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Suggest treatment for melanoma

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Posted on Fri, 12 Sep 2014
Question: Do you have a melanoma specialist?
Need second opinion on my treatment.
doctor
Answered by Dr. Monish De (11 hours later)
Brief Answer:
Sentinel lymph node biopsy recommended

Detailed Answer:
Hi

The standard treatment for melanoma is excisional biopsy.

A subsequent wide and deep excision is required to provide adequate tumour free margins as melanoma has known propensity for local recurrences.

A 1 cm tumour free margin for melanomas less than 1 mm in thickness and 1 to 2 cm margins for deeper primary lesions is recommended.

A setinel lymph node biopsy is advised as it reduced relative risk of recurrences at any site by 26% and reduced absolute chance of recurrences locoregionally from 15.6% to 3.4%.

Though it does not improve life expectancy i would recommend sentinel node biopsy as those with positive sentinel node had a worst outcome than those with negative sentinel node biopsy.

Hope i have answered your query.

Regards

DR De
Above answer was peer-reviewed by : Dr. Yogesh D
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Follow up: Dr. Monish De (22 hours later)
"A setinel lymph node biopsy is advised as it reduced relative risk of recurrences at any site by 26% and reduced absolute chance of recurrences locoregionally from 15.6% to 3.4%."
I don't understand how the biopsy of the sentinel node reduced risk of recurrences. Do you mean there is reduced risk of recurrence if the sentinel node is removed and the surrounding lymph nodes removed.. assuming it is positive for metastasis? And why wouldn't this have survival benefit if the mets in the nodes were removed early?
Thank you. I have reviewed a lot of the literature and see conflicting data on this point. I am a practicing physician in XXXXXXX I did call a dermatologist friend at USC and he said their practice would not recommend the biopsy either.
Thank you and I appreciate your opinion and want to be sure I understand you.
doctor
Answered by Dr. Monish De (3 hours later)
Brief Answer:
Surgical removal of melanoma

Detailed Answer:
Hi

I would recommend setinel lymph node biopsy in patients with melanoma tumors of intermediate thickness that is between 1 and 4 mm.

It is very useful for identifying small nearby metastases in these patients, who account for about one-third of all melanoma cases.

I would not recommend setinel lymph node biopsy in your case as your melanoma is only 0.94 mm thick.

A setinel lymph node biopsy can be used as a diagnostic staging test to determine the pathologic status of the regional lymph nodes and accurately identifies the presence of nodal metastasis.

The presence of a positive Sentinel lymph node is the single most important prognostic factor in determining the likelihood of survival.

In my view patients should be offered the option of Sentinel lymph node biopsy, when appropriate, to determine the status of the regional lymph nodes. This provides the opportunity for early therapeutic lymph node dissection, for which there is evidence of benefit in node-positive patients.

Furthermore, those patients identified with positive Sentinel lymph nodes are then eligible for adjuvant therapy with interferon alfa-2b, which is still the only Food and Drug Administration approved adjuvant therapy for melanoma and is considered by many to be the standard of care and the reference treatment against which all other adjuvant therapies should be compared.


It may only be considered in thin melanomas like yours only if it has certain high-risk factors, such as an ulcerated tumor or rapidly dividing cancer cells which u are not having.

Thin melanomas like in your case are the most common form of melanoma, and can usually be cured through surgical removal by wide excision of the primary tumor.

Regards

DR De


Above answer was peer-reviewed by : Dr. Bhagyalaxmi Nalaparaju
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Follow up: Dr. Monish De (31 hours later)
My melanoma is nodular and amelanotic. Since it was only .94mm in depth, should my follow up be any different from a superficial spreading melanoma of the same depth? I understand I have the most aggressive type. I think my melanoma falls in the 10% to 15% of all melanomas.
Thank you. This is my last question.
Sleepless in XXXXXXX with a young son.
doctor
Answered by Dr. Monish De (34 minutes later)
Brief Answer:
six monthly follow up for five years

Detailed Answer:
Hi

Since your melanoma is nodular and amelanotic follow up intervals are preferably six monthly for five years and yearly thereafter.

Follow up check up should include checking of the scar where the primary melanoma was removed , a feel for the regional lymph nodes, general skin examination and a full physical examination.

No tests are thought necessary for healthy patients who have remained well for 5 years or longer after removal of their melanoma.

If you have no more clarifications then please rate the answer and close the thread.

Regards

DR De







Above answer was peer-reviewed by : Dr. Vinay Bhardwaj
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Dr. Monish De

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Practicing since :2004

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Suggest treatment for melanoma

Brief Answer: Sentinel lymph node biopsy recommended Detailed Answer: Hi The standard treatment for melanoma is excisional biopsy. A subsequent wide and deep excision is required to provide adequate tumour free margins as melanoma has known propensity for local recurrences. A 1 cm tumour free margin for melanomas less than 1 mm in thickness and 1 to 2 cm margins for deeper primary lesions is recommended. A setinel lymph node biopsy is advised as it reduced relative risk of recurrences at any site by 26% and reduced absolute chance of recurrences locoregionally from 15.6% to 3.4%. Though it does not improve life expectancy i would recommend sentinel node biopsy as those with positive sentinel node had a worst outcome than those with negative sentinel node biopsy. Hope i have answered your query. Regards DR De