Is CLND really worth it?

My son is trying to decide whether to do the CLND (and clinicial trial).  As his doctor tells him that the CLND in his case is controvesial, he's inclined to watch and wait.  The specifics are 2 out of 2 nodes in the SLNB were positive, but with less than 10 cells each.  No ulceration of the original tumor and spitzoid features.  Since his CT scan showed tiny nodules on the lung, he decided to repeat the scan in 6 weeks before making any decision.  Since then, he seems more and more inclined to simply watch and wait.

My theory on this topic is why leave cancer in your body? It's a no brainer to me to surgically remove any cancer that you are able to before it turns into something you're not able to? I had this done in 2013 in my groin. I was 31 years old at the time with 4 children and if I had to do it all over again, I would in a heartbeat. I was in the same boat as well, terrified of both the clnd and then Ipi. I was crushed when I found out my slnb was positive but my surgeon never gave me the option of not doing it. I was told this was an aggressive, doesn't play by the rules type of cancer and this is what needs to be done. My surgeon was also a professor and had been doing this for 30+ years. So I geared up for the surgery and it wasnt fun let me tell you. I also got an infection which required more hospital stay. I also ended up with lymphadema. I have changed my life a little bit because of it but not much. I sleep with something on and because I am not able to wear a stocking during the day I have a pump I use. So yeah, a little inconvient but so is cancer and I have not recurred since.

I was in a similar situation.  The melanoma clinic I was at offered CLND as it was the "standard of care". I also was one positive node with a few cells.  My dermatolgist recommended against it and cited the DECOG study which showed no advantage of the CLND.  It was a difficult decision.  My issue with DECOG was the study is scientifically underpowered and only shows a 3 year survival rate.  There is another study on going, but the results will not be in for a few more years.  I had to make a decision with what I know now.  Ultimately, I decided to do an auxillary lymph node disection.  The data just wasn't there in the long term to forego the surgery.  I was concerned that I could have left a microscopic amount of cells in the lymph node basin that years from now would grow and cause more problems.  All my nodes came back clear, but you should know that's for obvious signs of cancer.  They do no disect the nodes as finely as the sentinel nodes. You may have removed microscopic cells.  No one will know.  I have minor side effects with small amount of occasional nerve pain, totally bearable.  I have full mobility and live a normal life.  I am coming up on 1 year NED.  Make the decision you feel most confortable with and never look back.  The only right decision is the one you can be at peace with.  Good luck.

I am sorry to hear that you are in in this situation, he sound eerily similar to mine and I to, was concerned about the surgery. I am not 7 weeks out from a full groin dissection and am so happy that I did it. The recovery was not easy, but it was not half as hard as I had anticipated. I did have my drain for 6 weeks but it was not as cumbersome as I thought and I just became used to it. I have zero swelling in my lower leg and ankle, and my right thigh is now only slightly larger then my left. I have gone for lymphatic drain massage 3 times to just "jump start" my system so to speak and I do wear my compression garment everyday. When I am sitting, I keep my feet elevated ( iIpurchased an amazing leg pillow from amazon) and doing these things have really helped. I had grave concerns as I am a flight attendant and my doctor has told me that as long as I follow what I am doing, ( garmet, elevating etc). I should be OK. I totally understand your concern, I just left it was best for me (one positive sentinel node was all I had), but again it is a personal decison and I wanted to ensure I did all I could. Please do not hesitate to contact me should you have any other questions, best of luck!!!

I would have to agree with you Brad, with the advantage of hind sight and progression it feels like a mistake!!! At the time, I just wanted to cut out any chance that Melanoma was still there. When the result of MSLT 2 are in, we will know for sure. Here is a little bit about the science that we are waiting for. Best Wishes to Anon while you are going through the process!!!Ed  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3463679/

Just a little bit more for those that are interested in CLND and SND from 2014 on Onclive with a great panel of experts. It is a little bit funny listening to experts from just 3 years ago talk about what to do for patients. The good news is we are getting close to having the data in from MSLT-2.  https://www.youtube.com/watch?v=XoK7TA7Jnjg  https://www.youtube.com/watch?v=joz-FHt-Hdg