Mark M

Thanks Ed.  I don’t see anything like that on the pathology report.  Would it be there if they ran it?  Was trying to attach this image of the report here, in case I’m just not looking in the right place – but doesn’t look like this editor allows attachments other than URLs…

Thanks for the link – good info!

 

Thanks – this is extremely helpful insight regarding the article, with the lens that although it’s optimistic based on my wife’s results, it’s never 0% risk.  I’m starting to figure that out as I keep reading and getting info…

Regarding the question on the results, am sure I’m bungling the terminology and possibly the data 🙂 – but the metastatic deposit is  subcapsular and .03mm in greatest dimension…  She was classified as stage IIIa – pT1a, pN1a micro-metastatic.  Am I possibly using the wrong number in the tumor size of the T1a?  I was using the .03mm above from the node vs. the .5mm original tumor size it says for Breslow thickness?  Maybe that’s where I got confused with the 30x comment???

Either way – looks like all of the reports and studies re: immunotherapy I’ve been seeing do not include folks in IIIa with <1mm.  But am definitely interested in looking at the other patient risk factors you point out.

Regarding the BRAF status, I have now been reading about it – but didn’t know to ask and do not see it notated anywhere in any results, so am assuming we need to ask for it?  Am assuming this is just a blood draw?

We are also getting a good referral for a melanoma specialist from a reliable friend we just talked to today who knows several in the Cleveland area… so, hopeful we can get someone with good references and credentials.

Thank you so much!  I already feel 30x smarter on this than yesterday 🙂

Thanks Ed and Celeste!~ will be looking at all of this and will try to absorb…  lots of homework and probably more questions 🙂  thx again

Hi Celeste,

Thank you so much for your quick and thorough response, and the insights on the doctors.  Based on the other discussions I’ve seen, was hoping to get into a dialogue with you – as you seem so helpful, and your journey and work is inspiring!!!

As I comb through all of this am sure I will have many more questions – but to the ‘gambling’ question, seems that my wife’s current stage, there is an amount of gambling on either choice, as we also got stats on the possible side effects of the immunotherapy options.  Of course, if this was further along and confirmed spread, it would be a no brainer…  I keep going back to the studies like you reference above that include only:  stage IIIA (at least one lymph node metastasis greater than 1 mm).  This is 30x the size of my wife’s metastasis at .03mm.  Just seems like that is significant?

I’ve also seen excerpts of reports/studies with quotes like this:  Importantly, patients with stage IIIA disease and a sentinel node metastasis of 1 mm or less were excluded from these trials.  The benefit of adjuvant therapy in these patients, who are at lower risk of relapse, is unknown. National Comprehensive Cancer Network guidelines caution that, in patients with very low-risk stage IIIA disease, the toxicity of adjuvant therapy might outweigh the benefit. 

And also found this study on The sentinel node invasion level (SNIL) as a prognostic parameter in melanoma (which doesn’t seem like it was controlled, but interesting):  https://www.nature.com/articles/s41379-021-00835-5

I know that no one is going to make this decision but us – but any help is deciphering what is legit or not in these studies etc, and more data and info is helpful insight.

Looks like we have some reading to do.  Thank you so much!!!

Mark M