How can a nodal basin recurrence happen after CLND?

LucyM · Experienced user Joined: 06 Jul 2009 Posts: 51

Hi all,

I thought I would see if anyone knew the answer here, because I find it very confusing and can't find anything by googling so would be really grateful if anyone has a handle on this particular question.

My friend has had a completion LND to one side, now has a new lump which the consultant thinks is probably melanoma, on the same side...she is going to have it resected in a couple of weeks.

The thing I don't understand is if she already had all the nodes out on that side, how there can be another one come up? They told her that it isn't a 'proper' recurrence, just that some cells probably got missed when the original dissection was done and have grown back.

Would this then indicate that the nodes had ECE or such? And how does it affect her chances of further/distant recurrence now this has happened?
Hoping for reassurance to pass on or just better understanding of the situation.

Thankyou.

brainman

Hi Lucy, I think your problem is in understanding what a Completion Lymph Node Dissection does. It does not remove "ALL" the lymph nodes from the body. It just removes those in the region around the cancer. Melanoma cancer cells are very sneaky. It is not unheard of that they do get past the front line lymph nodes and show up later elsewhere. Sad, but true. She will always have a certain level of danger that it will recur Sad

_________________
Jim
Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendroglioma grade 3, same location.
http://cancerforums.net/viewtopic.php?t=2405
My Story Part 1: http://cancerforums.net/viewtopic.php?t=2528
My Story Part 2: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 3: http://cancerforums.net/viewtopic.php?t=8029
Twitter: @JimHawkins54

LucyM · Experienced user Joined: 06 Jul 2009 Posts: 51

Hi Jim,

many thanks for taking the time to answer. She had a TLND to one side of her neck, and the MM has seemingly come back on the same side of the neck.

That's kind of what was confusing me - sorry, I ought to have explained better. Do they sometimes not remove all the nodes in the same region?

HaoleBoy · Senior User Joined: 19 Aug 2008 Posts: 108

Lucy, there are several factors which could've have led to recurrent melanoma in your friend's regional lymph node basin..... As you have already discerned, extracapsular extension of metastatic melanoma in a lymph node(s) is one.... the other is possible contamination of the surgical field; meaning, in the CLND excision of the lymph nodes, some of which may have harbored mets, there was inadvertent contamination of other tissue -- this is fairly rare in major hospitals with surgical oncology specialists since there are fairly strict surgical protocols in place to prevent, or mitigate, this possibility.... The other factor is that head and neck tumors are notorious for draining to several lymph node basins -- nodes under the jaw, the cheek area (forgot what these are called), the neck area and the collarbone area.....I guess the key is whether or not this met is a recurrence in a residual node, or in other tissue around her regional nodal basin....

I would have to go back and re-read your earlier posts to discern whether or not your friend's stage status has changed any as a result of this recurrence... At a minimum, she would seem to be Stage IIIB or IIIC.... Is she taking any adjuvant treatment ? In the US, GM-CSF (also known as Leukine) is close to being approved by the US Food & Drug Administration for adjuvant treatment of Stage III melanoma.... I would also strongly encourage your friend to have the Marsden (if that is where she is still being treated) to have this recurrent tumor tested for the B-RAF and and C-Kit genetic mutation.... There are some tailored treatments in development and in trials (in the US and perhaps elsewhere) in which the initial data seems promising for those whose melanomas exhibit these genetic mutations....

Regards, Hawaii Bob
Stage IIA

LucyM · Experienced user Joined: 06 Jul 2009 Posts: 51

Bob,

your post puts into words most eloquently the vague possibilities that had been swimming around in my head, I thank you for that.

It makes sense that it would be one or the other.

I am excited to read that there may be progress on the genetic front and have forwarded your suggestion to my friend that she ask for the tumour to be tested this time - I don't think they did the primary one.

She was stage 3c pretty much from the off, and they haven't upped it afaik as it's not classed as a 'proper' recurrence, although I think she mentioned the avastin might be out now - however she's decided not to take that option anyway, as it apparently blocks one route, and there are several, so eventually the thing will bypass that route if that makes any sense - this is how it was explained to her by her other prof.

She's got a place in a vaccine trial which sounds altogether more hopeful and was suggested by her Dr, I don't know the name of it but it does sound like it's had some pretty interesting results so far - just doesn't have the same kind of massive funding for some reason.

She's also taking the 'alternative' things such as bromelain and so on. Well, got to be worth a shot Smile

Thanks again for all your help.
Lucy

	Cancer Forums Forum Index -> Melanoma and Skin Cancer Forum	All times are GMT - 5 Hours
Page 1 of 1

A website for discussions about any type of cancer, including lung cancer, breast cancer, mesothelioma, prostate cancer, laryngeal cancer, leukemia, lymphoma, multiple myeloma and others