Questions to Ask Oncologist

Sorry you and your brother are dealing with this. He is lucky to have you in his corner.

At this point, there is not a lot to be known by anyone until the surgery is done and you get a path report on your brother’s sentinel node. Meaning – As I understand it you brother has a cutaneous lesion that is positive for melanoma per biopsy and is rather deep. That initiates the plan that you have in place – a WLE (wide local excision) to secure appropriate clear margins for the melanoma lesion and a SLNB (sentinel lymph node biopsy). These procedures should be done at the same time (and it sounds like that is the plan). Dye will be injected before the WLE and it will be traced to the location of the first (or first couple) of lymph nodes that the melanoma lesion drains to. The WLE and excision of the nodes that light up (usually 1-3) will be completed. Those nodes as well as the tissue removed around the melanoma lesion will be examined for melanoma and other information.

If the nodes are positive that will make your brother Stage III and he will have to think about adjuvant therapy or not. If the nodes are negative, he will be Stage II and have to settle on some plan of follow up. You also have to throw in the issue of scans and what findings you determine there. I’m sure the doc has a plan for that based upon what is or isn’t found. Of course if there are mets at a distant site, he will be Stage IV and that is a whole other treatment plan. So…..at this point you pretty much have to wait and see what is found. I would make sure that they test the lesion for its BRAF status. That is a mutation that can be treated, if present, by targeted therapy. It is pretty much done routinely these days, but I would still make sure it happens. Here is an explanation of BRAF: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2014/02/braf-inhibitors-for-melanoma-dabrafenib.html There are many BRAF/MEK combo’s these days…but that post explains what this is all about.

The search bubble at the top left of my blog is your friend. So is the search bubble on this forum. Sadly, any significant illness has it own language, and it is always incredibly foreign at first. When I was diagnosed as Stage IIIb in 2003 my sister (I learned later) sat with a medical dictionary while reading the papers and reports that my husband and I sent her. Needless to say, she has been a major support to me and mine!!! Believe it or not, I have worked very hard to make all posts on my blog as comprehensible to the medically unfamiliar and newly diagnosed – yet still excruciatingly medically and scientifically accurate – as possible. My take on the report is usually written in red beneath the article abstract. This is important stuff. Slang won’t do. Please take a few reads of the “primer” of treatment options I have put together: https://chaoticallypreciselifeloveandmelanoma.blogspot.com/2017/08/melanoma-intel-primer-for-current.html

IF (and I hope he is not) your brother turns out to be Stage III or Stage IV, it gives you all the treatment options you will then need to discuss with his doc. It also includes a list of useful acronyms in a link at the end. This stuff WILL become understandable if you read it through a few times. By the time my kids were in their teens (they were 10 and 12 when I was diagnosed) they could hang with any melanoma researchers in discussing the various treatment options that were still in trials at the time. You can do this!

So, all I can tell you at this point is support your brother. Help him get through the up-coming surgery. See what the scans show (if he has had them). See what the results of the SLNB show. Then you will have to go from there. Hope this helps. Ask more questions as you have the need. I wish you and your brother my best. Celeste