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Newly diagnosed stage 3

Forums General Melanoma Community Newly diagnosed stage 3

  • Post
    gabsound
    Participant

      Hi, I live in las Vegas and was recently diagnosed with stage 3 melanoma (thick lesion with ulceration, 1 positive node). About 5 years ago I had a basal cell cancer on my upper back and have had quite a few atypical moles removed that were moderate to severe dyplasia. My melanoma started as a pink lesion on my leg inside the knee region. Two different PA's from different Dermatology practices saw it and were not impressed. Finally I kept pestering with "what is this" and the edge got frozen because it was getting crusty like an actinic keratosis.

      Hi, I live in las Vegas and was recently diagnosed with stage 3 melanoma (thick lesion with ulceration, 1 positive node). About 5 years ago I had a basal cell cancer on my upper back and have had quite a few atypical moles removed that were moderate to severe dyplasia. My melanoma started as a pink lesion on my leg inside the knee region. Two different PA's from different Dermatology practices saw it and were not impressed. Finally I kept pestering with "what is this" and the edge got frozen because it was getting crusty like an actinic keratosis. At first it got smaller and peeled, but later started bleeding after I picked at it and it never healed. Biopsy came back melanoma.My PA thought was going to be a squamous Cell so did a shave bx (i;ve read that was not good). About 3 weeks ago I had a wide local incision and sentinel lymph node bx. Unfortunately sentinel node was positive with micrometastasis and woke up from surgery with rest of lymph nodes in the groin removed (I knew this was a possibility). I'm healing up fairly well and have tried going back to work part time this week,

      My blood work LDH is normal. I am awaiting results of my PET scan. Prior to pet scan I met with my oncologist, who said treatment for pt's like myself, fall in a "grey area". He said the interferon treatments are falling out of favor and said he was recommending a watch and wait for now. He is also checking with an associate who does more melanoma research (dr. Samlowski) to see if there are amy clincal trials I should be in.

      In doing research, I see for stage 3 adjunct therapy MAY be offered. Initially I was relieved thinking I could just get back to my life, but find myself doing more research and wondering if that is the wisest choice. The statistics for this cancer are pretty grim. The oncologist said interferon " is like having the flu for a year"-I don't know that I could handle that. Also, from what I have read it doesn't sound like it improves the overall survival rate, but delays return by about 7 months. So you kinda lose a year up front to get some time later-this sounds like kind of a wash.

       

      I'm wondering if any other stage 3 patients can comment on if they were given the watch and wait choice and what you decided to do and why.

      Also please feel free to correct me if my understanding of what I've heard and read so far, appears wrong.

      Sorry if I rambled a bit. It is such a relief to find this site and read these posts from people going through exactly what you are!!

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    • Replies
        BethA in VA
        Participant

          Sorry you had to join this group…but it is such a great group of people.  I didn't do interferon, but only b/c I was afraid of being sick and missing out on my grandbabies first year. Many others have done it with great strength and good results.   I'm sure lots of others will respond with advice.  So many have been thru this and can give details and good ideas.  I'm sorry you are going thru so much, and will keep you in my prayers (because that is what I do!). 

          Whatever you do…make sure the Dr you go to is a Melanoma specialist.  You are already ahead of the game…you are informed!!  When I was diagnosed (long ago), I didn't even know what MM was.   Good luck!!    Beth 3/B 

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          BethA in VA
          Participant

            Sorry you had to join this group…but it is such a great group of people.  I didn't do interferon, but only b/c I was afraid of being sick and missing out on my grandbabies first year. Many others have done it with great strength and good results.   I'm sure lots of others will respond with advice.  So many have been thru this and can give details and good ideas.  I'm sorry you are going thru so much, and will keep you in my prayers (because that is what I do!). 

            Whatever you do…make sure the Dr you go to is a Melanoma specialist.  You are already ahead of the game…you are informed!!  When I was diagnosed (long ago), I didn't even know what MM was.   Good luck!!    Beth 3/B 

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            Janner
            Participant

              Just a note, Dr. Samlowski is a very skilled melanoma doc – I would seriously consider any of his recommendations.  Clinical trials, interferon and watch and wait are about your options – and all are viable.  No treatments, to date, have shown an overall survival benefit and that means watch and wait is just as valid as anything else.

              Good luck on your decision,

              Janner

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                Vermont_Donna
                Participant

                  Hi,

                  Sorry that you have been diagnosed with melanoma but good that you found your way here. Treatment decisions are very personal, and you will see on this board that we have people who have done a variety of things, from "watch and wait" to a year of interferon (four weeks of high dose followed by 11 months of low dose injections), 4 weeks of high dose interferon, clinical trials, etc.

                  Sometimes you can only gain access to a treatment after you have "failed" others…ie do the Interferon, have a re-occurence, then are offered something else.

                  I think from your post above that you have a good grasp of melanoma,  are well informed, understand the disease initially and are pretty calm given this devastating news! Way to go! You will see that people can LIVE with this disease, and live full and happy lives. Now your life will be forever changed in that you will need to be vigilant about self monitoring and have more frequent skin exams by a dermatologist who knows melanoma well. You should look for anything that changes, no matter what color it is or anything new that pops up.

                  As for me, I chose to do the year of interferon, and have no regrets. I was pretty tired and did not work but applied for SSDI and was found eligible. After the year I returned to work and felt pretty good. I did have a re-occurence after a year (dont remember exactly when…..refer to my profile), and then after resection I did something else (sorry again refer to profile as I dont remember what came next…it is about 4 years later now). You are right in that interferon delays re-occurence but that "bought" time for me was precious, in that I felt that I was doing something to combat this disease and then other treatments were then offered when presented with the re-occurence. I have had many re-occurences since then and many other treatments. All treatments I feel have bought me time and have addressed the disease for a short period of time until I went on Ipi.

                  I am B-Raf negative so those trials are out. I was referred to do Ipi in a clinical trial at DHMC (Dartmouth Hitchcock Meical Center) and after the 4 initial doses I have had a complete response. I am in the 12 weeks of "watch and wait" and will resume treatment in mid-May. I also want to say that since my MM diagnosis I have had numerous suspicious moles that I have had biopsied that have been severely atypical as well as many that were melanoma, all confined to my right leg.

                  Good luck with your treatment options, dont look back, have no regrets and go on living life!

                  Vermont_Donna, stage 3a,

                  currently stable after 4 infusions of Ipilimumab

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                  Vermont_Donna
                  Participant

                    Hi,

                    Sorry that you have been diagnosed with melanoma but good that you found your way here. Treatment decisions are very personal, and you will see on this board that we have people who have done a variety of things, from "watch and wait" to a year of interferon (four weeks of high dose followed by 11 months of low dose injections), 4 weeks of high dose interferon, clinical trials, etc.

                    Sometimes you can only gain access to a treatment after you have "failed" others…ie do the Interferon, have a re-occurence, then are offered something else.

                    I think from your post above that you have a good grasp of melanoma,  are well informed, understand the disease initially and are pretty calm given this devastating news! Way to go! You will see that people can LIVE with this disease, and live full and happy lives. Now your life will be forever changed in that you will need to be vigilant about self monitoring and have more frequent skin exams by a dermatologist who knows melanoma well. You should look for anything that changes, no matter what color it is or anything new that pops up.

                    As for me, I chose to do the year of interferon, and have no regrets. I was pretty tired and did not work but applied for SSDI and was found eligible. After the year I returned to work and felt pretty good. I did have a re-occurence after a year (dont remember exactly when…..refer to my profile), and then after resection I did something else (sorry again refer to profile as I dont remember what came next…it is about 4 years later now). You are right in that interferon delays re-occurence but that "bought" time for me was precious, in that I felt that I was doing something to combat this disease and then other treatments were then offered when presented with the re-occurence. I have had many re-occurences since then and many other treatments. All treatments I feel have bought me time and have addressed the disease for a short period of time until I went on Ipi.

                    I am B-Raf negative so those trials are out. I was referred to do Ipi in a clinical trial at DHMC (Dartmouth Hitchcock Meical Center) and after the 4 initial doses I have had a complete response. I am in the 12 weeks of "watch and wait" and will resume treatment in mid-May. I also want to say that since my MM diagnosis I have had numerous suspicious moles that I have had biopsied that have been severely atypical as well as many that were melanoma, all confined to my right leg.

                    Good luck with your treatment options, dont look back, have no regrets and go on living life!

                    Vermont_Donna, stage 3a,

                    currently stable after 4 infusions of Ipilimumab

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                  Janner
                  Participant

                    Just a note, Dr. Samlowski is a very skilled melanoma doc – I would seriously consider any of his recommendations.  Clinical trials, interferon and watch and wait are about your options – and all are viable.  No treatments, to date, have shown an overall survival benefit and that means watch and wait is just as valid as anything else.

                    Good luck on your decision,

                    Janner

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                    Carmon in NM
                    Participant

                      Hi and I also am glad you found your way here, It's always the best I think to be able to talk directly with folks who have gone through the same experiences.

                      I was diagnosed stage 3b 8/2008 and chose the 'wait & watch' protocol because interferon seemed like a wash to me as far as delayed recurrance up against a year of treatment. I made it nearly two years before I advanced to stage 4 in 6/2010and I have no regrets at all about not doing interferon which was the only other option I was given at that time. I think the main thing is whatever you decide, be sure you are good with it and no second guessing or you will make yourself crazy!

                      I have just completed a clinical drug trial that was very successful for me even if it was a bit on the rough side but completely manageable for six months. The result was an adrenal tumor that went from 2.3 centimeters down to almost nothing on my last scans. I will be having surgery on April 19th to remove my right adrenal gland and anything that is left of that tumor.

                      I also had two brain mets that were treated with gamma knife surgery (GKS) which has also been completely successful for me with no new mets and the two mets appear to be nothing but scar tissue now with no activity on my last brain MRI.

                      I'm sharing these things so that you will know that even if you have recurrance and advance to stage 4, there are many more options now than there ever have been before and lots of folks are living long active lives even carrying the burden of melanoma. Once you get past the initial shock and fear that follows diagnosis and can begin to make decisions and plans you will begin to feel like you have a little control back in your life again.

                      All the best to you and please stick around and let us know what you decide and how you are doing! Carmon in NM

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                      Carmon in NM
                      Participant

                        Hi and I also am glad you found your way here, It's always the best I think to be able to talk directly with folks who have gone through the same experiences.

                        I was diagnosed stage 3b 8/2008 and chose the 'wait & watch' protocol because interferon seemed like a wash to me as far as delayed recurrance up against a year of treatment. I made it nearly two years before I advanced to stage 4 in 6/2010and I have no regrets at all about not doing interferon which was the only other option I was given at that time. I think the main thing is whatever you decide, be sure you are good with it and no second guessing or you will make yourself crazy!

                        I have just completed a clinical drug trial that was very successful for me even if it was a bit on the rough side but completely manageable for six months. The result was an adrenal tumor that went from 2.3 centimeters down to almost nothing on my last scans. I will be having surgery on April 19th to remove my right adrenal gland and anything that is left of that tumor.

                        I also had two brain mets that were treated with gamma knife surgery (GKS) which has also been completely successful for me with no new mets and the two mets appear to be nothing but scar tissue now with no activity on my last brain MRI.

                        I'm sharing these things so that you will know that even if you have recurrance and advance to stage 4, there are many more options now than there ever have been before and lots of folks are living long active lives even carrying the burden of melanoma. Once you get past the initial shock and fear that follows diagnosis and can begin to make decisions and plans you will begin to feel like you have a little control back in your life again.

                        All the best to you and please stick around and let us know what you decide and how you are doing! Carmon in NM

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                        RMcLegal
                        Participant

                          I was diagnosed Stage IIIc (14 malignant nodes) in 2003, and did a biochemotherapy clinical trial at the University of Colorado Cancer Center.  Today I'm still healthy and NED.  Sounds like you're seeing a melanoma specialist so you'll hear all of the options.  I never seriously considered the 'wait and see' approach– the statistics were just too grim and I couldn't stand to sit back and do nothing to put up a fight.  I've blogged about the lighter side of my long, strange trip at http://www.hotelmelanoma.blogspot.com.  Best wishes to you.

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                          RMcLegal
                          Participant

                            I was diagnosed Stage IIIc (14 malignant nodes) in 2003, and did a biochemotherapy clinical trial at the University of Colorado Cancer Center.  Today I'm still healthy and NED.  Sounds like you're seeing a melanoma specialist so you'll hear all of the options.  I never seriously considered the 'wait and see' approach– the statistics were just too grim and I couldn't stand to sit back and do nothing to put up a fight.  I've blogged about the lighter side of my long, strange trip at http://www.hotelmelanoma.blogspot.com.  Best wishes to you.

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                            washoegal
                            Participant

                              Hi,  you didn't give quite enough info here, and maybe at this point you really don't have it.  So I'll give you my story in hopes that it helps.

                              I'm a Stage 3a.  One Node with microscopic amounts of Mel.  I was diag Jan. 2010.  I was given same choices as you interferon or "wait and watch".  The deciding factor for me was that as my doctor explained it, decided a year of being pretty sick, patients that took interferion did not show any better survival rate.  That pretty much clinched it for me, my Onc who I trusted completed was not impressed with the drug, and I really didn't see much upside.  So I'm waiting and scanning….so for no Mel!  Next scan April.

                              That being said, it's a very personal decision what treatment you take for Mel.  You have to trust you Onc and yourself.  Once you make a decision don't look back!  Don't second geuss yourself. 

                              A few other things.  I'm in Carson City, so I looked into Mel secialists in LV.  I know there is one, and only one, group there.  I hope that is where you are.  Also talk to you doctor, if you haven't already, about the possibility  of lymphodema.  I got fit for a sleeve, in your case a stocking, immediately just to have it in case I needed it. 

                               

                              Good Luck

                              Mary

                              Stage 3a

                               

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                                Leah1030
                                Participant
                                  I have stage 3 and microscopic amounts in one node. After reading up on interferon i decided it would be best for me to wait and see. I ma taking the holistic approach.

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                                  Leah1030
                                  Participant
                                    I have stage 3 and microscopic amounts in one node. After reading up on interferon i decided it would be best for me to wait and see. I ma taking the holistic approach.

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                                    Leah1030
                                    Participant
                                      I have stage 3 and microscopic amounts in one node. After reading up on interferon i decided it would be best for me to wait and see. I ma taking the holistic approach.

                                      Loading spinner
                                      Leah1030
                                      Participant
                                        I have stage 3 and microscopic amounts in one node. After reading up on interferon i decided it would be best for me to wait and see. I ma taking the holistic approach.

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                                      washoegal
                                      Participant

                                        Hi,  you didn't give quite enough info here, and maybe at this point you really don't have it.  So I'll give you my story in hopes that it helps.

                                        I'm a Stage 3a.  One Node with microscopic amounts of Mel.  I was diag Jan. 2010.  I was given same choices as you interferon or "wait and watch".  The deciding factor for me was that as my doctor explained it, decided a year of being pretty sick, patients that took interferion did not show any better survival rate.  That pretty much clinched it for me, my Onc who I trusted completed was not impressed with the drug, and I really didn't see much upside.  So I'm waiting and scanning….so for no Mel!  Next scan April.

                                        That being said, it's a very personal decision what treatment you take for Mel.  You have to trust you Onc and yourself.  Once you make a decision don't look back!  Don't second geuss yourself. 

                                        A few other things.  I'm in Carson City, so I looked into Mel secialists in LV.  I know there is one, and only one, group there.  I hope that is where you are.  Also talk to you doctor, if you haven't already, about the possibility  of lymphodema.  I got fit for a sleeve, in your case a stocking, immediately just to have it in case I needed it. 

                                         

                                        Good Luck

                                        Mary

                                        Stage 3a

                                         

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                                        mom3girlsFL
                                        Participant

                                          Hi there,

                                          Sorry you have to be here but glad you found us.  This board will offer much advice and support!  I am 3c.  I decided to do interferon b/c I have 3 small girls and felt I needed to do anything that was available to me.  Unfortunately I had a recurrence shortly after starting the low dose phase.  I am currently "watch and wait" with a clear CT and xray as of this week (yay, 6 mths!).

                                          I think everyone would agree the high dose interferon is the worst part. The first week especially.  Once you start the self injection it's not too bad.  I was able to return to a somewhat normal life of working and all.

                                          It is a personal decision and you have to be comfortable with your choice.  I don't know if I would have been able to do the watch and wait as a choice, but now that I am here I realize that all of this is so out of my control.

                                          Good luck with your decision!

                                          Laurie

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                                          mom3girlsFL
                                          Participant

                                            Hi there,

                                            Sorry you have to be here but glad you found us.  This board will offer much advice and support!  I am 3c.  I decided to do interferon b/c I have 3 small girls and felt I needed to do anything that was available to me.  Unfortunately I had a recurrence shortly after starting the low dose phase.  I am currently "watch and wait" with a clear CT and xray as of this week (yay, 6 mths!).

                                            I think everyone would agree the high dose interferon is the worst part. The first week especially.  Once you start the self injection it's not too bad.  I was able to return to a somewhat normal life of working and all.

                                            It is a personal decision and you have to be comfortable with your choice.  I don't know if I would have been able to do the watch and wait as a choice, but now that I am here I realize that all of this is so out of my control.

                                            Good luck with your decision!

                                            Laurie

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                                            EmilyandMike
                                            Participant

                                              Hello and welcome – Sounds like you have a good handle on things.  I think you are stage 3a?  We have also found that 3a is a frustrating gray area just as your doc said.  The only options a doc can give you are watch and wait or interferon.  Melanoma clinical trials are not usually available to Stage 3a patients (they are more often available for 3b/3c and stage 4).  There is one blind adjuvant ipilumamab trial that is available to 3a.  I personally would recommend that over interferon…but you might not get the drug and you will need to start the trial soon after your surgery (think it is 8-12 weeks after node dissection).   http://clinicaltrials.gov/ct2/show/NCT00636168

                                              I would say you should study your sentinel node pathology.  When my husband was diagnosed with sub-micro metatastsis in the sentinel node, I read as many studies as possible on this. Perhaps the gray area comes from studies like the ones below that suggest 3a could be a false positive (because of the very small amount of melanoma) and that your immune system might be able to fight those few cells/very low tumor burden.  This could be why some studies exclude this group of patients in clinical trials.

                                              Here are some of those research reports that give me hope:

                                              "This large multicenter experience (n=595) has demonstrated that long-term follow-up of melanoma patients with minimal SN tumor burden (< 0.1 mm) indicates very low relapse rates and excellent MSS, seemingly identical to SN negative patients." http://meeting.ascopubs.org/cgi/content/abstract/27/15S/9005 http://jco.ascopubs.org/content/26/36/6011.full

                                              All my best to you

                                              Emily

                                              Wife of Mike Stage 3a – 18 mos NED with observation only

                                              http://www.emandmichael.com

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                                              EmilyandMike
                                              Participant

                                                Hello and welcome – Sounds like you have a good handle on things.  I think you are stage 3a?  We have also found that 3a is a frustrating gray area just as your doc said.  The only options a doc can give you are watch and wait or interferon.  Melanoma clinical trials are not usually available to Stage 3a patients (they are more often available for 3b/3c and stage 4).  There is one blind adjuvant ipilumamab trial that is available to 3a.  I personally would recommend that over interferon…but you might not get the drug and you will need to start the trial soon after your surgery (think it is 8-12 weeks after node dissection).   http://clinicaltrials.gov/ct2/show/NCT00636168

                                                I would say you should study your sentinel node pathology.  When my husband was diagnosed with sub-micro metatastsis in the sentinel node, I read as many studies as possible on this. Perhaps the gray area comes from studies like the ones below that suggest 3a could be a false positive (because of the very small amount of melanoma) and that your immune system might be able to fight those few cells/very low tumor burden.  This could be why some studies exclude this group of patients in clinical trials.

                                                Here are some of those research reports that give me hope:

                                                "This large multicenter experience (n=595) has demonstrated that long-term follow-up of melanoma patients with minimal SN tumor burden (< 0.1 mm) indicates very low relapse rates and excellent MSS, seemingly identical to SN negative patients." http://meeting.ascopubs.org/cgi/content/abstract/27/15S/9005 http://jco.ascopubs.org/content/26/36/6011.full

                                                All my best to you

                                                Emily

                                                Wife of Mike Stage 3a – 18 mos NED with observation only

                                                http://www.emandmichael.com

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                                                Jim M.
                                                Participant

                                                  I was diagnosed stage 3C in 11/07. I was offered Interferon, watch and wait or a clinical trial with Ipilimumab and vaccines. My thinking was the same as yours about Interferon. I felt watch and wait wasn't good enough. My doc. said 30% of those who watch and wait after surgery don't get a recurrence( which made me think the flip side of that is 70% do get a recrrence). After gathering 4 opinions from different docs I chose a trial with Ipilimumab with vaccines for resected melanoma. Three years later I'm NED but I'm on a steroid as a hormone replacement for hypopituitarism/ adrenal insufficiency, I have lymphedema in my right arm and now I'm on antibiotics for cellulitis. I'll never know if it was the best choice but I am alive, NED and praising God!

                                                   God guide you in your decisions,

                                                   Jim M.

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                                                  Jim M.
                                                  Participant

                                                    I was diagnosed stage 3C in 11/07. I was offered Interferon, watch and wait or a clinical trial with Ipilimumab and vaccines. My thinking was the same as yours about Interferon. I felt watch and wait wasn't good enough. My doc. said 30% of those who watch and wait after surgery don't get a recurrence( which made me think the flip side of that is 70% do get a recrrence). After gathering 4 opinions from different docs I chose a trial with Ipilimumab with vaccines for resected melanoma. Three years later I'm NED but I'm on a steroid as a hormone replacement for hypopituitarism/ adrenal insufficiency, I have lymphedema in my right arm and now I'm on antibiotics for cellulitis. I'll never know if it was the best choice but I am alive, NED and praising God!

                                                     God guide you in your decisions,

                                                     Jim M.

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                                                    gabsound
                                                    Participant

                                                      Thanks to all who have responded to my post. Hearing from others who are battling this disease is so valuable. And battle you have. What a brave group!! Still sorry to be on this ride. It's definitely a rollercoaster.

                                                      The results came back on my PET scan:

                                                      "There are extensive changes seen within the right groin and medial right thigh. Single area of increased hypermetabolic activity within the inferior portion of the right thigh incision where there is some thickening seen on the CT. The SUV is as high as 2.0. Suggest direct visualization and possible repeat biopsy and excision is suggested. There is low grade probable post surgcal activity within the right groin with no definite hypermetabolic lesions. The remainder of the PET findings demonstrate no evidence of distant metastatic disease."

                                                      My surgeon is the one that gave me the report and he said "that's why I don't do the PET scan this early". He thinks it's all related to the surgery and did not seem worried. I feel relieved, but know of course the scan will need to be repeated later to recheck that area. That part of my leg has been sore, but is less sore now than it was. Tomorrow makes 4 weeks from the date of my WLE and lymph node dissection.

                                                      I am awaiting my appiontment with Dr. Samlowski the oncologist who sees the most melanoma patients for my Oncology group. It's encouraging to have seen his name mentioned on the bulletin board. I will find out from him what exact stage I am in as of now since the other oncologist only said grade 3. I will see what options he presents and get back with everyone.

                                                      In relooking at my path report from lymph node bx it said a single focus measuring 2.9 mm in greatest dimension.in the sentinel node.

                                                      I also saw on a consult report that my Physician friend had that dx is superficial spreading Clark's level IV. Breslows depth 2.35 mm with ulceration present. Regression absent. Lesion now T3bN1M0.

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                                                      gabsound
                                                      Participant

                                                        Thanks to all who have responded to my post. Hearing from others who are battling this disease is so valuable. And battle you have. What a brave group!! Still sorry to be on this ride. It's definitely a rollercoaster.

                                                        The results came back on my PET scan:

                                                        "There are extensive changes seen within the right groin and medial right thigh. Single area of increased hypermetabolic activity within the inferior portion of the right thigh incision where there is some thickening seen on the CT. The SUV is as high as 2.0. Suggest direct visualization and possible repeat biopsy and excision is suggested. There is low grade probable post surgcal activity within the right groin with no definite hypermetabolic lesions. The remainder of the PET findings demonstrate no evidence of distant metastatic disease."

                                                        My surgeon is the one that gave me the report and he said "that's why I don't do the PET scan this early". He thinks it's all related to the surgery and did not seem worried. I feel relieved, but know of course the scan will need to be repeated later to recheck that area. That part of my leg has been sore, but is less sore now than it was. Tomorrow makes 4 weeks from the date of my WLE and lymph node dissection.

                                                        I am awaiting my appiontment with Dr. Samlowski the oncologist who sees the most melanoma patients for my Oncology group. It's encouraging to have seen his name mentioned on the bulletin board. I will find out from him what exact stage I am in as of now since the other oncologist only said grade 3. I will see what options he presents and get back with everyone.

                                                        In relooking at my path report from lymph node bx it said a single focus measuring 2.9 mm in greatest dimension.in the sentinel node.

                                                        I also saw on a consult report that my Physician friend had that dx is superficial spreading Clark's level IV. Breslows depth 2.35 mm with ulceration present. Regression absent. Lesion now T3bN1M0.

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