Lymph node dissection decision

Posted By
KDS
5/2/2014 2:30pm
View other posts by
KDS
Activity
Replies: 8

Hello all.  My husband recently had surgery to remove a 1.1 mm non-ulcerated melanoma on his leg - WLE and SNB (groin).  Very few cells (approx. 10) were found  microscopically in the sentinel node. PET was clear. Stage IIIA - T2a, N1a, M0. Now the decision is whether or not to do a full regional lymph node dissection in the next couple of weeks.  The medical oncologist says the odds are low (6-10%) that the other nodes are cancerous, but since he is in good health and relatively young (48) it might be worthwhile to do the full groin excision. The surgical oncologist doesn't think the risks (lymphedema, etc.) outweigh the benefit.  

If anyone else who experienced this situation would share their experience and outcome we would appreciate it.

Kath

Hi, sorry to hear of your husband's diagnosis.  I had the same decision to make, you can look back at my profile for details.  I chose to go forward with the complete removal of the lymph nodes.  A couple differences.  1) 2 of my 4 nodes had microscopic melanoma and 2) it was under my arm.  I strongly suspect lymphedema is much easier to deal with in the arm than in the leg AND HE WILL HAVE LYMPHEDEMA.  I still  happy I did it, for my own piece of mind, but it is not for everyone.  Lymphedema is manageable is you get on it right away and go to a certified massage therapist who specialized in it.  If you try to ignore it, it will cause you pain and aggravation.  If your husband is not one who likes to ignore thing than maybe he should reconsider having a complete lymph node dissection.

 

Good Luck,

Mary

Life is too short to be anything but happy. Falling down is a part of life, getting back up is living.

Hey Kath,

went through the same decision process in late 2011 after being diagnosed with IIIA (2 positive nodes with micro-mets).  My surgeon at MSKCC gave me two options: 1) monitor with ultra sound and 2) CLND in my left groin.  I went with the CLND after deciding I wanted to be as aggressive as possible.  The surgery went well even though three weeks later I wound up back at Sloan for 10 days to clear up a post op infection. After all this, I wore my compression stocking dutifully for about four months other than when I slept and exercised.

i haven't worn it since, work out regularly (including running, other cardio) and have had no noticeable lymphadema.  This is not to say there were no lingering side effects.  Mostly it's numbness near my upper thigh and ankle/calf near my WLE site.  I'm glad I did it.  There is risk and it's a personal decision with no right or wrong.  Just wanted to share my experience.

 

good luck!

Im 43. I am also stage 3A. In November 2012 i had the SNB. I had 3 groin nodes taken(2on left side and 1 on right). All three came back with microscopic. December 2012 I had  a bilateral inguinal node dissection. Having it done on both sides was rough. Recovery was very slow and I do have lymphedema. I wear my garment anytime I'm not home with my feet up. I hate the garment and I hate the lymphedema. But, I have no regrets about doing the surgery. My son was 1 1/2 at the time. And I had 3 of 3 nodes positive. I felt I HAD to do the surgery.

While the lymphedema sucks, it is manageable. I work, run, hunt, fish, golf, hike, play softball, play on the floor with my son, pretty much everything I did before. Yes, it is a little more difficult because of the garment, but still doable. 

My wife is now pregnant with a little girl. I left my job the end of last year and started my own business this year. I'm telling you this because even though having this surgery was tough and I've had challenges because of the lymphedema, I'm pretty sure that I could not have gone forward with my life looking forward to the future and enjoying the present if I hadn't had the surgery. I think I would have been consumed with concern about what might be going on inside my body wondering if I'd missed the chance to have this cancer completely removed from my body.

Just my experience and thought process. Hope it can help in some way. Good luck with your decision.

Thandster

(1 Peter 5:7 NLT). Give all your worries and cares to God, for he cares about you

KDS - (5/3/2014 - 12:39am)

Thank you all so much.  This is all very overwhelming, and it helps so much to hear from you all who have been through it. Thank you for your compassion and kindness.  He is leaning toward the watch/wait/ultrasound route. I will post an update when he decides. I'm sure we will have more questions as we navigate through this.  

Kath

Sorry you are having to face a tough decision.  Here is my synopsis of a recent study:

Lymph Node Test a Good Strategy for Melanoma: Study.    Maureen Salamon.
HealthDay Reporter.  2/12/2014.  Source:  New England Journal of Medicine, Faries and Balch.

"The study, initiated in 1994, randomly assigned about 2,000 patients to two groups.  The observation group had their [initial] lesion removed and their lymph nodes OBSERVED for recurrence, at which time they were removed.  The biopsy goup underwent lesion removal and a sentinel node biopsy, with immediate lymphadenectomy if melanoma was in the sentinel node."

Patients with intermediate-thickness melanoma lesions, who had their lymph nodes removed after the sentinel node tested positive, were 44% more likely to survive their melanoma, said Dr. Mark Faries (Director of melanoma research at John Wayne Cancer Institute, CA)."

"It makes sense:  Those who were not treated up front had their melanoma spread from the sentinel lymph node to the other lymph nodes in the area, [which can facilitate] a spread throughout the body," Faries said.  "This study provides concrete evidence that everything we had assumed about the sentinel node procedure...and lymph node treatment is true."

In the study's biopsy group, sentinel node results were the most important predictor for 10-year survival...in patients whose melanoma lesion was considered thick or intermediate. Disease free survival rates over 10 years were significantly better in the biopsy group in patients with intermediate lesion depth (71% vs 65% in the observation group) and at rates of (51% vs 41%) in patients with thick melanoma lesions.  Removing all the lymph nodes from an area of the body can result in lymphedema in some patients. But, with the survival rate improvements found in this study, the risk can be supported.

"If we know there's an increase for leg or arm swelling, we can justify [node removal]more to the patient if it increases survival, " Balch (Professor of surgical oncology, University of Texas, Dallas) said.  "This is the largest study ever done on this subject, and it's multinational with the longest follow-up.  It's really a seminal work."

It's a tough decision, but I hope this helps.  There is also "my take"  here - if you are interested:  http://chaoticallypreciselifeloveandmelanoma.blogspot.com/2014/02/lymph-node-removal-after-superficial.html

Wishing you both my best.  Celeste

 

chaoticallypreciselifeloveandmelanoma.blogspot.com

KDS - (5/3/2014 - 2:51pm)

Thank you Celeste. I had not seen that study, good information.  

Kath

Kath,

Your husband's situation is virtually identical to my wife's.  She, too, is stage IIIA.  She just had the clinical trial minimally invasive (laproscopic) version of the lymph node dissection (left groin) done at Duke University on April 14th.  She was able to return to work on the following Tuesday.  She actually felt well enough to return sooner, but wanted to play it safe.  Part of the trial involves periodic visits to have her leg measured for comparison to pre-surgery.  She had her first post-op follow up visit on the 28th, where they checked on the drain and gave us the pathology report (all clear).  Her only complaints so far have been a light numbness in areas, and tightness in her leg.  Pain, for her, was manageable with regular Tylenol after the first day or two.  Right now she is ending her 3rd week with the JP drain, and discharge levels are still too high to have the drain removed.  She also had a slight infection at the drain site, and is now on antibiotics to clear it up.  Dr. Tyler at Duke did mention that the drain time with the lapro surgery was typically longer than with the open incision surgery.  The question of whether or not to have the surgery was an easy one for her to make, and I'm glad that she had the lapro surgery done instead of the open incision.  I don't know where you are located, but I think I would talk to your surgical onc about the lapro surgery to see if it is available.

Les is seeing some slight swelling in her leg,down to her ankle and into her foot, along with the numbness and tightness I already mentioned.  She said that the numbness is kinda like it went about half-way asleep, but without the tingling.  Once the drain is out she will be getting back into her exercise again to see if that will help keep the lymphedema at bay.  She has not been fitted for a compression garment yet, but we will ask about that when we go back for the next visit.

Dave

KDS - (5/3/2014 - 2:49pm)

Thank you Dave- great information, we will look into lapro. Wishing your wife a speedy recovery.  

Kath