Posted on 03/06/2022 8:47:16 PM PST by ConservativeMind
For years, surgery for patients with stage III melanoma—melanoma that has spread to the lymph nodes—involved removing those lymph nodes along with the primary tumor. Known as completion lymph node dissection (CLND), the surgery was meant to ensure that no cancer remained after surgery.
More recently, however, cancer surgeons have discovered that CLND has the potential to cause more problems than it solves. In most cases, patients do better on immunotherapy alone than they do when their surgery involves removal of the lymph nodes, due to potential complications from lymph node surgery.
Torphy, working with McCarter and the other researchers, looked at data on 90 patients who underwent sentinel lymph node biopsy (a procedure to determine if a skin melanoma has spread microscopically) only for stage III melanoma but did not undergo CLND. Of those patients, 56 received immunotherapy and 34 did not. Those who received immunotherapy had better rates of distant metastasis-free survival, meaning their cancer was less likely to come back.
"Previous clinical trials with the use of adjuvant immunotherapy for melanoma had required a CLND," McCarter says. "This study used real-world data from our stage III melanoma patients who were treated with immunotherapy without having a prior CLND.
"It takes years to change people's practice patterns. I still have conversations with community surgeons who treat melanoma, asking me, 'Should I be doing these regional node dissections?' even though this data has been out for five to 10 years now," McCarter continues. "They're afraid to give up what they used to do, and they're afraid that they are doing a disservice to the patients or not giving them the best chance, when in reality, our understanding of cancer biology has evolved. We now have effective immunotherapy, which is overcoming some of the limitations of surgery while improving outcomes."
(Excerpt) Read more at medicalxpress.com ...
“It takes years to change people’s practice patterns.“
Folks, doctors cannot possibly have the current information they need. They have jobs and lives and can’t read all the new research. As this study author proves, even “10 years” later, cancer specialists STILL DON’T KNOW the right thing to do, now. These are specialists who do this work daily, are well-intentioned, yet are clueless.
You need to go into visits with your doctors and specialists armed with a modicum of knowledge. It is for your benefit, your family’s, and that doctor and his or her future patients.
Bump
Re-bump.
(I’ve had two melanomas removed—each side of upper back).
As the victim of an "excisional" melanoma biopsy for an usual but completely benign lichenoid keratosis, it is unbelievable how much tissue they carve out of you for anything that even remotely resembles a melanoma.
This happened 25 years ago, and I am still angry about it.
At the time, I lived just a few blocks from the dermatology clinic of a major university.
They called a clinical conference after I was examined by a resident with less than a month of experience. Every dermo MD and pathologist in the Department came in for a look-see.
They literally talked each other into a state of hysteria. One of the young MDs present was the future president of the American Dermatology Association!
Adjusted for inflation, the entire fiasco cost me almost $5,000.
Exactly a year later, while browsing periodicals at my local library, I glanced at the cover of the New England Journal of Medicine and saw a photograph of the same kind of lesion I had. Apparently, these lesions were being misidentified all over the USA.
Globally, in 2012, it newly occurred in 232,000 people.[2] In 2015, 3.1 million people had active disease, which resulted in 59,800 deaths.
It is very rare to actually have “melanoma,” fortunately. Only 232,000 people, worldwide, get it, per year, or “0.003%” (population is now 7.9 billion).
It sounds like misidentification has got to be off the charts common.
I had a similar encounter with a stupid dermatologist at a hospital for an obvious basal cell carcinoma. Textbook picture, caught super early.
She looked at it and said she’d need to biopsy (no, not necessary). She injected and sliced off the bubble, taking, in her words, “97%” of the tumor, for the test sample.
It was positive as a “basal cell carcinoma,” so she scheduled me for the follow up to take care of the rest. I arrived, and there were two female assistants to help and a cart with an electrodesiccation. I asked her why she was going to do that, when there is a cheap ointment that will cure basal cell. She was astonished I brought it up and said, “Well, men prefer to have scars.” She literally said that!
I told her I wanted the prescription and she gave it to me and I went back a month later and she said that got the remaining 3%.
The STUPID dermatologist should have given me the prescription BEFORE slicing off my skin (got a scar from that, for sure) and if it was basal cell, it would have been confirmed by being affected or cured.
The biopsy, the equipment, the two extra assistants—all of that was PURE WASTE for which I had to pay. The biopsy alone was over $600, after insurance.
The prescription was $30!
Things like that make me quite uptight. It’s a scam AND THE DOCTORS KNOW IT!
Too many doctors are programmed for padding their pockets and not helping the patient. Same with many dentists and their “upsell” methods. Find ones who aren't crazy.
It has been that way since the 1990s.
No doubt fear of malpractice liability and potentially terminal patients also factor into it.
On the other hand, excisional biopsies and lab work are definitely profit centers.
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