Saturday, February 15, 2014

Lymph node removal after superficial melanoma do or not to do????

My TWO primary melanoma lesions (first to my right back - 0.61mm) and later to my left forearm (0.5mm) were technically thinner than the depth indicating the need for a sentinel node biopsy.  However, since I was more of the bent to...get that shit out of there....I pushed for it anyway.  I feel it was a good thing I did.  After my first primary, a node in my right axillae was indeed positive for micrometastasis.  I had a complete right axillary lymphadenectomy done with the removal of 16 additional nodes, none of which were positive.  However, I feel certain I would have dealt with spread very soon after that initial lesion had I not taken the steps I did.  As it was, I was disease free until almost 5 years later, when I had the second primary and pre-emptively had all the nodes (13) in the left axillary basin removed.  None were positive.  Luckily, I have never developed lymphedema in either arm.  Unluckily, I obviously progressed to Stage IV with lung and brain mets three years after the last superficial lesion.  Perhaps this is easier for me to say since I did NOT develop lymphedema, but I am glad I had the complete lymphadenectomies done and really do not think I would be here today had I not.  For what it's worth....

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 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 if you are being faced with it.   - c

No comments:

Post a Comment