Stage Three Options -- Complete Neck Dissection or Surveillance

Posted By
lkb
1/10/2018 2:42pm
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lkb
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Replies: 13

Many among us might find this discussion of interest.

http://www.nejm.org/doi/full/10.1056/NEJMclde1712449?query=featured_home...

Primary scalp lesion excised in October 2017; SLNB removed and revealed two positive nodes. Stage IIIA.

Hi IKB, so after you read the comparison did it change your thinking at all? What is interesting is that they picked one opinion from Dr. Ross and Dr. Balch who are both surgeons and the second opinion is from a Melanoma Oncologist from France. What would be interesting in my opinion would be to have them both along with other experts argue their views on a Onclive peer view. In my humble opinion since we are in the age of Immunotherapy drugs which use the human immune system to fight the Melanoma that it would make sense to leave the Lymph system intact as much as possible in order to have as many of those little nodes as possible to be able to activate T-cells. Best Wishes IKb in your journey!!!Ed

Here is a terrific website and webinar on STage III Options http://melanomainternational.org/webinar/2016/01/decision-making-for-mel...  by an expert doctor

Hi Anon, I love listening to Dr.Jason Luke talk about melanoma but this presentation from two years ago doesn't take into consideration all of the new data and approvals. The Melanoma world is moving fast and for stage 3 patients a lot has happened in the last two years. A few things come to mind like the MSLT-2 trial results, Ipi approval, Nivo approval and just yesterday Pembro. If you look at this link on Onclive and search under Melanoma or Melanoma + Immunotherapy many of the new approvals and research are discussed. Also for those with the Braf mutation here is new stage 3 findings. http://www.onclive.com/web-exclusives/fda-grants-adjuvant-dabrafenibtram...

there are two new approvals but it doesn't change the questions about full node dissection and whether taking these therapies is a good idea at 3a.  Throwing therapies at the disease isn't always the best idea,, but thanks for posting you should've done that in the first place instead of trying to undercut someone else's post.

Love being anon..

So Anon, can I call you Anon, is that ok with you? I hope so!!! The original point of the post is I think to show how different experts view the same patient. Maybe I am wrong on this point, maybe not. I will say it again, I love listening to Dr. Jason Luke talk about melanoma, and in the past I have given the same link out to new poster looking for general advice on staging. The journal article is very specific and is trying to challenge medical professional to think and they are trying to include the most recent adjuvant drug approvals and studies into their arguements. Just think how things will change for adjuvant melanoma patients when Pembro which allowed 3a patients into the study and the targeted therapy combination from the combi-AD trial get approved in the very near future!!! They would have to change this article to include the Braf status and posibility of getting Pd-1 drug vs Interferon which is still standard of care in many countries for 3a or observation. Consider also all the neoadjuvant trials that are happening as well and what that might mean!!! When it comes to Melanoma and your comment about "throwing therapies isn't always the best idea" makes me feel that you haven't had to face an Oncologist who is about to tell you if your scans show if your Melanoma has progressed or not!!! Feel free Anon to come out of the darkness to the light!!!Ed

I love me some Ed!!!  Your comment is on point.  FYI -this anon is the same anon that always posts the old news from MIF.  I could tell you who they are, but that would let my research techniques out of the bag!!  At any rate, they always have the same typo:  "STage"  Oh, well.  I think most folks at MPIP know they can look at MIF if they want to.  Hope you have a great weekend!  Love, c

MIF is the melanoma site that has the HONCODE designation.   You can trust they aren't shooting from the hip as they are the only site recommended by the National Cancer Institute.  And they don't have a blog about making cookies and melanoma that is called Chaotically????  that they promote constantly.  They also don't let people make personal attacks.  

I thought that anyone that is interested in the topic of having CLND or watch and wait based on New MSLT-2 porspective data might find this aim at melanoma presentation interesting. It was held in the fall of 2017 at University of Michigan.https://www.youtube.com/watch?v=p_T186r5gIE

 Talk about darkness.   Anger management is a good thing Ed.  Everyone here has a fake name it just isn't anon, actually anon is more honest than Bubbles, Melanoma Joe and on...

Hi Anon, I can't image why any one dealing with Melanoma would be prone to getting angry!!! I get the reason that new members use the Anon button etc etc. but when someone like yourself that has an agenda, to promote the Melanoma International web site on this forum, then yes it does piss me off!!! I like to able to click on a person name or fake name and see what their status is or what treatments they have had in the past before responding to their questions. Also, for those of us that have been lucky in our treatments to be around for a long time, speaking for myself, I find it very comforting to see the name who is giving advice because there is a trust level that develops over time. I know it might be hard for someone like you to understand but those of us that have been around here for awhile have seen posters come and go that try to sell products or promote treatments that they benefit from financially. So, I guess I have become a little protective of the site and when someone like yourself who uses the Anon title to hide your agenda, then I might come off as a being a little aggressive. ONe final thought is that when someone like Janner or Celeste or Jenn post here, there is a sense of trust that they have built up with the members over time, and members know that they have their best interests in mind. When, someone like you posts here, it makes me wonder, what is your agenda???Ed

The agenda is to point people to a site they can trust because it has the HONCODE designation and is moderated.  Sharing resources isn't a competition.  there is nothing sold, information is not a product.  Check out what HONCODE means. https://www.healthonnet.org/HONcode/Conduct.html?HONConduct286972

It provides a safe place to search any health topic.  It is very hard to get that designation.  There's no advertising allowed unless it is made transparent.  there is no asking for a donation before you gain access.   That's the agenda, moderation and  transparency.  Safety for patients to be shared.

Speaking strictly from my own experience, the CLND I had at stage 3 and the difficult recovery from it has been my biggest challenge.  I had nerve damage which has led to chronic pain as well as lymphedema.  I understand that no surgery is without the possibility of unintended consequences.  

At the time it is what was recommended so I have no regrets about it, but if it were no longer the standard I would think hard about the decision knowing what I know now.  I did progress to stage 4 despite the nodes being removed and had combo therapy which has led to NED for the past 5 months.  However, I had side effects from immunotherapy too as so many do- I'm now on synthroid and I had severe colitis.  So there are issues with either approach, making the point that the therapies are not at all benign.

Also, aren't people are entitled to thier opinions and even their agendas if they have them, and to be anonymous if they want to?  I have stayed away from here a lot because of this kind of treatment of people, and I just now came back to see what was up.  I'll probably stay away more now.  Posting anon because I don't want hating on me!