Stage IIIC need advice please

Wait and watch is a terrible approach. Request to have your blood tested for circulating tumour DNA to help inform your treatment options. The tests take 8-12 weeks to come back right now at U of M. There are only 4-5 biochemical pathways that your melanoma can mutate through and learning which pathway needs to be shut down is critical in melanoma. if they know which pathways are affected, then it is much easier to select a checkpoint inhibitor that is right for you. 

There is also genetic testing available at U of M now which can at least tell you if you have any of the major melanoma genes. It's still a matter of controlling whichever pathway is going haywire, but it's much easier to target the checkpoint inhibitor if you know what is going on. Education is everything. 

I highly recommend enrolling in a clinical trial; it has made a huge difference in my quality of life..

Raegen

Hi – Glad you posted to let us know how you're doing – I'm so sorry to hear they had to take alot of that finger, though with the history you gave us before, I guess it wasn't surprising for you – and at least you aren't dealing now with the pain that caused. Am sorry also that you're at stage 3c!!! It's great the scans are clear though!!

If I were in your shoes now, 'watch and wait' would be out of the question – I would want the immunotherapy (ipi) that is given as adjuvant treatment for stage 3. If you do a little search on here, you'll see that there are many people undergoing this therapy right now.

Doing a CLND is a debatable issue now (I believe – forgive me if I'm wrong because I haven't studied the issue – just a recent new discussion) following the premise that the immunotherapy will go after any remaining cells in the lymphs.

There's many on here also attending MD Anderson with great things to say about the facility and its professionals, so it sounds like you're (finally) in good hands. 

So again, if immunotherapy is offered (and I'm pretty sure it will be), I'd take it if it was me … and hopefully that will be the last treatment you will ever require!!

Please let us know how you make out. Wishing you the best always!!

Barb 

Hi jc2dad, this has been a very interesting post so far with many varied suggestion. I will assume that your team at MD Anderson have staged you already and I am curious did they say 3b or 3c. There was some data out in June about the benefits of CLND from the MSLT-11 study, here is a link if you are interested http://www.nejm.org/doi/full/10.1056/NEJMoa1613210   . I also have a link to an Onclive video from 3 months ago talking about adjuvant melanoma options and it features Michael Davies of MD Anderson.  ttps://www.youtube.com/watch?v=7BIXL2A1EKc  . Davies is leaning towards getting into clinical trials at this point which makes a lot of sense from an access to the best new drugs and close follow up and scans!!! Best Wishes with a tough decision!!!Ed

I have always tended to skew very aggressive with attacking melanoma, so take this for what it's worth from my personal perspective…….. I would not watch and wait. Your body has already shown that there was spread via the lymphatic system, and it cannot be ruled out that it is already in the blood. You may very well be clean and clear at this point. Buuuuuut… as one who learned that she'd advanced to stage IV via a grand mal seizure (mets to the brain) … I'm a little jumpy about left over micro-bits and pieces. Melanoma doesn't play nice. Yervoy is already an adjuvant option for stage III. Being treated at MD Anderson, I'm guessing there's a pretty strong shot at finding a possible PD1 trial you could shoot for as well. A trial option may answer your question regarding whether or not CLND should be considered… depending on what pre-trial treatments have already been done/not done, and what the ideal trial candidate looks like. If immunotheraputic drugs are going to be effective for you… they'll be effective both inside and outside the lymph nodes. You're in a solid treatment facility full of brainiacs who have access to more options than most other places. Drill them with questions, and make them use those well oiled minds! : )  It all comes down to possible positives of each option, versus the possible negatives of each, and what will make YOU the most comfortable.