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Based on the information you submitted
You have
Stage III
Melanoma
Introduction:
Patients with Stage III disease have involvement of the regional lymph nodes, and stage III disease is further categorized into Stages IIIA, IIIB, IIIC and IIID.
The initial workup depends on the stage of the disease.
For patients with Stage IIIA, imaging studies (e.g., CT, CT/PET, or MRI) should be considered for baseline staging, and to address any signs and symptoms reported by patients. For patients with
Stage IIIB/C/D, imaging studies (e.g., CT, CT/PET, or MRI) should be offered for baseline staging, and address any signs and symptoms reported by patients.
For all stage III patients, testing for a BRAF mutation of the tumor is performed
Survivor Outcome:
According to the 2018 AJCC data, the melanoma-specifical survival probability for patients with stage III disease:
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For stage IIIA, the 5-year and 10-year melanoma-specific survival probability are 93% and 88%, respectively.
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For stage IIIB, the 5-year and 10-year melanoma-specific survival probability are 83% and 77%, respectively.
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For stage IIIC, the 5-year and 10-year melanoma-specific survival probability are 69% and 60%, respectively.
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For stage IIID, the 5-year and 10-year melanoma-specific survival probability are 32% and 24%, respectively.
Treatment:
Adopted from NCCN Guideline 2022
The primary treatment for stage III melanoma involves excision of the primary tumor along with a standard surgical margin of 1-2 cm. For melanomas with Breslow thickness between 1-2mm, the standard surgical margin is 1cm. For melanomas with a Breslow thickness of 2mm, the standard surgical margin is 2cm.
With respect to treating the lymph node, there is an option of using ultrasound to monitor the lymph node for recurrence, or complete lymph node dissection to remove the rest of lymph nodes in the region.
In the past, all patients with positive sentinel lymph node biopsy (SLNB) have been advised to receive complete lymph node dissection (CLND). Recent studies showed that CLND did not improve overall survival or melanoma-specific survival when compared to patients who were followed with clinical observation alone. As a result, a large percentage of surgical oncologists have elected not to recommend CLND. Also, CLND has significantly higher complications, including poor wound healing, infection, bleeding under the skin, neuropathy (nerve injury), and lymphedema (swelling of the limb).
Your physicians, specifically the medical oncologists may discuss the role of adjuvant treatment and neo-adjuvant treatment including immunotherapy using either nivolumab (Optivo) or pembrolizumab (Keytruda), or a combination of targeted therapy dabrafeninb/trametinib for patients that has a specific tumor mutation called BRAF V600.
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INTERVIEW WITH THE EXPERTS
01
Dr. Thomas Wang discusses the management of stage III disease and the role of complete lymph node dissection
02
Dr. Dan Coit discusses the role of complete lymph node dissection and why are we performing less of this procedure.
03
Dr. Paul Chapman discusses the role of adjuvant treatment for stage III disease
04
Dr. Richard Carvajal discussing the role of adjuvant treatment for stage III disease
05
Dr. April Salama discusses the role of adjuvant treatment for stage III disease
06
Dr. April Salama discusses the role of neo-adjuvant treatment for stage III disease
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