipi work if I had a low burden of disease. They are still trying to crack that nut – when to use what drug(s) and should they be pulsed to avoid resistance.
Best of luck, whatever you decide, you need to buy into it and never look back. If you aren't on the same page as your doctors, tell them and work together to come up with a plan. Or get a second opinion.
Sorry long, but that was the frustrations I had when first diagnosed so many years ago. It isn't as cookie cutter as breast cancer treatments are for the majority of those cases.
KK
-
- July 9, 2014 at 7:30 am
Yes you have every right to be concerned. If the sentinal node that lit up was indeed deep and not tested and he became IIIC then that node could have mets as well. His disease seems particularly aggressive in spite of surgery.
You are asking the right questions. Get a second opinion with an explination of why your docs think the way they do. As far as I see it, full dissection would be the standard of care +/- radiation to the nodal basin. All that can have significant and long term effects.
Considering how aggressive his disease seems to be, it may be better to forget the dissection, do radiation of the area, then Ipi (excellent papers were recently written on the greater effectiveness / synergy of using radiation prior to Ipi).
The other option is to assume he is on his way to stage IV, again forget the nodal basin due to the side effects and do systemic treatment on or off trial. Either way I would personally do something systemic. I am NOT a big fan of interferon. It helps some, but marginally so. IL-2 is the same however if you DO completely respond, there is a high likelyhood of a durable remission or at least life extension. INF doesn't have that significant prolonged survival. At least IL-2's side effects stop almost immediately after treatment.
No, IL-2 isn't typically done for stage IIIc.
Yervoy or combination therapy is better. Try to find a trial that has that scheme for the trial arms, or have your onc start meds off trial all together.
Inhibitors – Braf, MEK, PD=1, EAP (not sure of the abbreviaton)
Immune modulators – GMCSF (contriversial some help, others not)
Vaccines haven't faired well consistantly.
As scary as it seems, for me knowing what I now know about current melanoma research, I would avoid the radical dissection unless nodes causing pain / getting large, and instead radiate the area and start ipi. As to when to add the inhibitors, I would probably save that for later and let Ipi work if I had a low burden of disease. They are still trying to crack that nut – when to use what drug(s) and should they be pulsed to avoid resistance.
Best of luck, whatever you decide, you need to buy into it and never look back. If you aren't on the same page as your doctors, tell them and work together to come up with a plan. Or get a second opinion.
Sorry long, but that was the frustrations I had when first diagnosed so many years ago. It isn't as cookie cutter as breast cancer treatments are for the majority of those cases.
KK
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