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Staging Question

Forums Cutaneous Melanoma Community Staging Question

  • Post
    tim brown
      Hi there from Oxford, England (or Eng-er-land as you folks sometimes pronounce it). I am Tim, 63,  a retired Intelligence Officer and aspiring author.

      Brief Summary: April 2020. Massive lump in left axilla – thought to be lymphoma related but diagnosed melanoma of Unknown primary(MUP). No co-morbidities, so performance status of zero (PS o).

      Lymph node dissection and excision 2 weeks later. Pathology reported 4 of the 15 nodes were cancerous, BRAF wild type, but NRAS positive.  Stage set at 3C.
      June 2020- started  adjuvant pembrolizumab – administered 6 weekly due to Pandemic. Found it pretty easy initially. (Note: All this was provided free of charge by the UK National Health Service)

      Jan 2021, Grade 1 or 2 colitis started, then in early Feb, recurrence (20x 25 mm tumor) in the same axilla. Pembro was stopped and I underwent further surgery at the beginning of March. Healing well but the surgeon had no margins to play with as the tumor was right up against the ulna nerve.
      Apart from regular MRI and CT scans, no treatment envisaged unless or until further recurrence. If it returns locally, then surgery or TVEC. Otherwise Ipi/Nivo combo is waiting in the wings. (Note: Relatlimab combo is still some way off, and even then it might not be the silver bullet that we are hoping for, according to one of my oncologists).

      My Question: The first oncologist said that the recurrence, although local, took me to Stage 4, while his younger colleague disagrees, saying it was still Stage 3, (albeit recovering). Which view is correct?

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          More knowledgeable peeps will answer this later I am sure. In my little bit of a brain, I would think that you would continue to be 3C since the cancer has not spread to a distant location from the original location. I believe that you would be stage IV if your nasty beast had spread to another location, but I could be wrong. Sounds like the treatment has been okay. I also contracted colitis during immunotherapy, and it isn’t fun. Been NED for a while now, but still have ongoing stomach issues, have been told it’s probably my new norm. Hope you have nothing grow back!!!


          tim brown
            Thanks Ted, that’s the answer I want! .

            I guess the alternate view is that the lymph nodes were the secondary location (by proxy),  ergo it has spread. Onwards and upwards

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