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Axillary Lymph Node Dissection

Forums General Melanoma Community Axillary Lymph Node Dissection

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      After reading the PET scan, my surgeon consulted with the oncologist and decided to move forward with the dissection (reduce tumor burden).  The PET showed activity in the left arm pit but nothing else (regional)  The surgeon was scheduled for vacation but came in to do the dissection as he said this was more important.  So two weeks after the biopsy they went in Tuesday and removed the lymph nodes.  I thought they would cherry pick the lymph nodes that lit up so I asked about margins.  He said they will remove a section of lymph nodes and surroundng tissue and let the pathologist pick out the lymph nodes.  He said margins don't apply here like in breast cancer.  His analogy was taking out a slice of pizza and having the pathologist pick out the pepperoni.  We met the next day for discharge and he said don't be surprised if there was extensive cancer in this region.  In other words, some of the other nodes will most likely have cancer cells even though they did not  lite up on the PET.  I now meet with the oncologist in 10 days  to decide the appropriate follow-up treatment.  My BRAF was still being analyzed (over two week now). 

      I'm impressed with the communication between the surgeon and the oncologist (he is a melanoma specialist).  It feels we are moving at lighting speed and I hope we are making the right decisions.

      He said to expect some numbness in the arm in a week or so followed by some nerve pain as they try to repair themselves.  Small price to pay if we can contain this beast. 

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          1) BRAF should be back in the next few days. 

          2) Ask if they would be willing to check Tumor Mutational Burden and PD-L1 expression. Neither are mandatory, but can inform your likelihood of responding meaningfully to Nivolumab or Pembrolizumab monotherapy. Many academic oncologists won't take these factors into account, but some will, and if they will agree to check them, then you will have that option as well. 

          3) Best of luck! Hoping for the best!

            ed williams

              Hi majahops, both tests (tmi and Pd-L1)would be helpful if a patient had lung cancer or colon but doesn't really change anything in the decision making process for melanoma as to what treatment option to persue. The trials have kept data on Pd-L1+ status and it does show higher response rates for positive patients but it is not black or white more of a gray area do to the fact so many pd-L1- patients respond in melanoma. Academic centres might look at both as a matter of routine research but very unlikely to happen in non academic hospitals. There is a lot going on in the field of hot vs cold tumors and hopefully soon oncologist will be able to know based on tumor specimen, if they should go with Ipi/Nivo or just a monotherapy pd-1 drug but we are not quite there yet. Welcome to the forum!!! What is your melanoma status if you don't mind me asking?

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