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Removing melanomas on skin on Stage 4 patient
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Removing melanomas on skin on Stage 4 patient

› Forums › General Melanoma Community › Removing melanomas on skin on Stage 4 patient

  • Post
    • November 2, 2011 at 3:55 pm
    dearfoam
    Participant

      Background: Dad's melanoma was discovered as a batch of several tumors in lungs and brain. After biopsy, it was discovered he'd had a melanoma removed from neck years before that he forgot about. Treatments got underway immediately and no dermatologists were involved looking him over.

      Background: Dad's melanoma was discovered as a batch of several tumors in lungs and brain. After biopsy, it was discovered he'd had a melanoma removed from neck years before that he forgot about. Treatments got underway immediately and no dermatologists were involved looking him over.

      Fastforward to last month: After saved biopsy sample was deemed insufficient for BRAF testing, other options for new biopsies of mets were also ruled out because of his physical condition/ risks to brain. I had noticed an ulcerated mole on his torso which we thought coudl be melanoma, and went to a dermatologist, who removed three moles. All were positive melanomas and went off for BRAF test (still waiting). At the time of appointment, the ulcerated mole didn't look like a Mel, but was.

      Now one on his face has swollen and has started bleeding. I noticed another on arm has a scab. Dad claims to not pick at these but I have caught him doing just that. The Onc's nurse said to contact the dermatologist.

      What I am wondering is, if htere are more melanomas popping up, do we need to have them all removed? It would seem like we should remove as much as possible to reduce other growth and spread. I just don't know what is the routine with this sort of thing.

      We see the Mel specialist on Monday after the CT scan. Should find out about the BRAF tests, too. I am also waiting to hear back from that dermatologists office as to what she thinks. In the meantime would be interesred in your feedback.

      Thanks,

      DF

    Viewing 5 reply threads
    • Replies
        • November 2, 2011 at 4:01 pm
        justlittleoleme
        Participant

          Is he on any systemic treatment? I would think if he was they wouldn't take them off, just watch to see if they shrink due to the treatment.

          If he isn't, it would make sense to have them removed.  No reason to let 'em hang out and get more friends!

          • November 2, 2011 at 4:01 pm
          justlittleoleme
          Participant

            Is he on any systemic treatment? I would think if he was they wouldn't take them off, just watch to see if they shrink due to the treatment.

            If he isn't, it would make sense to have them removed.  No reason to let 'em hang out and get more friends!

            • November 2, 2011 at 4:01 pm
            justlittleoleme
            Participant

              Is he on any systemic treatment? I would think if he was they wouldn't take them off, just watch to see if they shrink due to the treatment.

              If he isn't, it would make sense to have them removed.  No reason to let 'em hang out and get more friends!

              • November 2, 2011 at 4:05 pm
              Jamietk
              Participant

                I am sorry to hear of your dad's diagnosis. Someone please correct me if I'm wrong, but this sounds ike these spots, especially the one on the face, are mets and not new primary melanomas. For that reason, I think the treatment would be determined by the Onc as part of the overall stage 4 treatment plan. I don't think having a derm remove them like you would a new suspicious mole is the route to take. Again, someone more experienced with stage 4, please correct me if I'm wrong.

                 

                  • November 2, 2011 at 4:18 pm
                  MichaelFL
                  Participant

                    I agree, sounds more like melanoma tumors and not new mole melanomas.

                    • November 2, 2011 at 4:59 pm
                    dearfoam
                    Participant

                      Thanks for your replies!

                      At least one she removed in October was described as In Situ, but I am not sure if that means it wasa seperate Melanoma or not – the dermatoligist (of all three) said they coudl be mets or new, but most likely mets. He has been on Temodar since May of this year. SInce things starte doff so bad to begin with, I never personally did an extensive inventory of all his moles. But it seems like there are more noticably suspicious ones now than before.

                      The office just called and said to wait and see what the Oncologist (Mel specialist) says Monday. They will be happy to help after he sees them. I think the derm's office is overflowing right now so they want to see if he thinks it is urgent.

                      My main question was if these moles present more options for the Melanoma to continue to spread or is it sorta useless like chipping at an iceberg to remove them? I guess it can wait til Monday.

                      I suppose I am a little anxious about his CT scan (chest/ab/pelvis) and test results that we will get next Monday. The thoughts of this stuff continuing to pop up even though he is on Temodar is discouraging. My gut tells me if these things are getting nasty/ not shrinking on his skin, they probably aren't behaving inside either. And then not knowing if he has another treatment option – for the Zelboraf, SRS, or anything – is hard to not think about.

                      -DF

                      • November 2, 2011 at 7:48 pm
                      Janner
                      Participant

                        The mole you mention that was "in situ" is a new primary.  In situ means it's confined only to the epidermis and has about a 100% cure rate.  Probably not likely to spread any time soon.  The real question are the other moles.  If the pathology lists them as a new primary (Breslow Depth, Clark's Level, etc), then yes, they probably should be removed.  You don't really want new sources of melanoma.  However, it's a judgement call in someone stage IV.  If these lesion are metastatic instead of new primaries, then systemic treatment is a better choice.  Much of this depends where your Dad is in his treatment.  An in situ is unlikely to change quickly – or even change his prognosis.  But if his disease is under control, then removing any new sources of melanoma would be to his advantage.  New primaries are NOT related to metatstatic disease – they are independent occurrences of melanoma.  The pathologist has to look at each biopsy to tell if it is a primary (simply stated:  grows from the top down) or a metastatic lesion (grows from the vessels up).

                        Best wishes,

                        Janner

                        • November 2, 2011 at 9:35 pm
                        dearfoam
                        Participant

                          Thanks for the clarification. When that office called to confirmthe biopsies were all melanoma, I was just glad we had something to test and didn't ask a lot of questions like Breslow depth etc. (It was also early and I had not had any coffee yet.) I think I will be able to get a paper copy of the report next week.

                          So if all three moles are being ested for BRAF, the in situ one might be a moot point, but if the others are positive, then we have a chance for Zelboraf. So many ifs!

                          Thanks,

                          DF

                          • November 2, 2011 at 9:35 pm
                          dearfoam
                          Participant

                            Thanks for the clarification. When that office called to confirmthe biopsies were all melanoma, I was just glad we had something to test and didn't ask a lot of questions like Breslow depth etc. (It was also early and I had not had any coffee yet.) I think I will be able to get a paper copy of the report next week.

                            So if all three moles are being ested for BRAF, the in situ one might be a moot point, but if the others are positive, then we have a chance for Zelboraf. So many ifs!

                            Thanks,

                            DF

                            • November 2, 2011 at 9:35 pm
                            dearfoam
                            Participant

                              Thanks for the clarification. When that office called to confirmthe biopsies were all melanoma, I was just glad we had something to test and didn't ask a lot of questions like Breslow depth etc. (It was also early and I had not had any coffee yet.) I think I will be able to get a paper copy of the report next week.

                              So if all three moles are being ested for BRAF, the in situ one might be a moot point, but if the others are positive, then we have a chance for Zelboraf. So many ifs!

                              Thanks,

                              DF

                              • November 2, 2011 at 7:48 pm
                              Janner
                              Participant

                                The mole you mention that was "in situ" is a new primary.  In situ means it's confined only to the epidermis and has about a 100% cure rate.  Probably not likely to spread any time soon.  The real question are the other moles.  If the pathology lists them as a new primary (Breslow Depth, Clark's Level, etc), then yes, they probably should be removed.  You don't really want new sources of melanoma.  However, it's a judgement call in someone stage IV.  If these lesion are metastatic instead of new primaries, then systemic treatment is a better choice.  Much of this depends where your Dad is in his treatment.  An in situ is unlikely to change quickly – or even change his prognosis.  But if his disease is under control, then removing any new sources of melanoma would be to his advantage.  New primaries are NOT related to metatstatic disease – they are independent occurrences of melanoma.  The pathologist has to look at each biopsy to tell if it is a primary (simply stated:  grows from the top down) or a metastatic lesion (grows from the vessels up).

                                Best wishes,

                                Janner

                                • November 2, 2011 at 7:48 pm
                                Janner
                                Participant

                                  The mole you mention that was "in situ" is a new primary.  In situ means it's confined only to the epidermis and has about a 100% cure rate.  Probably not likely to spread any time soon.  The real question are the other moles.  If the pathology lists them as a new primary (Breslow Depth, Clark's Level, etc), then yes, they probably should be removed.  You don't really want new sources of melanoma.  However, it's a judgement call in someone stage IV.  If these lesion are metastatic instead of new primaries, then systemic treatment is a better choice.  Much of this depends where your Dad is in his treatment.  An in situ is unlikely to change quickly – or even change his prognosis.  But if his disease is under control, then removing any new sources of melanoma would be to his advantage.  New primaries are NOT related to metatstatic disease – they are independent occurrences of melanoma.  The pathologist has to look at each biopsy to tell if it is a primary (simply stated:  grows from the top down) or a metastatic lesion (grows from the vessels up).

                                  Best wishes,

                                  Janner

                                  • November 2, 2011 at 4:59 pm
                                  dearfoam
                                  Participant

                                    Thanks for your replies!

                                    At least one she removed in October was described as In Situ, but I am not sure if that means it wasa seperate Melanoma or not – the dermatoligist (of all three) said they coudl be mets or new, but most likely mets. He has been on Temodar since May of this year. SInce things starte doff so bad to begin with, I never personally did an extensive inventory of all his moles. But it seems like there are more noticably suspicious ones now than before.

                                    The office just called and said to wait and see what the Oncologist (Mel specialist) says Monday. They will be happy to help after he sees them. I think the derm's office is overflowing right now so they want to see if he thinks it is urgent.

                                    My main question was if these moles present more options for the Melanoma to continue to spread or is it sorta useless like chipping at an iceberg to remove them? I guess it can wait til Monday.

                                    I suppose I am a little anxious about his CT scan (chest/ab/pelvis) and test results that we will get next Monday. The thoughts of this stuff continuing to pop up even though he is on Temodar is discouraging. My gut tells me if these things are getting nasty/ not shrinking on his skin, they probably aren't behaving inside either. And then not knowing if he has another treatment option – for the Zelboraf, SRS, or anything – is hard to not think about.

                                    -DF

                                    • November 2, 2011 at 4:59 pm
                                    dearfoam
                                    Participant

                                      Thanks for your replies!

                                      At least one she removed in October was described as In Situ, but I am not sure if that means it wasa seperate Melanoma or not – the dermatoligist (of all three) said they coudl be mets or new, but most likely mets. He has been on Temodar since May of this year. SInce things starte doff so bad to begin with, I never personally did an extensive inventory of all his moles. But it seems like there are more noticably suspicious ones now than before.

                                      The office just called and said to wait and see what the Oncologist (Mel specialist) says Monday. They will be happy to help after he sees them. I think the derm's office is overflowing right now so they want to see if he thinks it is urgent.

                                      My main question was if these moles present more options for the Melanoma to continue to spread or is it sorta useless like chipping at an iceberg to remove them? I guess it can wait til Monday.

                                      I suppose I am a little anxious about his CT scan (chest/ab/pelvis) and test results that we will get next Monday. The thoughts of this stuff continuing to pop up even though he is on Temodar is discouraging. My gut tells me if these things are getting nasty/ not shrinking on his skin, they probably aren't behaving inside either. And then not knowing if he has another treatment option – for the Zelboraf, SRS, or anything – is hard to not think about.

                                      -DF

                                      • November 2, 2011 at 4:18 pm
                                      MichaelFL
                                      Participant

                                        I agree, sounds more like melanoma tumors and not new mole melanomas.

                                        • November 2, 2011 at 4:18 pm
                                        MichaelFL
                                        Participant

                                          I agree, sounds more like melanoma tumors and not new mole melanomas.

                                        • November 2, 2011 at 4:05 pm
                                        Jamietk
                                        Participant

                                          I am sorry to hear of your dad's diagnosis. Someone please correct me if I'm wrong, but this sounds ike these spots, especially the one on the face, are mets and not new primary melanomas. For that reason, I think the treatment would be determined by the Onc as part of the overall stage 4 treatment plan. I don't think having a derm remove them like you would a new suspicious mole is the route to take. Again, someone more experienced with stage 4, please correct me if I'm wrong.

                                           

                                          • November 2, 2011 at 4:05 pm
                                          Jamietk
                                          Participant

                                            I am sorry to hear of your dad's diagnosis. Someone please correct me if I'm wrong, but this sounds ike these spots, especially the one on the face, are mets and not new primary melanomas. For that reason, I think the treatment would be determined by the Onc as part of the overall stage 4 treatment plan. I don't think having a derm remove them like you would a new suspicious mole is the route to take. Again, someone more experienced with stage 4, please correct me if I'm wrong.

                                             

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