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Brother Diagnosed Today

Forums General Melanoma Community Brother Diagnosed Today

  • Post
    Cyndie in Texas
    Participant
      Hi y’all…My brother had a biopsy last week for a bump on his scalp and the dermatologist called today and told him it was melanoma. My brother is not the type to ask questions so I hardly know anything other than he has melanoma and the dermatologist said he needs to see an oncologist immediately which the office said they sent a request to the oncologist for an appointment for him. My brother is going to sign a release so I can talk to the dermatologist but I have no idea what to ask him. Can anyone provide me with some basic questions to ask? It seems rather sudden to push for an oncologist so soon but I really don’t know if that seems normal or not.

      Thank you!

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    • Replies
        TexMelanomex
        Participant
          Cyndie,

          Yes, I would absolutely get with a melanoma specialist sooner rather than later. Since you are in Texas I can’t recommend MD Anderson highly enough. My melanoma started on my scalp as well and they (MD Anderson -Dr. Ross and Dr. Amaria) were amazing in treating it and me! Many people here will tell you that you are in better hands with a melanoma specialist than a general oncologist and MD Anderson is one of the major league centers of melanoma treatment in terms of specialists, access to treatments, and even clinical trials if needed. I hope this helps, your brother is fortunate to have an advocate like you. I waited far too long to see my dermatologist but once they diagnosed me they also recommended a local oncologist, I’m glad I went to MD Anderson instead. Warrior On!

          Tex

            Cyndie in Texas
            Participant
              Thank you for responding, Tex. I really appreciate your advice. He has an appointment at 9:40 this morning so we will see. I was hoping to go with him but I couldn’t get there quick enough (I live part time in Michigan and part time in Houston). I noticed in one of your posts that you talked about bringing more awareness for veterans with melanoma – my brother is a veteran so I may need to reach out to you again. He is 54 yrs old and currently lives in Tyler. I’m hoping the doctor will let my brother call me to listen in since no one else is there with him…fingers crossed!
              mandyjill
              Participant
                Cyndie,
                I see a melanoma oncology specialist is Dallas at Baylor. Dr. Lance Cowey. Just fyi. He is awesome and has a great reputation. Just curious who your brother is seeing.
                Amanda
                Cyndie in Texas
                Participant
                  HI Amanda – I am going to talk to my brother about getting a second opinion so he may be more open to getting one in Dallas rather than MD Anderson in Houston. I am concerned that the doctor’s he is seeing are not Melanoma specialists. I am going to ask the plastic surgeon about this when I go to the appointment on Tuesday. His oncologist is Dr. Su and his surgeon is Dr. Saar. Thank you for the recommendation!
                  Betsyj
                  Participant
                    Hi Cyndi, I just looked in on this site for the first time in years, and saw your post. My husband is a melanoma 3C survivor. We began the journey in CA and received excellent care at UCSF. We recently moved to Lindale and asked for a referral, thinking we’d be traveling at least as far as Dallas, as we want a melanoma specialist. Our UCSF doctor referred us to Dr. Jade Homsi in Tyler. We haven’t made an apt yet, as we’ve only been here a few months, but I trust our CA doctor and look forward to meeting our new one.
                    Cyndie in Texas
                    Participant
                      HI Betsy! Thank you for the recommendation. I am going to discuss with my brother about getting a second opinion and I will let him know about Dr. Homsi. I really appreciate the information!
                    jbronicki
                    Participant
                      Hi Cyndie,

                      I live in Texas and also work in Michigan so last year actually had an apartment in Ann Arbor and house here. I’m so sorry that you have had to join us on the board on behalf of your brother, but (kind of unfortunately) we have a big Texas contingency on our board that are willing to help in any way.

                      I would definitely ask for a copy of the biopsy report. I would start by asking about the biopsy and what information is on there. this is the first information you get that tells you some things about the melanoma like how deep it is, etc. That will tell you what you are dealing with originally and then next steps are usually the Wide Local Excision (surgery) and depending on the depth, etc, and usually a SNLB (sentinel lymph node biopsy) will occur at the time of the excision. They will remove the lymph nodes after they inject a tracer to show where the drainage goes to. https://www.mayoclinic.org/tests-procedures/sentinel-node-biopsy/about/pac-20385264 This will give you even more information about whether there was any spread to the lymph nodes right near the melanoma. These are the first steps your brother will go through. Once you have this information, you’ll be able to ask about the treatment options based on what this initial information tells you.

                      You want to make sure that your brother gets his surgery done by a oncology surgeon (not general) or even better, one that specializes in melanoma, like here at MD Anderson. That is where my husband had his surgery and he is seen by Dr. Amaria, like TexMelanomaex . https://www.mdanderson.org/research/departments-labs-institutes/departments-divisions/surgical-oncology/faculty-staff.html

                      First, try to get the information about the biopsy. It should be a file or document that has all the characteristics of the melanoma. Then if you are comfortable, you can share some of that information on this board and people can give you information about the possible treatment options and what the current thinking is about how to treat the melanoma.

                      I would definitely recommend MD Anderson since you are in driving distance. My husband’s surgeon was Dr. Janice Cormier, couldn’t recommend her higher! She is great and really teamed up with Dr. Amaria after the surgery. My husband had a large (22mm deep) melanoma, so the WLE and SLNB were crucial.

                      If you need to meet up with people here in Houston, we are always available both our home and just to meet people that went through this. The med center can be a lot to navigate but would gladly help in any way. My brother was a veteran, he passed away two years ago (not from Melanoma or any cancer, but went through a lot with the VA Hospital. he would want us to help other veterans). Veterans are pretty darn stoic sometimes, I understand your wanting to advocate for him. My husband didn’t ask one single question, I had to be the one to advocate for him. It can be tough being the person without melanoma but wanting to help. Please ask any questions here on this board, we will support you. I’m glad your brother signed a release so they can share all the information with you, good for him!

                      Hugs,
                      Jackie

                        jbronicki
                        Participant
                          We are in Pearland by the way!
                          Cyndie in Texas
                          Participant
                            That is where I am at, too! I always say Houston because no one knows where Pearland is!
                            Cyndie in Texas
                            Participant
                              I don’t know if I’m posting in the right spot but my brother had his appointment. The doctor he went to see is Dr. Jingdong Su at Texas Oncology in Tyler. I still don’t know what his biopsy results are but I put a call into the doctor’s office to find out. He is scheduling him for a PET scan on Friday to see if the cancer has spread to his lymph nodes and then sending him to a plastic surgeon to have his mole cut out…which I’m totally confused by that and will get clarification when they call me back. My brother either got it confused or maybe that is what is normally done?? The doctor did say the spot is about the size of a nickel which I don’t know if that’s good or bad. If the cancer has spread the doctor told him immune therapy for a year.

                              Will the doctor’s office be able to tell me over the phone the biopsy results? For instance, the size, etc.

                              Thank you all for your posts and taking the time out to help me through this! I will post after I talk to the doctor’s office!

                              AnxiousDad
                              Participant
                                Hi,

                                The main reason for a plastic surgeon would be because it ends up being a lot bigger of a cut than you think it would be. They dont just cut the mole out, they cut a pretty big area around it out…and then have to try to make it look pretty afterward. It’s not too uncommon to have a plastic surgeon do this, especially if it’s around the face or head or other conspicuous area.

                                I had mine on my temple. I was sent to a head and neck surgeon who did an amazing job stitching me up.

                                Best of luck, your Brother is so very lucky to.have you.

                                Cyndie in Texas
                                Participant
                                  Thank you for the information. I’m still waiting for the doctor’s office to call me but I’m assuming that a surgeon will be doing that actual removal and the plastic surgeon will do the stitching, etc. So many questions! He has his PET scan on Monday so hoping for positive news from that! Have a wonderful day and I will post more as I find out!
                                  jbronicki
                                  Participant
                                    Was thinking about you and your brother today. Hoping the doctor’s office gets back to you with the information pretty soon, that will be helpful. It’s hardest in the beginning when there is unknowns and limbo is so tough. Glad your brother is getting his PET scan on Monday, that will provide even more information!
                                    Cyndie in Texas
                                    Participant
                                      Hi Jackie! I talked to the doctor’s office yesterday and this is what they told me:
                                      1. The dermatologist did a shave biopsy and the test results didn’t have measurements but said positive for Malignant Melanoma. He was not able to get it all.
                                      2. The PET scan will only show if it has spread to his bones and organs and not necessarily his lymph nodes.
                                      3. He will have a lymph node biopsy when the do the surgery to remove the spot on his scalp
                                      4. At his follow-up appointment they will have him do molecular testing and blood work and discuss the results of his PET scan and that the PET scan results are never given by phone or earlier than the follow-up appointment.

                                      I’m flying in from Michigan Monday night to go to his consult with the plastic surgeon Tuesday morning. It still seems strange to me that a plastic surgeon will be doing the entire surgery but I guess this is just my ignorance of how this all works. You are right – the unknowns and waiting are very difficult!

                                      I am one of the ones that didn’t realize how serious Melanoma is. I knew it was a type of skin cancer but really had no idea. This has been an eye-opener in so many ways.

                                      jbronicki
                                      Participant
                                        Hi Cyndie,

                                        So glad you are starting to get information. I’m not a shave biopsy expert or biopsy expert (we had someone on our board that was truly an expert in this area, but is not on currently active, but I read through many of her old posts to get an idea). Shave biopsies are usually thin shaves of skin from the area, here is the link from a previous post and if you scroll down to reply by Janner, good description:

                                        https://melanoma.org/legacy/find-support/patient-community/mpip-melanoma-patients-information-page/shave-biopsy-what-was-my-dr-thinking

                                        The main thing is they don’t know depth of melanoma still since they didn’t get clear margins. But research shows, once you are past the biopsy stage, the rest of the information you gather is still the same (lymph node involvement, PET Scan to detect any spread to organs, etc) and is what determines your treatment and outcomes. So they will excise it now and do the Sentinel Lymph Node Biopsy which is exactly right to do. I’m really not sure about the plastic surgeon part since we went right to a surgeon at MD Anderson and they removed it quickly. Also, being on his scalp, I would ask what margins they plan on taking around the melanoma. They took 2 cm margins around my husband’s since it was so large, but I know on the scalp they can’t always take such large margins. You may want to post a new question/thread on the board and ask about the opinion of using plastic surgeon for this excision, since I’m not really sure. Given that your brother does have melanoma and it is on his scalp and they didn’t get clear margins (which suggests some depth but not sure what depth), I would want to be aggressive at this point and make sure he has the appropriate surgeon and the most comprehensive treatment options once you have all the information: 1) Pathology report from the excision where they look at the characteristics of melanoma under the scope, etc. 2) Information whether the Sentinel Lymph Node (s) are positive or negative, etc and 3) PET scan to check everything else. They will be able to stage your brother after these things are done. So glad you are flying in to be with your brother and get copies of whatever you can and do they have a patient portal? I have access to my husband’s MD Anderson patient portal, so I have all his reports in one place and then I copy them into my own folder in case I ever lose access to the system or catastrophic IT failures:) They are definitely doing all the right things now for your brother including the molecular testing which will show if he has the BRAF mutation, which gives him another treatment option if needed. At this point you all are still in the surgical procedure and information gathering stage, I know it is so hard. But you will get the rest of the information you all need soon. I’m hoping that everything comes back clean and SNLB is negative and so on. But we are here for you all no matter what and treatment options if god forbid it did spread at all, are light years better than just 5 years ago. Hugs. And feel free to reach out and don’t hesitate to get 2nd opinion at MD Anderson either if your brother is up for that.

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