Stage 3C – no adjuvant treatment available due to MS

So sorry you had to become a member of this club. "Observation Only"/"Watch & See" is a bonafide option for Stage III folks. And, there are a number of people who do well with it. But I can certainly understand the lack of a warm and fuzzy feeling you have toward it. Nivolumab/Opdivo may be an option for you and its side effects are not as harsh as Ipi's. Have you asked the onc about that? If you're being seen at MD Anderson they should be up to speed on that. 

With regard to MS — please bear with me on this — in many cases it ends up being a case of misdiagnosed Lyme Disease. I've seen this first hand, which is why I'm bringing it up. Lyme is not an autoimmune disease so you would have more options available for melanoma treatment. It's also not restricted to just the east coast. Actually, it can be found all throughout the US, Canada, and Mexico. It may behoove you to get a second opinion on your MS to make sure it actually is MS and not Lyme. Lymenet.org will have more information about that. In your case a diagnosis of Lyme would work to your benefit in terms of melanoma treatment options. I know this sounds bizzare and I apologize in advance if this is a sore subject. 

The MS definitely complicates your situation. Tight time span scans are a good idea. IF… and that is indeed an IF… IF you progress, those frequent scans should detect things in "early phase". I know, it seems weird to consider anything that would place you into stage IV as "early phase"… buuuuut… the sooner the better for noting any progression. Smaller lesions would be easier to attack, both surgically as well as chemically. With Ipi being the "bad boy" of harsh side effects, you are probably wise in avoiding it with your MS. That is certainly something you don't want to aggrevate unless it becomes absolutely "necessary" to take the risk. I'm assuming since surgery, nothing active is showing… yes? You're technically NED at this point, right?  I can't imagine how unnerving watch and wait must be for stage 3 patients, particularly someone with an aggressive nature. Prior to Yervoy, there wasn't much option, and Yervoy is still fairly new to the stage 3 adjuvent protocols… so I imagine there must be at least a few others here in the "watch and wait" boat with you. 

All of that said….. should you progress… IF IF that occurs, you are not totally without immunotherapy options. Investigations and research in treating autoimmune patients with Ipi and/or either of the PD1 agents is in the early stages. The longer you go with clean scans, the more learning is being done, and the more docs can mitigate the additional risks. At this point, there are TWO noted cases of melanoma patients with MS being treated with Ipi. One ended up doing just fine on it… the other had a flare of the MS.  Both of these case reports comeing from 2014, and still being the same two referenced at ASCO 2017. 

Fingers and toes crossed for continued clean scans for you.