MRF-Logo2019-Horizontal-RGB
Baffled – Update on Brother-in-Law with MUP
REGISTER
The information on this site is not intended or implied to be a substitute for professional medical advice, diagnosis or treatment. Content within the patient forum is user-generated and has not been reviewed by medical professionals. Other sections of the Melanoma Research Foundation website include information that has been reviewed by medical professionals as appropriate. All medical decisions should be made in consultation with your doctor or other qualified medical professional.

Baffled – Update on Brother-in-Law with MUP

› Forums › General Melanoma Community › Baffled – Update on Brother-in-Law with MUP

  • Post
    • October 21, 2014 at 2:24 am
    Girl52
    Participant

      Got message from sis tonight: surgeon says BIL's lymph nodes clear (nothing said about WLE tissue yet). Yay! What does it mean to have pathology of metastatic melanoma with clean nodes? What would staging be here? And if primary remains unknown, could this mean there's still something in there somewhere that could pop up? Does anyone know where further testing/treatment/watch-wait goes from here in a case like this? Does this depend on results of WLE (e.g., satellite lesions, in-transit, etc.)?  Thank you for any insight.

    Viewing 5 reply threads
    • Replies
        • October 21, 2014 at 3:42 am
        Janner
        Participant

          Just like the surgeon said, it wouldn't surprise him if there was melanoma or if there wasn't melanoma in the nodes.  Nodal disease doesn't change much in BIL's case.   In-transits are stage III, just as I've said before.  And yes, stage III means "systemic" disease (no longer localized) and that there could be other microscopic melanoma elsewhere….. or NOT.   His treatment options are the same as any other stage III individual:  watch, Interferon, clinical trial.  Those are the ONLY options for stage III – it doesn't matter that he had an unknown primary and others have nodal disease.  There are no other methods of testing.  Nothing depends upon the WLE – he's still stage III.   So, he gets to choose his treatment options, see the derm for periodic skin checks and possible scans (again, depends on doctor and institution).  That's it. 

          You can check out his staging here:  http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-staging

          As I see it, he is staged: T0 N2c M0 which translates to Stage IIIB or IIIC.  I can't seem to find the exact distinction for your BIL.  Stage IIIB has a distinction of intransits that fit BIL, but all show having a primary.  Stage IIIC has the distinction of intransits with nodal disease with or without a primary.   I suspect he'd be considered stage IIIB.

          As you can see from the staging chart for stage IIIB (there are many sites that spell out staging), there are others who are stage IIIB with different types of metastasis, but they all have a similar prognosis. 

          Quote from another site:  Patients with in-transit metastases (intralymphatic) or satellite lesions without lymph node disease have a prognosis which is similar to patients with lymph node metastasis (Buzaid et al., 1997). These patients are now staged as N2c disease.

          • October 21, 2014 at 3:42 am
          Janner
          Participant

            Just like the surgeon said, it wouldn't surprise him if there was melanoma or if there wasn't melanoma in the nodes.  Nodal disease doesn't change much in BIL's case.   In-transits are stage III, just as I've said before.  And yes, stage III means "systemic" disease (no longer localized) and that there could be other microscopic melanoma elsewhere….. or NOT.   His treatment options are the same as any other stage III individual:  watch, Interferon, clinical trial.  Those are the ONLY options for stage III – it doesn't matter that he had an unknown primary and others have nodal disease.  There are no other methods of testing.  Nothing depends upon the WLE – he's still stage III.   So, he gets to choose his treatment options, see the derm for periodic skin checks and possible scans (again, depends on doctor and institution).  That's it. 

            You can check out his staging here:  http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-staging

            As I see it, he is staged: T0 N2c M0 which translates to Stage IIIB or IIIC.  I can't seem to find the exact distinction for your BIL.  Stage IIIB has a distinction of intransits that fit BIL, but all show having a primary.  Stage IIIC has the distinction of intransits with nodal disease with or without a primary.   I suspect he'd be considered stage IIIB.

            As you can see from the staging chart for stage IIIB (there are many sites that spell out staging), there are others who are stage IIIB with different types of metastasis, but they all have a similar prognosis. 

            Quote from another site:  Patients with in-transit metastases (intralymphatic) or satellite lesions without lymph node disease have a prognosis which is similar to patients with lymph node metastasis (Buzaid et al., 1997). These patients are now staged as N2c disease.

            • October 21, 2014 at 3:42 am
            Janner
            Participant

              Just like the surgeon said, it wouldn't surprise him if there was melanoma or if there wasn't melanoma in the nodes.  Nodal disease doesn't change much in BIL's case.   In-transits are stage III, just as I've said before.  And yes, stage III means "systemic" disease (no longer localized) and that there could be other microscopic melanoma elsewhere….. or NOT.   His treatment options are the same as any other stage III individual:  watch, Interferon, clinical trial.  Those are the ONLY options for stage III – it doesn't matter that he had an unknown primary and others have nodal disease.  There are no other methods of testing.  Nothing depends upon the WLE – he's still stage III.   So, he gets to choose his treatment options, see the derm for periodic skin checks and possible scans (again, depends on doctor and institution).  That's it. 

              You can check out his staging here:  http://www.cancer.org/cancer/skincancer-melanoma/detailedguide/melanoma-skin-cancer-staging

              As I see it, he is staged: T0 N2c M0 which translates to Stage IIIB or IIIC.  I can't seem to find the exact distinction for your BIL.  Stage IIIB has a distinction of intransits that fit BIL, but all show having a primary.  Stage IIIC has the distinction of intransits with nodal disease with or without a primary.   I suspect he'd be considered stage IIIB.

              As you can see from the staging chart for stage IIIB (there are many sites that spell out staging), there are others who are stage IIIB with different types of metastasis, but they all have a similar prognosis. 

              Quote from another site:  Patients with in-transit metastases (intralymphatic) or satellite lesions without lymph node disease have a prognosis which is similar to patients with lymph node metastasis (Buzaid et al., 1997). These patients are now staged as N2c disease.

              • October 21, 2014 at 12:15 pm
              Linny
              Participant

                Having clear lymph nodes is a good thing. However, your BIL is definintely not out of the woods yet. Based on what you've mentioned in earlier posts, your family's challenge will be to get him to Johns Hopkins, which appears to be the closest melanoma center to you all.

                If this were me I'd be wondering if they missed any lymph nodes. Maybe the results of the WLE will shed some more light on his situation.

                If he does go to Hopkins, don't be surprised if they tell him he will have the rest of his lymph nodes removed from the affected basin. My cancerous node was removed locally. The subsequent CT scan I had done locally was clear. There appeared to be no further spread. Sound familiar? LOL.

                At my appointment with the dematologist at Hopkins, I did ask him why they wanted to operate if everything was clear. His reply was that the melanoma could still be lurking in that lymph node basin. I was surprised. But in hindsight, the rationale for that surgery appeared to have been based on the results of this study on unknown primaries and lymphadenectomies: http://jco.ascopubs.org/content/26/4/535.full. "Unless the results of this work-up are positive for metastasis beyond the regional basin, patients should undergo therapeutic (and potentially curative) regional lymphadenectomy as the standard of care."

                With melanoma, there's always a risk of something reappearing, hence the vigiliance.

                  • October 21, 2014 at 1:03 pm
                  Girl52
                  Participant

                    Janner and Linny: Thank you for such great staging and other information. I want to relate to my sister early today, if possible. Am hoping they'll hear re: WLE and that surgeon will tell BIL that he's not out of the woods. Will do my best to emphasize to sis that it is now more and not less important to see a melanoma expert and not rely on opinion or recommendation of GP.

                    Linny, I also wondered if they might have missed something. With unknown primary (though it was probably regressed skin tumor?), how do you know the sentinel node of the metastasis is the sentinel node of the primary? 

                    Will read through links again carefully. You're the best. Will post again if I hear anything else today. Am on the Hopkins bandwagon. enlightened    

                    • October 21, 2014 at 1:14 pm
                    Linny
                    Participant

                      With unknown primary (though it was probably regressed skin tumor?), how do you know the sentinel node of the metastasis is the sentinel node of the primary?

                      Exactly. About all doctors know is that the melanoma most likely started on the skin. Someplace. I think you need to know the exact location of the primary in order to trace the route of the melanoma when you do a sentinel node biopsy. Janner has more expertise in that area than I do, and I'm hoping she'll chime in soon with a better answer than what I just gave you.

                      • October 21, 2014 at 3:33 pm
                      Janner
                      Participant

                        I've already asked that very same question.  I don't think you can assume anything.  I had told you previously that if the SNB was positive, that meant there was nodal spread.  But if it was negative, it didn't mean things were in the clear, it just means that those particular nodes are clear.  No guarantee of any others.  No guarantee that there isn't melanoma "in transit" elsewhere either.  The SNB had limited benefit in my book in this case.  The real difference is stage IIIB versus stage IIIC, I guess, and their associated survival risks. But even the staging is a bit compromised because that typically depends on removing all the nodes in the case of stage III, and BIL hasn't had that done.

                        • October 21, 2014 at 3:33 pm
                        Janner
                        Participant

                          I've already asked that very same question.  I don't think you can assume anything.  I had told you previously that if the SNB was positive, that meant there was nodal spread.  But if it was negative, it didn't mean things were in the clear, it just means that those particular nodes are clear.  No guarantee of any others.  No guarantee that there isn't melanoma "in transit" elsewhere either.  The SNB had limited benefit in my book in this case.  The real difference is stage IIIB versus stage IIIC, I guess, and their associated survival risks. But even the staging is a bit compromised because that typically depends on removing all the nodes in the case of stage III, and BIL hasn't had that done.

                          • October 21, 2014 at 3:33 pm
                          Janner
                          Participant

                            I've already asked that very same question.  I don't think you can assume anything.  I had told you previously that if the SNB was positive, that meant there was nodal spread.  But if it was negative, it didn't mean things were in the clear, it just means that those particular nodes are clear.  No guarantee of any others.  No guarantee that there isn't melanoma "in transit" elsewhere either.  The SNB had limited benefit in my book in this case.  The real difference is stage IIIB versus stage IIIC, I guess, and their associated survival risks. But even the staging is a bit compromised because that typically depends on removing all the nodes in the case of stage III, and BIL hasn't had that done.

                            • October 21, 2014 at 1:14 pm
                            Linny
                            Participant

                              With unknown primary (though it was probably regressed skin tumor?), how do you know the sentinel node of the metastasis is the sentinel node of the primary?

                              Exactly. About all doctors know is that the melanoma most likely started on the skin. Someplace. I think you need to know the exact location of the primary in order to trace the route of the melanoma when you do a sentinel node biopsy. Janner has more expertise in that area than I do, and I'm hoping she'll chime in soon with a better answer than what I just gave you.

                              • October 21, 2014 at 1:14 pm
                              Linny
                              Participant

                                With unknown primary (though it was probably regressed skin tumor?), how do you know the sentinel node of the metastasis is the sentinel node of the primary?

                                Exactly. About all doctors know is that the melanoma most likely started on the skin. Someplace. I think you need to know the exact location of the primary in order to trace the route of the melanoma when you do a sentinel node biopsy. Janner has more expertise in that area than I do, and I'm hoping she'll chime in soon with a better answer than what I just gave you.

                                • October 21, 2014 at 1:03 pm
                                Girl52
                                Participant

                                  Janner and Linny: Thank you for such great staging and other information. I want to relate to my sister early today, if possible. Am hoping they'll hear re: WLE and that surgeon will tell BIL that he's not out of the woods. Will do my best to emphasize to sis that it is now more and not less important to see a melanoma expert and not rely on opinion or recommendation of GP.

                                  Linny, I also wondered if they might have missed something. With unknown primary (though it was probably regressed skin tumor?), how do you know the sentinel node of the metastasis is the sentinel node of the primary? 

                                  Will read through links again carefully. You're the best. Will post again if I hear anything else today. Am on the Hopkins bandwagon. enlightened    

                                  • October 21, 2014 at 1:03 pm
                                  Girl52
                                  Participant

                                    Janner and Linny: Thank you for such great staging and other information. I want to relate to my sister early today, if possible. Am hoping they'll hear re: WLE and that surgeon will tell BIL that he's not out of the woods. Will do my best to emphasize to sis that it is now more and not less important to see a melanoma expert and not rely on opinion or recommendation of GP.

                                    Linny, I also wondered if they might have missed something. With unknown primary (though it was probably regressed skin tumor?), how do you know the sentinel node of the metastasis is the sentinel node of the primary? 

                                    Will read through links again carefully. You're the best. Will post again if I hear anything else today. Am on the Hopkins bandwagon. enlightened    

                                  • October 21, 2014 at 12:15 pm
                                  Linny
                                  Participant

                                    Having clear lymph nodes is a good thing. However, your BIL is definintely not out of the woods yet. Based on what you've mentioned in earlier posts, your family's challenge will be to get him to Johns Hopkins, which appears to be the closest melanoma center to you all.

                                    If this were me I'd be wondering if they missed any lymph nodes. Maybe the results of the WLE will shed some more light on his situation.

                                    If he does go to Hopkins, don't be surprised if they tell him he will have the rest of his lymph nodes removed from the affected basin. My cancerous node was removed locally. The subsequent CT scan I had done locally was clear. There appeared to be no further spread. Sound familiar? LOL.

                                    At my appointment with the dematologist at Hopkins, I did ask him why they wanted to operate if everything was clear. His reply was that the melanoma could still be lurking in that lymph node basin. I was surprised. But in hindsight, the rationale for that surgery appeared to have been based on the results of this study on unknown primaries and lymphadenectomies: http://jco.ascopubs.org/content/26/4/535.full. "Unless the results of this work-up are positive for metastasis beyond the regional basin, patients should undergo therapeutic (and potentially curative) regional lymphadenectomy as the standard of care."

                                    With melanoma, there's always a risk of something reappearing, hence the vigiliance.

                                    • October 21, 2014 at 12:15 pm
                                    Linny
                                    Participant

                                      Having clear lymph nodes is a good thing. However, your BIL is definintely not out of the woods yet. Based on what you've mentioned in earlier posts, your family's challenge will be to get him to Johns Hopkins, which appears to be the closest melanoma center to you all.

                                      If this were me I'd be wondering if they missed any lymph nodes. Maybe the results of the WLE will shed some more light on his situation.

                                      If he does go to Hopkins, don't be surprised if they tell him he will have the rest of his lymph nodes removed from the affected basin. My cancerous node was removed locally. The subsequent CT scan I had done locally was clear. There appeared to be no further spread. Sound familiar? LOL.

                                      At my appointment with the dematologist at Hopkins, I did ask him why they wanted to operate if everything was clear. His reply was that the melanoma could still be lurking in that lymph node basin. I was surprised. But in hindsight, the rationale for that surgery appeared to have been based on the results of this study on unknown primaries and lymphadenectomies: http://jco.ascopubs.org/content/26/4/535.full. "Unless the results of this work-up are positive for metastasis beyond the regional basin, patients should undergo therapeutic (and potentially curative) regional lymphadenectomy as the standard of care."

                                      With melanoma, there's always a risk of something reappearing, hence the vigiliance.

                                  Viewing 5 reply threads
                                  • You must be logged in to reply to this topic.
                                  About the MRF Patient Forum

                                  The MRF Patient Forum is the oldest and largest online community of people affected by melanoma. It is designed to provide peer support and information to caregivers, patients, family and friends. There is no better place to discuss different parts of your journey with this cancer and find the friends and support resources to make that journey more bearable.

                                  The information on the forum is open and accessible to everyone. To add a new topic or to post a reply, you must be a registered user. Please note that you will be able to post both topics and replies anonymously even though you are logged in. All posts must abide by MRF posting policies.

                                  Popular Topics