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11/12/2017 2:33pm
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Hi my name is Wendy, I am a 45 yr old married mom to 4daughters who was diagnosed in August of 2017, with stage 3 melanoma on my left leg.  On November 2nd I had surgery to remove the rest of the tumor and the affected lymph nodes, also had a skin graft for the tumor site.  I just found out that 2 of the 3 lymph nodes they removed from my groin were now I go to my Drs next week to discuss what's next.  Needless to say I'm nervous, but am also looking for questions or things I should bring up to my surgeon.  I'm an going to ask about a PET scan and recommendations on oncologists, and what's the advantages to surgery vs the ultrasound testing every 3 months.  Just trying to be as informed as possible.  

ed williams - (11/12/2017 - 4:53pm)

Hi Wendy, here are a couple of links for Adjuvant treatments of melanoma. First one is from ESMO fall of 2017 results of current trials of drugs.   Second link is to New England Journal article comparing Ipi vs Nivo for stage 3 melanoma patients.

ed williams - (11/12/2017 - 4:58pm)

You might find these two on what to do about lymph nodes helpful,   second link is video of findings of study on MSLT-11 trial

ed williams - (11/12/2017 - 5:02pm)

Sorry about first link, not sure why it isn't available. If you do a google search for MSLT-2  findings, you should be able to find it. It was released in June 2017 just after ASCO. Best Wishes in your journey!!!Ed

ed williams - (11/12/2017 - 5:05pm)

Here is the link again, hopes it workes this time!!!

Bubbles - (11/12/2017 - 6:28pm)

Sorry you are dealing with this.  The 2 most important things you can do for yourself at this time are:

1.  Arm yourself with information (You are on your way to doing that!!!)

2.  Make sure you are seeing a melanoma specialist.

The links Ed shared are awesome.  Here is a primer of melanoma care I put together that may help break down the crazy:  

Here is the latest I posted re adjuvant care in particular:  

Here is an article that addresses ultrasound as follow-up:

Ultrasound-based follow-up does not increase survival in early-stage melanoma patients: A comparative cohort study. Ribero, Podlipnik, Osella-Abate, et al.  Eur J Cancer. 2017 Sep 7.

Different protocols have been used to follow up melanoma patients in stage I-II. However, there is no consensus on the complementary tests that should be requested or the appropriate intervals between visits. Our aim is to compare an ultrasound-based follow-up with a clinical follow-up.

Analysis of two prospectively collected cohorts of melanoma patients in stage IB-IIA from two tertiary referral centres in Barcelona (clinical-based follow-up [C-FU]) and Turin (ultrasound-based follow-up [US-FU]). Kaplan-Meier curves were used to evaluate distant metastases-free survival (DMFS), disease-free interval (DFI), nodal metastases-free survival (NMFS) and melanoma-specific survival (MSS).

A total of 1149 patients in the American Joint Committee on Cancer stage IB and IIA were included in this study, of which 554 subjects (48%) were enrolled for a C-FU, and 595 patients (52%) received a protocolised US-FU. The median age was 53.8 years with a median follow-up time of 4.14 years. During follow-up, 69 patients (12.5%) in C-FU and 72 patients (12.1%) in US-FU developed disease progression. Median time to relapse for the first metastatic site was 2.11 years for skin metastases, 1.32 for lymph node metastases and 2.84 for distant metastases. The pattern of progression and the total proportion of metastases were not significantly different in the two centres. No difference in DFI, DMFS, NMFS and MSS was found between the two cohorts.

Ultrasound-based follow-up does not increase the survival of melanoma patients in stage IB-IIA.

My read on that article is that US was not really the best choice for f/u in these Stage I and II melanoma patients...and I certainly don't think it would be the best idea for a Stage III patient.  However, that is something you can discuss with your doctor.

Hang in there.  Ask questions when you need.  There are many caring knowledgable peeps here.  Yours, Celeste


wmpado - (11/12/2017 - 8:31pm)

Wow, thank you so much for the awesome information.....very helpful and greatly appreciated 

momof4boys - (11/12/2017 - 9:33pm)

Im pretty biased as I was in the same boat as you 4 1/2 years ago. I did the clnd and have not recurred. I have scans this week so I'm hoping it stays that way. I did get lymphedema and will have that forever. I also did Ipi. - (11/14/2017 - 1:19pm)

Great results momof4boys. Would you please let me know for how long and frequency that you had ipi? Only 4 times or you also had maintenance doses during 1 or 2 year?

momof4boys - (11/14/2017 - 9:34pm)

Yes I was able to do it all including maintenance. So basically what for like a year, year and a half. I did 3mg and the only real side effect was itching which I controlled first with benadryl then a prescription later. So yeah, it wasnt bad at all. Fatigue the day of infusion. I have scans thur so hopefully nothing has changed.

Nashvillian - (11/14/2017 - 3:19pm)

Dx in July this year. Had surgery Stage 3b and now on Opdivo in Adjunctive Therapy. The owrst part has been the sirgery to remove 30 lymph nodes in my neck and it has not healed well. Other than that it has not been terrible.

Stage 3b, ipdivo failure, taf/mek currently . Starting 10/13/17