adjuvant therapy for stage 1b?

Hi kspfjsaf

From what I know, the treatment your wife has been given and the follow up are what's recommended for stage 1b (I am in Australia). It sounds like textbook treatment to me, any other intervention would be premature and possibly do more harm than good. I can't add much more than to say I'm pleased that the WLE and SLNB were clear, and for all intents and purposes your wife is now considered NED.  I've heard of much higher mitotic rates than 2 (though 0 is ideal…) and much deeper mels than 1.12. I'm hoping this is the end of your wife's brush with melanoma and that over time she just goes from strength to strength. That said, I'm all for 2nd opinions so going to another mel centre won't hurt.

Stars

Hi kspfjsaf

From what I know, the treatment your wife has been given and the follow up are what's recommended for stage 1b (I am in Australia). It sounds like textbook treatment to me, any other intervention would be premature and possibly do more harm than good. I can't add much more than to say I'm pleased that the WLE and SLNB were clear, and for all intents and purposes your wife is now considered NED.  I've heard of much higher mitotic rates than 2 (though 0 is ideal…) and much deeper mels than 1.12. I'm hoping this is the end of your wife's brush with melanoma and that over time she just goes from strength to strength. That said, I'm all for 2nd opinions so going to another mel centre won't hurt.

Stars

Hi kspfjsaf

From what I know, the treatment your wife has been given and the follow up are what's recommended for stage 1b (I am in Australia). It sounds like textbook treatment to me, any other intervention would be premature and possibly do more harm than good. I can't add much more than to say I'm pleased that the WLE and SLNB were clear, and for all intents and purposes your wife is now considered NED.  I've heard of much higher mitotic rates than 2 (though 0 is ideal…) and much deeper mels than 1.12. I'm hoping this is the end of your wife's brush with melanoma and that over time she just goes from strength to strength. That said, I'm all for 2nd opinions so going to another mel centre won't hurt.

Stars

The shock is real but the plan of action set out by your doc is realistic.  No insurance company will pay for any treatment or scans for stage 1b.  Truthfully, scans haven't been shown to increase survival rates and some institutions won't even do them for stage 3/4 unless you have symptoms.  PET scans are only so helpful because they don't pick up microscopic disease, only tumors of about 5mm and larger.  They also are prone to false positives.  All the new treatments are still experimental as adjuvant therapy and not  available outside a trial for stage 3 let alone stage 1b.  More isn't always better, some times it,just is more!  No melanoma center will do anything differently than what you described.  Remember, they see a lot of melanoma and know that the chances are good your wife won't deal with this again.  Also, the drug field is changing rapidly.  Doing treatments now may disqualify you later in clinical trials when it counts.  And less toxic drugs may be on the horizon.  Your wife is following the standard protocol for her stage.

Best wishes,

Janner

stage 1b since 1992, 3 mm primaries

The shock is real but the plan of action set out by your doc is realistic.  No insurance company will pay for any treatment or scans for stage 1b.  Truthfully, scans haven't been shown to increase survival rates and some institutions won't even do them for stage 3/4 unless you have symptoms.  PET scans are only so helpful because they don't pick up microscopic disease, only tumors of about 5mm and larger.  They also are prone to false positives.  All the new treatments are still experimental as adjuvant therapy and not  available outside a trial for stage 3 let alone stage 1b.  More isn't always better, some times it,just is more!  No melanoma center will do anything differently than what you described.  Remember, they see a lot of melanoma and know that the chances are good your wife won't deal with this again.  Also, the drug field is changing rapidly.  Doing treatments now may disqualify you later in clinical trials when it counts.  And less toxic drugs may be on the horizon.  Your wife is following the standard protocol for her stage.

Best wishes,

Janner

stage 1b since 1992, 3 mm primaries

The shock is real but the plan of action set out by your doc is realistic.  No insurance company will pay for any treatment or scans for stage 1b.  Truthfully, scans haven't been shown to increase survival rates and some institutions won't even do them for stage 3/4 unless you have symptoms.  PET scans are only so helpful because they don't pick up microscopic disease, only tumors of about 5mm and larger.  They also are prone to false positives.  All the new treatments are still experimental as adjuvant therapy and not  available outside a trial for stage 3 let alone stage 1b.  More isn't always better, some times it,just is more!  No melanoma center will do anything differently than what you described.  Remember, they see a lot of melanoma and know that the chances are good your wife won't deal with this again.  Also, the drug field is changing rapidly.  Doing treatments now may disqualify you later in clinical trials when it counts.  And less toxic drugs may be on the horizon.  Your wife is following the standard protocol for her stage.

Best wishes,

Janner

stage 1b since 1992, 3 mm primaries

Just wait… The stories I have read are, removed a skin met went on lived my life thought everything was fine and 6-10 years later found several internal mets. Then started something.

In 6-10 years the technology is going to be much more advanced.  We seem to be on the edge of all sorts of things, like testing for PD-1.  Right now we are giving PD-1s to lots of people and it is working in less then half.  In the next couple years I think they will be able to test to see if a PD-1 will work before they give it.  There is also a vaccine that goes directly into the tumor in the works.  Definitely keep doing skin checks and keep asking the docs about scans (because that technology will advance also) but at this point wait and watch.  Vitamin D testing/supplements might be worth looking into if you want to do something proactive.

Just wait… The stories I have read are, removed a skin met went on lived my life thought everything was fine and 6-10 years later found several internal mets. Then started something.

In 6-10 years the technology is going to be much more advanced.  We seem to be on the edge of all sorts of things, like testing for PD-1.  Right now we are giving PD-1s to lots of people and it is working in less then half.  In the next couple years I think they will be able to test to see if a PD-1 will work before they give it.  There is also a vaccine that goes directly into the tumor in the works.  Definitely keep doing skin checks and keep asking the docs about scans (because that technology will advance also) but at this point wait and watch.  Vitamin D testing/supplements might be worth looking into if you want to do something proactive.

Just wait… The stories I have read are, removed a skin met went on lived my life thought everything was fine and 6-10 years later found several internal mets. Then started something.

In 6-10 years the technology is going to be much more advanced.  We seem to be on the edge of all sorts of things, like testing for PD-1.  Right now we are giving PD-1s to lots of people and it is working in less then half.  In the next couple years I think they will be able to test to see if a PD-1 will work before they give it.  There is also a vaccine that goes directly into the tumor in the works.  Definitely keep doing skin checks and keep asking the docs about scans (because that technology will advance also) but at this point wait and watch.  Vitamin D testing/supplements might be worth looking into if you want to do something proactive.

First I want to say that I do agree with the above.  What Janner said about sometimes more is not better, it's just more is very, very true, and it is something many of us faced with a cancer diagnosis will struggle with.

I will also say that my oncologist told me she has a stage I melanoma patient who comes in yearly for followup, for lymph node checks, blood work, and she pays for her own PET CTs out of pocket because it makes her feel better.  Insurance won't cover them so she does this on her own.  She is 10 years out and still free of recurrence.  This particular clinic offers greatly reduced rates on PET CTs to patients who choose to do this when insurance won't pay.  If you can find a clinic or can afford to pay for a PET CT and having negative results will be reassuring to you, why not?  Aside from the risk of false positive findings as your doctor pointed out, maybe it WILL make you both feel better.  And my feeling is that if it makes the two of you feel better, why not get a second opinion?  There IS some variability in followup plans even among melanoma specialists.

You can also ask where your wife's melanoma is most likely to metastasize (melanoma does tend to spread to certain locations based on the location of the primary), and ask if it is possible to have an xray done of that area every so often.  You can ask whether it would be worthwhile to check blood LDH levels periodically.  My understanding is that some specialists do this, others don't.

Good luck, and may your wife be one of the majority who go on to never have to deal with melanoma again.

First I want to say that I do agree with the above.  What Janner said about sometimes more is not better, it's just more is very, very true, and it is something many of us faced with a cancer diagnosis will struggle with.

I will also say that my oncologist told me she has a stage I melanoma patient who comes in yearly for followup, for lymph node checks, blood work, and she pays for her own PET CTs out of pocket because it makes her feel better.  Insurance won't cover them so she does this on her own.  She is 10 years out and still free of recurrence.  This particular clinic offers greatly reduced rates on PET CTs to patients who choose to do this when insurance won't pay.  If you can find a clinic or can afford to pay for a PET CT and having negative results will be reassuring to you, why not?  Aside from the risk of false positive findings as your doctor pointed out, maybe it WILL make you both feel better.  And my feeling is that if it makes the two of you feel better, why not get a second opinion?  There IS some variability in followup plans even among melanoma specialists.

You can also ask where your wife's melanoma is most likely to metastasize (melanoma does tend to spread to certain locations based on the location of the primary), and ask if it is possible to have an xray done of that area every so often.  You can ask whether it would be worthwhile to check blood LDH levels periodically.  My understanding is that some specialists do this, others don't.

Good luck, and may your wife be one of the majority who go on to never have to deal with melanoma again.

First I want to say that I do agree with the above.  What Janner said about sometimes more is not better, it's just more is very, very true, and it is something many of us faced with a cancer diagnosis will struggle with.

I will also say that my oncologist told me she has a stage I melanoma patient who comes in yearly for followup, for lymph node checks, blood work, and she pays for her own PET CTs out of pocket because it makes her feel better.  Insurance won't cover them so she does this on her own.  She is 10 years out and still free of recurrence.  This particular clinic offers greatly reduced rates on PET CTs to patients who choose to do this when insurance won't pay.  If you can find a clinic or can afford to pay for a PET CT and having negative results will be reassuring to you, why not?  Aside from the risk of false positive findings as your doctor pointed out, maybe it WILL make you both feel better.  And my feeling is that if it makes the two of you feel better, why not get a second opinion?  There IS some variability in followup plans even among melanoma specialists.

You can also ask where your wife's melanoma is most likely to metastasize (melanoma does tend to spread to certain locations based on the location of the primary), and ask if it is possible to have an xray done of that area every so often.  You can ask whether it would be worthwhile to check blood LDH levels periodically.  My understanding is that some specialists do this, others don't.

Good luck, and may your wife be one of the majority who go on to never have to deal with melanoma again.

Your wife is in a very good situation.  If she wants to "do something", I would recommend doing all that she can to support her immune system.  It is said that cancer cannot exist if the immune system is functioning perfectly.  This early stage melanoma could be a warning that its time to take care of her overall health.  Adopt a healthy diet, exercise, reduce stress (really important as chronic stress suppresses the immune system).  Most of all, experience joy and laughter as much as possible.  Truly happy people have lower incidences of many illnesses and tend to live longer.  Doing these things will contribute greatly to quality of life and very much counts as "doing something" to avoid a recurrence.

Cheers!

Maggie

Your wife is in a very good situation.  If she wants to "do something", I would recommend doing all that she can to support her immune system.  It is said that cancer cannot exist if the immune system is functioning perfectly.  This early stage melanoma could be a warning that its time to take care of her overall health.  Adopt a healthy diet, exercise, reduce stress (really important as chronic stress suppresses the immune system).  Most of all, experience joy and laughter as much as possible.  Truly happy people have lower incidences of many illnesses and tend to live longer.  Doing these things will contribute greatly to quality of life and very much counts as "doing something" to avoid a recurrence.

Cheers!

Maggie

Your wife is in a very good situation.  If she wants to "do something", I would recommend doing all that she can to support her immune system.  It is said that cancer cannot exist if the immune system is functioning perfectly.  This early stage melanoma could be a warning that its time to take care of her overall health.  Adopt a healthy diet, exercise, reduce stress (really important as chronic stress suppresses the immune system).  Most of all, experience joy and laughter as much as possible.  Truly happy people have lower incidences of many illnesses and tend to live longer.  Doing these things will contribute greatly to quality of life and very much counts as "doing something" to avoid a recurrence.

Cheers!

Maggie