Anal Melanoma: Wide Local Excision vs. Full APR Resection
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Anal Melanoma: Wide Local Excision vs. Full APR Resection

› Forums › General Melanoma Community › Anal Melanoma: Wide Local Excision vs. Full APR Resection

  • Post
    • September 28, 2016 at 1:43 am
    Cindyco
    Participant

    After several consultations, and in the interest of time, it looks like my mother will have her anal melanoma mass and inguinal lymph node resection removed by a three surgeon team at Kaiser.  These surgeons are part of the melanoma clinic in Riverside and believe in a more aggressive approach.  It also turns out that the Chief of Surgery at Riverside is currently battling melanoma as well and is therefore very supportive of melanoma treatment.

    The surgeon examined her today and told us that since her mass is higher in the anal canal than previously thought, they can possibly remove it locally instead of performing the full APR resection.  Since APR doesn't significantly extend a patient's life, he said that it would be our decision.  However, this would leave behind a suspicious mesorectal lymph node.  She is frightened about the APR resection, and we don't want to put her through it if it significantly decreases her quality of life.  On the other hand, even a remote chance is something to consider.  Leaving a suspicious mesorectal lymph node behind is like a bomb waiting to explode. 

    I wrote to Dr. Ribas at UCLA and he told me that in cases where the disease hasn't spread beyond the pelvis, aggressive resection is the way to go.  Has anyone faced a similar decision?

Viewing 2 reply threads
  • Replies
      • September 28, 2016 at 7:56 pm
      debwray
      Participant

      Hi Cindy,

      Removing the main tumour is a no brainer..the question is what e!se is also removed. 

      Could you get the docs to spell out pros cons and risks.

      It is probable that with a tumour of 4cm the me!anoma cells may be in the nearby lymph nodes .

      Cutting them out might prevent more spread…but might not as it may have already got beyond the lymph system.

      So you could go for the bigger surgery but in spite of this still end up with problems elsewhere.

      So you could opt for the equivalent of a lumpectomy with a more systemic treatment on top to deal with lymph nodes etc.. or maybe immunotherapy plus targeted radiation to the area ?

      I am not qualified to advise but can only say the sort of things you could ask.

      There are a number of options and surgeons tend to favour the surgical procedure . Medical oncologists may have a slightly more nuanced view. Keep asking questions. Find out how many of this type of surgery they conducted in the last year…are they an expert in this procedure. 

      Ask about the side effects from the procedure.. Lymphoedema  and other quality of life issues.

      You might find more information on forums dealing with bowel cancer about the personal impacts of the procedure as this is not the most common site / surgery for melanoma.

      Good luck.. It is important your mom understands the choices she is making and the possible consequences  as this makes it easier to come to terms with probable issues as you have decided to make the trade off.

      With the best of wishes to you and your mum,

      Deb

       

       

      • September 28, 2016 at 7:56 pm
      debwray
      Participant

      Hi Cindy,

      Removing the main tumour is a no brainer..the question is what e!se is also removed. 

      Could you get the docs to spell out pros cons and risks.

      It is probable that with a tumour of 4cm the me!anoma cells may be in the nearby lymph nodes .

      Cutting them out might prevent more spread…but might not as it may have already got beyond the lymph system.

      So you could go for the bigger surgery but in spite of this still end up with problems elsewhere.

      So you could opt for the equivalent of a lumpectomy with a more systemic treatment on top to deal with lymph nodes etc.. or maybe immunotherapy plus targeted radiation to the area ?

      I am not qualified to advise but can only say the sort of things you could ask.

      There are a number of options and surgeons tend to favour the surgical procedure . Medical oncologists may have a slightly more nuanced view. Keep asking questions. Find out how many of this type of surgery they conducted in the last year…are they an expert in this procedure. 

      Ask about the side effects from the procedure.. Lymphoedema  and other quality of life issues.

      You might find more information on forums dealing with bowel cancer about the personal impacts of the procedure as this is not the most common site / surgery for melanoma.

      Good luck.. It is important your mom understands the choices she is making and the possible consequences  as this makes it easier to come to terms with probable issues as you have decided to make the trade off.

      With the best of wishes to you and your mum,

      Deb

       

       

      • September 28, 2016 at 7:56 pm
      debwray
      Participant

      Hi Cindy,

      Removing the main tumour is a no brainer..the question is what e!se is also removed. 

      Could you get the docs to spell out pros cons and risks.

      It is probable that with a tumour of 4cm the me!anoma cells may be in the nearby lymph nodes .

      Cutting them out might prevent more spread…but might not as it may have already got beyond the lymph system.

      So you could go for the bigger surgery but in spite of this still end up with problems elsewhere.

      So you could opt for the equivalent of a lumpectomy with a more systemic treatment on top to deal with lymph nodes etc.. or maybe immunotherapy plus targeted radiation to the area ?

      I am not qualified to advise but can only say the sort of things you could ask.

      There are a number of options and surgeons tend to favour the surgical procedure . Medical oncologists may have a slightly more nuanced view. Keep asking questions. Find out how many of this type of surgery they conducted in the last year…are they an expert in this procedure. 

      Ask about the side effects from the procedure.. Lymphoedema  and other quality of life issues.

      You might find more information on forums dealing with bowel cancer about the personal impacts of the procedure as this is not the most common site / surgery for melanoma.

      Good luck.. It is important your mom understands the choices she is making and the possible consequences  as this makes it easier to come to terms with probable issues as you have decided to make the trade off.

      With the best of wishes to you and your mum,

      Deb

       

       

Viewing 2 reply threads
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