Without a more complete story I cannot tell you what I would absolutely do. If all scans are negative and this was the only lesion I had, here are the things I would consider and discuss in-depth with my doc:
1. I would want to know my BRAF status. Targeted therapy can work rapidly, and there are good reports (many were included in the link I shared with you previously) in the neoadjuvant setting.
2. I would want to know the plan for follow-up if I were to take Keytruda. Meaning, when would re-scanning take place? When, and based on what criteria, would they consider removing the lesion? Do they have any info on how that choice would be impacted by COVID in your area?
3. I would be very interested in a discussion and possible trial of intralesional therapy. Medication that is injected directly into a lesion that is accessible (which yours clearly is) that can get rid of the lesion and have a bystander effect (kills off lesions that are NOT directly injected). Here are many reports:
https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=intralesional&max-results=20&by-date=true
4. Given that this lesion is located along the scar of your prior carotid surgery, is it in an area that would make removal complicated?
Things to keep in the back of your mind.
1. Lots of Stage IV patients with active, present lesions throughout their body, for whom surgery is not an option, can have those lesions resolve on either targeted or immunotherapy.
2. Any treatments, whether intralesional, targeted, or immunotherapy, that can shrink the tumor will make removal, should it even be needed, easier.
This is probably not the answer you want to hear. But this IS precisely what I would be asking my doc. Hope that helps. Celeste
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