Should I have additional testing/scans??

Posted By
jetdoctor67
11/13/2017 1:59pm
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Replies: 6

Hello All,

I was recently diagnosed (Sept 8, 2017) with nodular melanoma on my left ear (size 0.4cm, depth .6mm) from the dermatology pathology report. I had a WLE and SNLB on Oct 25, 2017 where 10 lymph nodes were removed.  I received the pathology report which said the tumor was actually 1.5mm deep.  The good news is that no traces of metastases was identified in any lymph nodes.  My final pathologic staging is (pTNM) pT2a,N0.  My doctor (plastic surgeon) has not recommended any further treatment or scans.  My question is should I request or see an oncologist and/or request a chest x-ray and CT scan if for no other purpose to have a baseline if more melanoma is diagnosed in the future.  I welcome any suggestions or comments.

Thank you all,

Terry

I would encourage you to see a medical oncologist and to push for scans.

My wife had a WLE/SLNB in December 2016.   Margins were clear.   Nodes were clear.   PET scan was clear.   Fast forward to July of this year and I took her to the ER as she was dizzy (about two weeks before her next scheduled PET scan).   ER did a MRI and found two brain mets.   They had not done a MRI on her in December, so brain was not evaluated.   She has had craniectomy, Gamma Knife, and is currently on Ipi/Nivo and is doing well, but the diagnosis of brain mets was quite a shock.  She had only seen a surgical oncologist in December, and the ER doctor was disbelieving that she didn't have a regular medical oncologist for regular follow ups.

It doesn't hurt to try but you may not be able to have a CT scan - at least that insurance will pay for.  For stage 1b, scans aren't usually done.  So convincing insurance to do a baseline on early stagers isn't likely unless a doc has reason to suspect something.  Chest X-Ray is certainly cheaper and easier to justify.  Some oncologists don't always follow early stagers either, but hey, you lose nothing by trying.

Anonymous - (11/14/2017 - 10:34am)

You need melanoma specialist, and they will recommend what to do. No scans for stage 1. The insurance is not going to pay for it.

It can't hurt to push for a CT, but unlikely you'll get most docs or insurance to do it. At the very least, finding a really good dermatologist  would be my top priority. A derm who has focus on skin diseases... not cosmetic practices. You need close monitoring, not a facial. If you can get a GP to order up a chest xray (lungs are one of the most common places for internal metastasis) once or twice a year, that'd be an extra bonus for vigilance.  

My vote is to establish a relationship with an onc specialized in melanoma.  When I was 1B, I initially had skin checks and x-rays/LDH every 3 months - then went down to 4-6 months.  While I personally detected a lump (so not actually as a result of clinical monitoring) having a relationship and specialized center was important for quick action when there was a problem.

  Hopefully you will never advance from your current stage, but melanoma should not be taken lightly!

- J.

Thank you everyone for your comments and suggestions it is very much appreciated.  Tried to set up an appointment with a melanoma Oncologist and was turned away because I'm currently cancer free.  Told they don't do prevention.  Have a follow up appointment with my plastic surgeon Tuesday and see if he can do anything or I will see my GP and see if he can order a Chest x-ray at least.  Frustrating.  Once again Thank you.