Unsure about treatment plan

Hi Pricilla 

That's great news that your PET and brain scans have come back clear but I can understand why you're wondering if you should have further treatment other than a wide local excision (WLE).

I haven't been in your position but I'd suggest you give your SCNS a call tomorrow and ask her to explain why you don't require any further treatment. It's important for your own peace of mind that you understand the rationale behind the MDT's decision that you don't require further treatment other than a WLE.

((hugs))

Hi Priscilla, I would ask about immunotherapy. 

My husband had stage 3B melanoma. The biopsy showed there were satellites, so he was aent for an WLE. The results of that was they got it all, and they told him he had the 'all clear'. We thought he would get immunotherapy but he didnt. That was Aug 29th 2024. He was then followed up with CT scans and checks at the hospital every 3 months with the consultant. His last scan and checks in June 25, came back, still clear and good. At the end of Aug.this year, 2025, he had pain in his back. It felt like muscular pain. He then started losing his appetite. He ended up going to hospital and they did scans. Its now in his liver, he has a large haemotoma on his back, it us causing him so much pain and they think it is a cancer but its too dangerous to take a sample and there are abnormalities in the bones. 

We met with the oncologist a couple of weeks ago. I asked should my husband have been given immunotherapy afer the WLE? I was told that is a good question and yes he should have within 12 weeks.of the WLE. He tried to explain a mistake that was made due to.timing of the pathology report or something, which made no sense.

Our doctors are amazing but if you have a niggling feeling something isnt right. Push for what you think is right, make them look at your records and provide you with a reason for the steps they have taken. Do not sit silent with a feeling of unease, push them so they either do more or can reassure you that what they are doing is right for you.

I feel my husband has been totally let down from his GP to his consultant. I feel completely let down. Even his most recent visit at the hospital i felt he was treated terribly. His oncologist and her team, I trust but I.think had the original consultant did the immunotherapy we might not be where we are right now.

I dont want to frighten you, please just make sure you feel reassured by your team. Sending love ️ 

Thank you, I have been feeling uneasy, happy that my scans were clear but from everything I’d read on here I thought something isn’t right. I will ask about immunotherapy at my next appointment.

I had a biopsy with a micro-satellite and was staged at 3b. A WLE and CT scans followed and both were clear. I was referred to a medical oncologist at a specialist hospital, saw her last week and discussed the pros and cons of immunotherapy. I decided to opt in and begin a year of Pembrolizumab in a couple of weeks - nine sessions six weeks apart if I can take it. 
Based on my experience so far, seems to me that you, too, should be offered the immunotherapy. 

Can someone explain what is meant by ‘satellite’ and ‘micro satellite’ findings in this instance? Are you referring to extracapsular spread of the disease from lymph node?

My original melanoma was a Pt2a and required a WLE and SLNB. The SLNB showed cells in the lymph and I was given a diagnosis of stage 3A (MRI and CT scans came back clear). I chose not to go down the immunotherapy route and the targeted treatment for BRAF mutation is not an option (they failed to test/lost the sample). I’m just under observation with 3 monthly visits to the dermatologist and 6 monthly CT scans.

I’m not a clinician and there are plenty of definitions out there for these two ‘extras’. This is the basics I got from a web search: 

In melanoma, a micro satellite is a microscopic cluster of melanoma cells located adjacent to or deep to the primary tumour that is separated from it by a layer of unaffected normal tissue.

 Melanoma can show extra capsular spread (ECS), which is when the cancer cells break through the lymph node's outer capsule and extend into the surrounding fatty tissue. 

Incidentally, my oncologist told me that once they’d identified the micro satellite in the biopsy, that alone bumped me up to a 3b from a 2a and a SLNB would have been superfluous. (Just in case anyone else goes this same route and wonders why no lymph node action).