My husband's situation

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5/5/2014 10:14pm
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Replies: 5

My husband is 84 years old.  In February, he was diagnosed with lentigo maligna melanoma on his arm and had an excision by the dermatologist.  In March or April, he had a full skin exam and three spots were biopsied.  One large spot on his abdomen came back with melanoma at a depth of 0.8 mm.  I asked the Nurse Practioner to read the biopsy report to me but she didn't seem to want to do this.  The dermatologist has referred him to a surgical oncologist and the NP said the surgeon may want to do a SNB.  We meet with the surgeon on Wednesday.

Of course I am very worried.  First, the NP did not remove the entire lesion.  Part of the brown mark is still on his skin.   Could the entire lesion actually be deeper than what the pathology report said?  Also, I'm worried that two melanomas discovered so near in time might indicate some sort of spread.  What do others think?

I'm also afraid that the surgeon might not want to be aggressive enough because of my husband's age. On the other hand, I don't want him to suffer through a bunch of painful procedures and treatments either.

I've been lurking on this site for a while and am very grateful for it.  I realize that this is small potatoes compared to what others are so bravely facing but I am still terrified - mostly of the unknown.

 

 

Janner - (5/5/2014 - 11:13pm)

My Dad was first diagnosed at age 81.  Age does play a factor here.  However, you have a say in how aggressive or not aggressive you want them to be.  My Dad's docs at the VA were going to do everything according to standard protocol, but that didn't fit in with my Dad's wishes.  I had to go to bat for him to have them do what my Dad wanted.  Least treatment possible to get the most bang for the buck essentially.

First off, the lesions are unlikely to be related.  The pathology wouldn't have given a depth on the second one but said "metastatic disease" if that is what they thought.  Metastatic disease would be characterized differently in pathology.  As for the remaining pigmented area, the depth would not change as they generally try to get the most dense area in a biopsy.  But that isn't 100% and yes, it could be deeper if the margins were not clear.  (Get a copy of both pathology reports for your own records). 

My questions for you are similar to what I went through with my Dad.  If the SNB is positive, would your husband want to have the lymph node dissection?  With a lesion on the abdomen, this could drain to either/both groin areas or some abdominal areas or even the armpits.  Would your husband want to go through the surgery to remove nodes from the affected lymph node basin(s)?  This is major surgery and can have complication including swelling/lymphedema.  If he were to have the lymph node dissection, would he consider doing treatment at stage III?  Currently, Interferon is the only approved treatment.  It doesn't really affect overall survival and I know I wouldn't have put my Dad on it for anything.  It affects quality of life way too much.  There aren't a lot of other options.  At 84, he might not qualify for any clinical trials.  Age or other conditions can be disqualifying factors.  You'd have to look for those types of things.  For me, I looked at what treatments my Dad would qualify for if he had the surgery, what the surgery could mean for quality of life and then I worked backwards on what really made sense for my Dad. My Dad's lesion was much deeper (2.22mm) and he did the minimum he could in the way of treatment.  He recently passed away at age 89.  Maybe doing some more surgery or treatment might have extended things, maybe it would have made quality of life much worse for him.  There is no second guessing, you just decide what really makes the most sense to you - regardless of what the doctor's say.  This is HIS decision, no one elses.  If I can help at all, please let me know.  (Go to my profile and send me an email from there).

 

 

Thank you for responding!  We know so little about the pathology report that we'll have to see what the doctor says tomorrow.  Personally, I am almost as hesitant about the thought of a lymph node dissection as I am with the thought of interferon.  Both sound like a lot of pain for just a little gain.  The upside to the SNB would be the comfort if it were negative.  My husband just played nine holes of golf this AM and has plenty of life left in him.  It will entirely up to him.  I am just very very worried.  It helps to talk about it with someone who understands.

 

 

 

Janner - (5/6/2014 - 4:39pm)

Feel free to email me (janrguard-mpip@yahoo.com) either before or after your appointment.  Get pathology reports!  I know a lot about this stuff in general (long time melanoma survivor) and then I went through all this with my Dad.  My Dad was really active at 84, too.  He was doing ok until he fell of a bicycle at about 85 and broke his femur.  So I understand where you are coming from.

washoegal - (5/6/2014 - 11:03pm)

Janner is probably the most knowledable in this situation but being stage 3a I think I can add a few things.  First, remember it is you right to have you medical reports.  So make sure you get them!  Second, A SNB really isn't too bad.  It's out patient surgery and if you come out negative you'll feel a whole lot better.  You must have it done now, you can't go back late and have it done.  Finally, if you have positive results and they suggest anything further remember you have time to collect your thought and get information.  You don't have to make a decision right away. 

Take notes and try to remain calm.  Generally the older you are the slower growing this cancer is.

Good Luck,

Mary

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

Thanks so much to both you and Janner.  I have my fingers crossed for a positive conversation with the surgeon this morning!