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Melanoma Recurrence Back again

Forums Cutaneous Melanoma Community Melanoma Recurrence Back again

  • Post
      Well, I’m back. My Husband was first Diagnosed with stage 2 b Nodular Melanoma of his Posterior upper arm including shoulder 19 months ago. He had Local Wide Excision and had 3 lymph nodes removed and found to be clear. Fast forward to July 2020. Recurrence in the original scar . Once again surgery was performed. I am including the Derm Report following second surgery. He is now considered Stage 3 B. Cat Cans and brain MRI show no disease. So far, He has had a round of Radiation treatments 21 treatments. He will be on Opdivo once a month for 12 months starting October 6th.
      This is his pathology report after second surgery was performed.
      Clarks Level-V
      Growth phase-Vertical
      Mitoic Rate-7-8mm
      Perrenial invasion-Not Identified
      Tumor Infiltrating Lymphocites–Non Brisk
      Pathologic stage- pt4a
      Metastases in transit are present.
      Oncologist says he want to do Opdivo to keep it from coming back.

      Is this the right course of treatment?


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          Sorry that your husband recurred to the extent that he has. However, he seems to be on the right path for prevention of further spread. Adjuvant treatment (treatment after obvious disease has been surgically removed and/or zapped via radiation) has been proven to be very helpful in preventing further recurrence. Targeted and immunotherapy can be used. Here is a recent post of studies reviewing both:

          Here are a zillion reports on adjuvant therapy generally –

          And finally, while radiation alone is not that effective in melanoma, combining it with immunotherapy has been shown to be very beneficial. Here are lots of reports on that topic:

          Hope that helps. I wish you and your husband my best. Celeste

              Thank you so much! We thought we were done with it the first time around. They said they had gotten it all but I guess you never really know.
              They are being much more aggressive this time. I am praying they can slow it or stop it from progressing to Stage 4I
              He is nervous about the treatment and side effects but we believe this is the best course of treatment and your words have helped!
              Thank you
                Dear Karen – I am sorry for what your husband is going through. I went through something similar – WLE on my lower left leg May 2014, recurrence on my scar ealry 2016, second surgery (more difficult much longer to heal). No lymph nodes so just regional movement. At that time adjuvant opdivo was not available so i went into a trial adjuvant ipi versus adjuvant pembro. I was put on ipi, side effects too bad, and sadly a third occurrence a few months later in the same area. Then they put me on pembro since surgery didnt seem to be working, just led to recurrences. This was pretty depressing and I can imagine must be the same for your husband and you – especially when i was under the (mistaken) impression that the initial surgery had caught it and margins were good.

                All I can say is dont give up. In your case the opdivo is a good idea and may well prevent a recurrence. Side effects are typically not too bad and the beneifts potentially great. And this way you can keep monitoring the area to check for no recurrences.

                Although it is some time back now, I can relate to what you must be going through and how unlucky you are. I hope that your husband is recovering from his second surgery and that the opdivo will work
                Best wishes Mark

                  Thanks Mark!
                  His surgery has been pretty rough. I would show u pics of how much they removed, we got the pics of it. He has less movement in his arm and the radiation has really done a number on him, but he is a strong otherwise healthy man. I get confused by all of this because they say they are doing it to keep it from coming back, yet everything points to recurrence due to disease progression. Is there such a thing as a complete cure? I get really confused talking to the Drs.
                    Hi Karen,

                    My melanoma was on my lower left leg. The first operation (when I was Stage II) was not too bad, I cant remember how much time I took off work, if anything. Second time around needed a skin graft and this meant a few weeks off work and again crutches which I hate and am useless with. My surgery looked awful – i have photos – and i had to bandage it up for a long time afterwards. Now it’s much better. So I would focus on making sure the surgery heals.

                    He had a recurrence due to disease progression but if the surgery removed all then in theory he should be fine. The problem is that small melanoma cells may still be lurking around. That’s why they are putting him on opdivo now to try to forestall another recurrence. He may not need this opdivo since it may not recur. But they are probably concerned that since it recurred before it may recur again, that surgery is not enough. So opdivo seems a good idea, i would definitely do it.

                    In terms of cure, we dont know. My doctor says in my case he would not speak of a cure unless I was without disease for 10 years, then he might think we had cured it (this is not to say it wont come back since I may be prone to new melanomas). I dont think there are any clear victories – we cannot be sure. We will only know later when we die of something else! But the odds can be good and they tend to improve if you can go a few years without a recurrence. So many of us are actually cured, we just dont know this for certain. This adds a different perspective to life though, to be incredibly grateful to be alive. I have lost this feeling now (to some extent), but when on treatment it was particualrly intense. In a way wonderfully intense.

                    I believe thiis website has lots of resources on the various stages. Bubbles blog has lots of cases and advice. I would say in your husband’s case if it has not spread to the lymph nodes and it stays local (which was my case) then he may have better chances. I hope your husband reads the bulletin board and the info here and understands the stages. A complete cure does seem possible, its just that you may not know this,

                    Good luck

                      Thank you Mark! After reading as much as possible on this site and others. we are feeling much better about things. My husband was not sure about the Opdivo until we did some research. He now understands the importance of it. after all, His recurrence happened within 18months and was very large, so treatment is the best plan for him. He has also had several basil cell carcinomas removed recently as well. The Dr also just did a biospy today on another suspicious area on his neck., but we are hoping that it is nothing. One thing I can say, Is I am so grateful to all those who have had to go through this and who went through trials The trials and the brave souls who go through them give people like my husband a chance at life due to the new drugs so, thank you to all for that!. I am glad you are still around to share your story. It sounds similar to what my hubby is now enduring. You give us hope!
                      Yoav Shtainman
                        I had similar Melanoma in 2013 and after two surgeries I start getting Keytruda Immunotherapy and after two infusions I was clean. I continue the treatment for 2 year every three weeks without any side effects and also full body imaging every six month. Now in Oct 2020 I am clean and getting imaging once a year to make sure nothing came back.
                          That is Awesome news! Thank you for sharing
                            That is awesome! It encourages me, as I am on cycle 4 of Keytruda for nodular melanoma on scalp IIIc3. So far no lymph node involvement, and healing well from wide excision, reconstruction and skin graft surgery. Thankful for this treatment.
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