The stage remains at 2C, or possibly 3.
This isn’t as great as the melanoma disappearing, but is awesome compared to what we feared most. The PET showed all major organs are clear, no bone affected. There is increased activity in the scalp, which may be related to the existing lesion.
The other area of concern is some muscle which surrounds the sentinal lymph node. This is the first lymph node(s) where cancer cells are most likely to spread from a primary tumor. Dr. Reid thought this is because some may have gotten into the lymph node. This node will be biopsied, and may lead to the removal of other lymph nodes in his neck (left side). This is still considered part of the staging procedure. For more information about sentinel lymph node biopsy in regard to melanoma, click here.
Clinical Trials and 2nd Opinion
Dr. Reid welcomed questions. We asked about clinical trials for melanoma at the University of Iowa. He knows Dr. Hoshi, the surgical oncologist there, as well as Dr. Mohammed Milhem, the oncologist. He highly suggested we get another opinion, saying “Melanoma is nothing to mess around with. It’s possible you can have access to better meds and newer treatments, and if it were my wife having this done, I’d get 6 or 7 different opinions.” We really appreciated his sincerity, care and willingness to answer our questions candidly. He also said, “If this was breast or colon cancer, I would say no need, but melanoma is very serious and worth every possible consideration. But we can’t delay, so we will keep things moving.” I can’t tell you how delighted I was to hear this. So while we research a bit more, we will still keep things moving.
Kevin likes being close to home, so we’re going to see if he can do the clinical trials, and some work here at Hall Perrine if possible. Dr. Reid’s office made an appointment with the University of Iowa’s clinical trial office for melanoma, and we will meet with them later in the week to discuss. He also made an appointment with the plastic surgeon.
What Happens Next?
- 2nd Opinion at the University of Iowa – this week
We’ll meet with a surgical oncologist and oncologist (who handles the meds) to discuss Kevin’s diagnosis, treatment and possible clinical trials specifically targeting melanoma.
- Meet with Plastic Surgeon to discuss Wide area excision – this week
The next step is to get rid of the lesion. This surgery is called a wide, local excision. In Kevin’s case, due to the depth and size of the melanoma, the surgeon will need to go 2 cm around the area. As Dr. Reid put it, “First I draw a circle around the melanoma. Then I draw a circle which is 2cm wider all around, and that’s where we’ll cut.” However, with the scalp, circle-shapes don’t heal as well as football shapes, so the excision will be angled higher up and down, so the skin will mend better. This will also require a skin graft, probably from Kevin’s inner thigh, so he sees a plastic surgeon this Thursday.
- Set a date for the Wide Area Excision Surgery – no date yet
We won’t know the exact date until after meeting with the plastic surgeon, and back to Dr. Reid, but this surgery will likely take place later next week at the earliest.
- Biopsy of the sentinel node – not date yet
Biopsy will be done during the wide area excision surgery. This is a live biopsy, not a frozen one. This will be the biopsy of the sentinel node (see diagram above). This is tricky surgery. We want to meet with the U of I to see if having this surgery beforehand disqualifies Kevin from clinical trials.
- Deciding which place to go – Hall Perrine or University of Iowa? – Hopefully this week
With clinical trials, Kevin has a better chance of fighting the melanoma cells directly, not just cutting them out and watching for cancer. While the cancer fortunately, hasn’t spread far, there remains the danger that it can. Many of the trials offer newer and more effective meds for this type of cancer, and these meds are not available to everyone yet. Also, while our insurance is great, our financial condition is not. Since it’s a trial, some or all of the associated costs will be covered, which helps a great deal. The oncologist there can advise about which way to go.