My mum was dignosed as primary mucosal melanoma around cardia of stomach. The primary tumer is is a short pedicle polyps 5.7*5cm, basal part of tumor is around 2cm, it came from mucous layer. She had a ESD surgery first because thegastroscope biopsy result showed benign. But after the dignose with phthology, she received another surgery with a wider dissection (proximal gastrectomy).The pathology after surgery showed another small 1*1*0.5cm tumor in the same cardia area and 1 metastatic lymph node metastasis located in the right of cardia (out of 21 dissected lymph node) with negative up and down incisal edge. The surgeon said that my mum is a T2N1M0. Immunohistochemical result：Negative in BRAF, CKIT & NARS, PD-L1 22C3. The hospital also held a MDT to discuss this case. However, the next treatment suggestion is not clear, they are saying that this is a rare case and there is no clear evidence showing any effective treatment plan for this kind of mucosal melanoma.My mum is under observation now without any adjuvant treatment.Some doctors suggest to use interferon alfa or could even try PD1 (though it is not approved by CFDA yet now in China). I had checked NCCN guidelines, clinical trial results and articles… …I know observation is a choice, but is struggling if we should use some medcine to "control" this a bit.
And also the smaller tumor(1*1*0.5), is it a satellite or in-transit or another primary? My mum should belong to stage 3, right?
How can I predict how invasiveness this tumer is? Would Ki-67 help to predict? Would a tumer genetic testing(showing TMB, MSI) help to predict?
How should I choose the treatment ? What should I pay attention to if my mum just wait and watch?
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