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Surgical Question
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Surgical Question

› Forums › General Melanoma Community › Surgical Question

  • Post
    • May 11, 2016 at 11:04 pm
    KeepHeadUp
    Participant

      Thanks for all of the insight on this board.  I am so inspired and amazed by the number of proactive, intelligent individuals posting and fighting here.  Thank you in advance for your time and expertise!  

       

      I am currently recovering from a right groin dissection for 3B melanoma, originally diagnosed on my lower back in 2007 as a think uneventful melanoma.  Unfortunately it came back.    Still have my little drain friend and am looking forward to losing that next week.  ; )  I am considering clinical trials and recently a melanoma specialist surgical oncologist has presented that in his opinion I need a dissection of my deeper nodes. That was not done by my surgeon.  I had only 7 nodes in my groin and 1/7 was positive for melanoma.  The original surgeon has indicated that he feels that not to be necessary at this time as nothing showed on the PET and only one node was positive and other nodes were clean.   Evidently the deeper nodes can be dissected using robotic surgery and it is much less invasive than in the past. Evidently there is a 15% chance of melanoma in the deeper nodes.  I am unsure about proceeding with the additional surgery.   Can anyone advise?  Are the deeper nodes a standard of care?  I have also heard mixed replies in regards to lymphadema, etc. assoc with deeper node dissection.  

       

      Thanks for sharing your expertise.  Getting conflicting opinions and feeling overwhelmed by the weight of these decisions.  

       

       

    Viewing 8 reply threads
    • Replies
        • May 11, 2016 at 11:07 pm
        KeepHeadUp
        Participant

          should read "thin, uneventful melanoma"  Should have written that differently… sorry for my typo…I do understand that ALL melanomas are quite eventful…  

          • May 11, 2016 at 11:07 pm
          KeepHeadUp
          Participant

            should read "thin, uneventful melanoma"  Should have written that differently… sorry for my typo…I do understand that ALL melanomas are quite eventful…  

            • May 11, 2016 at 11:07 pm
            KeepHeadUp
            Participant

              should read "thin, uneventful melanoma"  Should have written that differently… sorry for my typo…I do understand that ALL melanomas are quite eventful…  

              • May 11, 2016 at 11:58 pm
              BrianP
              Participant

                Most surgeons still recommend the CLND.  There was a study released last year out of Germany which claimed CLNDs do not improve longterm survival.  Europe seems to be moving away from CLNDs.  You are beginning to hear some experts question CLNDs here in the states but for now it still is the standard procedure for most cases.  I wouldn't be surprised if in a few years if it is done much less frequently.  Here is a discussion of the study.

                http://www.cancernetwork.com/asco-2015-melanoma/no-need-lymph-node-dissection-certain-melanoma-patients

                Brian

                • May 11, 2016 at 11:58 pm
                BrianP
                Participant

                  Most surgeons still recommend the CLND.  There was a study released last year out of Germany which claimed CLNDs do not improve longterm survival.  Europe seems to be moving away from CLNDs.  You are beginning to hear some experts question CLNDs here in the states but for now it still is the standard procedure for most cases.  I wouldn't be surprised if in a few years if it is done much less frequently.  Here is a discussion of the study.

                  http://www.cancernetwork.com/asco-2015-melanoma/no-need-lymph-node-dissection-certain-melanoma-patients

                  Brian

                  • May 11, 2016 at 11:58 pm
                  BrianP
                  Participant

                    Most surgeons still recommend the CLND.  There was a study released last year out of Germany which claimed CLNDs do not improve longterm survival.  Europe seems to be moving away from CLNDs.  You are beginning to hear some experts question CLNDs here in the states but for now it still is the standard procedure for most cases.  I wouldn't be surprised if in a few years if it is done much less frequently.  Here is a discussion of the study.

                    http://www.cancernetwork.com/asco-2015-melanoma/no-need-lymph-node-dissection-certain-melanoma-patients

                    Brian

                    • May 12, 2016 at 1:59 pm
                    Bubbles
                    Participant

                      I am sorry you are dealing with a recurrence. The clear answer regarding complete lymph node dissection is murky at best! Here is a link (with more links within) to some of the latest reports on several of the issues you are looking at:

                      http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/02/patients-wtih-microscopically.html

                      No matter what you decide about additional lymph node removal, with your recurrence and stage, I would be talking to my docs about systemic therapy. I would imagine that you qualify for ipi/yervoy that is FDA approved as adjuvant treatment for NED folks…should you wish to do it….as well as other clinical trial options.

                      i wish you my best. Celeste

                      • May 12, 2016 at 1:59 pm
                      Bubbles
                      Participant

                        I am sorry you are dealing with a recurrence. The clear answer regarding complete lymph node dissection is murky at best! Here is a link (with more links within) to some of the latest reports on several of the issues you are looking at:

                        http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/02/patients-wtih-microscopically.html

                        No matter what you decide about additional lymph node removal, with your recurrence and stage, I would be talking to my docs about systemic therapy. I would imagine that you qualify for ipi/yervoy that is FDA approved as adjuvant treatment for NED folks…should you wish to do it….as well as other clinical trial options.

                        i wish you my best. Celeste

                        • May 12, 2016 at 1:59 pm
                        Bubbles
                        Participant

                          I am sorry you are dealing with a recurrence. The clear answer regarding complete lymph node dissection is murky at best! Here is a link (with more links within) to some of the latest reports on several of the issues you are looking at:

                          http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2016/02/patients-wtih-microscopically.html

                          No matter what you decide about additional lymph node removal, with your recurrence and stage, I would be talking to my docs about systemic therapy. I would imagine that you qualify for ipi/yervoy that is FDA approved as adjuvant treatment for NED folks…should you wish to do it….as well as other clinical trial options.

                          i wish you my best. Celeste

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