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Treatment decision–weigh in?
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Treatment decision–weigh in?

› Forums › General Melanoma Community › Treatment decision–weigh in?

  • Post
    • January 23, 2020 at 1:34 am
    lkb
    Participant
      Hello melanoma smarties!

      After a year of intralesional injections and Pembro, three tumors have disappeared and I’ve developed vitiligo (but no serious or unmanageable side effects). For my only remaining lesion (neck), I need to decide between surgical removal and continued treatment. Latest scans show stability; remaining lesion has stopped shrinking and is either melanoma or just an enlarged lymph node.

      Surgery (unlike biopsy) would give certainty (possible NED!), but last time it caused (temporary) nerve damage.
      Continued Pembro, however, carries other risks—thyroid, diabetes, gastro, overtreatment, etc.

      Weigh in? Thank you!

    Viewing 3 reply threads
    • Replies
        • January 23, 2020 at 1:45 am
        Bubbles
        Participant
          First of all – YAY!!!!!!!!!!!!!!!!!!! Welcome to a whiter shade of pale and disappearing tumors!!!! Why is it an either or? Could the lesion be biopsied with less risk of damage and if it is dead leave it and stop treatment? What nerve damage are you looking at? All of my surgeries have left some amount of nerve damage – some that resolved and some that didn’t. What sort of issue do you think you are looking at? What about splitting the difference? Another 6 months of pembro and f/u scans – if no change – then quit????

          Given most of that response consists of questions, probably not what you were looking for! HA! But still – YAY!!!! celeste

          • January 23, 2020 at 2:04 am
          ed williams
          Participant
            My first thought would be to ask for a Pet-Ct to see if there is any SUV uptake of the radioactive sugars, if none then good chance tumor is just showing up on scans and is dead tissue (that is what my situation with lung met turned out to be after 4 years of regular ct scans and considered a partial responder I was able to get approval of Pet-ct showing no SUV uptake). If still active and SUV uptake then staying on treatment or the surgery choice would make more sense. Good luck with decision!!!Ed
              • January 23, 2020 at 2:10 am
              Bubbles
              Participant
                Good recommendation!!! I like this plan! c
              • January 23, 2020 at 2:50 am
              lkb
              Participant
                Thank you, both, Celeste and Ed! My onc says she would not be satisfied with a negative biopsy, because micro cells could lurk in another part of the lump. Below is my table of scan results for this lump. My onc thinks the recent increased SUV could be related to a cold I had in December, rather than progression. I’m grateful for your thoughts to this point; if you have any more after seeing these numbers, please let me know. Again, my thanks.
                Dec 2018 1.1 cm SUV 12.8
                Jan 2019 1.1 cm SUV 15.8
                Apr 2019 1.1 cm SUV 12.8
                July 2019 0.9 cm SUV 9.29
                Oct 2019 0.9 cm SUV 7.5
                Jan 2020 0.9 cm SUV 9.0
                • January 23, 2020 at 1:27 pm
                Edwin
                Participant
                  I would consider surgery or radiation and consider continuing Pembro immunotherapy for several months. In April 2018 a PET/CT scan showed more activity at a lymph node in my neck. An MRI showed a tumor there. My oncologist sent me to a surgeon, who declined to do surgery. Instead I had radiation to that tumor.
                  PET scan SUV maximum of lymph node under my left jaw.
                  3.7 2018 April
                  4.2 2018 September
                  4.0 2018 December
                  3.2 2019 March
                  2.6 2019 July
                  2.0 2019 December ( “activity at background levels” )
                  I still receive nivo immunotherapy. I still sometimes have a little pain from a CLNB done in my neck in August 2014.
                    • January 23, 2020 at 5:47 pm
                    lkb
                    Participant
                      Thank you, Edwin. I’m making an appointment with the surgeon; it’s possible he will decline, since he has performed two partial neck dissections on me already. Nobody has mentioned radiation, so that will be my next question. Any side effects from it?
                      • January 23, 2020 at 6:05 pm
                      Edwin
                      Participant
                        My 2018 neck tumor was near my 2014 CLNB. This was one reason the surgeon did not want to remove the tumor. My only side effect from the radiation was fatigue. I was fortunate. I was told that the radiation could cause serious problems due to the location of the tumor.
                        • January 23, 2020 at 7:02 pm
                        lkb
                        Participant
                          Ah, that might be the reason, they have not suggested radiation for me–current bump is close to previous neck dissection. Thanks for your reply.
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