Biopsy or Not?

When I had cataract surgery on both eyes in August 2018, I needed 3 weeks without Opdivo infusions before and after that surgery. I was receiving Opdivo every 2 weeks. I skipped 2 infusions of Opdivo. If your lymph node biopsy shows melanoma or your next PET scan shows more activity in it, radiation might be an alternative to surgery. With radiation you could continue receiving Opdivo. In April 2018 I received radiation to a cancerous lymph node while continuing to receive Opdivo infusions. This combination of radiation and immunotherapy seems to have worked.

1. Given that the scan you reference was in Jan, and you are to have another scan in 3 months – you don’t have that long until the follow-up scan.
2. As you noted, it is too early determine much of anything in the way of a response from your Opdivo (nivolumab) doses. When dealing with immunotherapy of all stripes, melanoma experts recommend – “Be patient with the patient.” Still, the spot that is noted on your recent scan could be an inflammatory response by the influx of t cells to a patch of melanoma cells that Opdivo has stimulated them to do away with as we speak. Or….as is common with findings on scans, it could be a red herring that we only have to deal with because now we know it is there. Either way – in light of those facts, waiting to rescan would be an acceptable plan.
3. Recent positive reports on “NEO-adjuvant” responses – treating the patient with known melanoma intact – is another reason why waiting to rescan may be wise. Here are lots of reports on neoadjuvant treatment: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=neoadjuvant
4. Another reason to be a bit leery of biopsy is that if not done very carefully with proper technique by a surgeon well versed in the removal of cancerous lesions, the biopsy itself can be a source of spread.
5. That said, I see no reason why surgery or biopsy would necessitate a cessation of your Opdivo. Stopping therapy would not be something I would want to experience were I in your shoes.
6. The only reason I can see for biopsy at this point, is that if it is positive for melanoma, you would know that you were Stage IV and therefore eligible for the ipi/nivo (ipilimumab [yervoy] WITH nivolumab [opdivo]) immunotherapy combo. If you (or your doc) wouldn’t switch to that therapy (it is only approved for Stage IV patients currently) then I’m not sure the biopsy would have much value at this time. If you’re not going to switch to ipi/nivo, then I guess I don’t really see the point. And lots of Stage IV patients do perfectly well on nivo alone. I am one. Stage IV in 2010 after brain and lung mets. Nivo trial until 2013. No further treatment and remain NED for melanoma today.

I hope I haven’t made the situation more confusing – but melanoma ain’t easy! Ask more questions as you have the need. There are many smart and caring peeps on this forum! I wish you my best. celeste