Positive lymph nodes biopsy

I am sorry for what you and your wife are dealing with. You sound as though you have done some melanoma home work already but here are some sites/links that may be helpful:
Here is the MRF melanoma guidebook: https://online.flippingbook.com/view/340078/
Here is some information regarding Stage III melanoma, since if I am reading what you report correctly and no further evidence of spread is found, your wife will be Stage IIIB: https://www.aimatmelanoma.org/stages-of-melanoma/stage-iii-melanoma/

So….what do you do about all that? First, let me try to answer your questions:

You will need to ask about the amount of melanoma in the lymph nodes. Did it remain within the lymph node? (It sounds as though it did from what you report and that is good.) What is the BRAF status of the tumor within the node and from her cutaneous lesion? There ARE different treatment options depending on mutation status.

No one wants radiation of any kind. However, the scans needed for diagnosing and following melanoma provide minimal radiation, especially when compared to progression without recognition. (Many of us here have had more scans than we can count and we haven’t grown three heads. Yes. That’s melanoma humor and it helps!)

Should brain mets occur they do so. Location of the primary lesion or initially affected nodes are not relative in any of the literature or experience I have noted.

Now….it is good that the lesion has been removed along with the positive sentinel nodes. It is of course a negative prognostic sign that two nodes were affected with melanoma. Unfortunately, your wife’s age (younger than 40), presence of mitoses, ulceration and thickness are all negative prognostic signs as well. Hopefully, no more melanoma lesions will be found on scans and she will remain a Stage III melanoma patient. If lesions are found she will progress to Stage IV.

Choosing a treatment path in melanoma is intensely personal. That said, were I in your wife’s shoes, given the presentation and factors I just covered, I would run to the nearest melanoma specialist I could find and seek adjuvant care (treatment provided despite no evidence of current disease) in the form of immunotherapy or targeted therapy (something that works only if you are BRAF positive) ASAP!!!

No, I didn’t start speaking Greek. Just melanoma jargon. Here is a primer I put together that covers all current routine melanoma treatment options and a link definitions of acronyms at the end: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/08/melanoma-intel-primer-for-current.html

Here are innumerable reports on adjuvant treatment: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/search?q=adjuvant

I know that is a lot to take in. However, you can do it!! Your wife is lucky to have you in her corner.

FYI: There is much hope! Melanoma is not the death sentence it once was. Like your wife, I was diagnosed with Stage IIIb melanoma in 2003 at the age of 39. None of today’s therapies were available at that time. In fact they were only FDA approved in 2011 and the adjuvant use even later. So….no matter what I wanted, I was relegated to watch and wait. So, I watched until I progressed to Stage IV melanoma with brain and lung mets in 2010. After having the right upper lobe of my lung surgically removed and the lesion to my brain radiated…I qualified for an NED arm of a Stage IV trial of nivolumab (Opdivo) that year. I and my fellow ratties took nivo for 2 1/2 years. We have done very well!!! In fact, despite my sordid history, I remain NED for melanoma to this day with my last treatment in June of 2013.

I wish you both my best. Ask more questions as you have the need. This board is filled with many caring and knowledgeable peeps. Celeste

Do whatever Bubbles says! Especially run to a melanoma specialist. Get on an airplane, whatever it takes. Best wishes to you both!

Just to clarify our responses about speed and planes, Jean! I was not aware you were in the UK, though we have lots of peeps from everywhere on this forum. While there are differences in the UK vs US systems of healthcare, I can note pros and cons of both. In the US, we have a less structured system in some ways. While there may be some benefit in that, it can also mean you could be treated by someone who knows very little about or has no experience in treating your disease. In the UK, things are more structured. Granted, there can be downsides to that, but given that the NHS protocols are in place, you are likely to get up-to-date care no matter where you go! So that is good. Our recommendations of “speed” are related to that as well. You are not in a “crisis” situation. I mean, you don’t need to sit on this…but I think if you continue to make progress as you describe things will be fine.

You are correct, there is a tiny bit of literature that addresses location of mets based on location of original lesion as well as origin of mets – as in where mets start first and then tend to spread, etc. Guess it wasn’t entirely fair to ignore it, but given where you are and how inconclusive that data is, I didn’t want get into the weeds too much. To be more accurate, I probably should have stuck with what we absolutely know about melanoma ~ it is utterly unpredictable and does whatever it wants no matter what we think we know about it! My usual phrase is: Melanoma sucks great big green stinky wizard balls!!! Still, your wife has you and hope!!! That is something indeed. Will keep fingers crossed that her scans are clear. Stay in touch. c