Urgent! Competent & Up-To-Date Clinical Oncologist

[moonseeker]

Dear all:

Once more your help is needed. We need a recommendation for treatment of a Stage 2 Malignant Melanoma. At this time the lesion has been removed and a wide excision has taken place,

What is needed now is a competent oncologist to guide through CT/PET scans and treatment of metastases etc.

Location Pattaya, but we doubt the local doctors are experienced enough. BPH Wattanasoth would be preferred as prior good experiences. We are prepared to travel to any country, expect USA, as not covered there.

Thank you very much for any advise and personal experience. Moonseeker>

[Sheryl]

If you are prepared to travel, nowhere in the world is there as much expertise in treatment of melanoma as in Australia.

There are some good oncologists in Bangkok but they will not have specialization in, or much experience with, melanoma since it is rare in Asians.

If I were you, since it sounds like you have insurance cover worldwide except the US, I would consider going to Australia at least for consultation and development of a treatment plan. Specifically, here http://www.melanoma.org.au/ for state of the art care.

[moonseeker]

If you are prepared to travel, nowhere in the world is there as much expertise in treatment of melanoma as in Australia.

There are some good oncologists in Bangkok but they will not have specialization in, or much experience with, melanoma since it is rare in Asians.

If I were you, since it sounds like you have insurance cover worldwide except the US, I would consider going to Australia at least for consultation and development of a treatment plan. Specifically, here http://www.melanoma.org.au/ for state of the art care.

Dear Sheryl

Thank you for that great advise. Will await staging and get in touch with them asap. Good night and thank you again. MS>

[moonseeker]

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If you are prepared to travel, nowhere in the world is there as much expertise in treatment of melanoma as in Australia.

There are some good oncologists in Bangkok but they will not have specialization in, or much experience with, melanoma since it is rare in Asians.

If I were you, since it sounds like you have insurance cover worldwide except the US, I would consider going to Australia at least for consultation and development of a treatment plan. Specifically, here http://www.melanoma.org.au/ for state of the art care.

Dear Sheryl

Thank you for that great advise. Will await staging and get in touch with them asap. Good night and thank you again. MS>

Hi Sheryl

I am looking at the various options here at the moment. Amazingly Wattanasoth Dr.s show mostly empty profiles. Looks definitely better in Bumrungrad with more choice and some foreign educated oncologists.

My problem is that I hate to become a burden to anybody during chemo etc. for anyone, here I could afford to hire somebody. If I head back to my home country I will interrupt the lives of my family friends, which I want to avoid at all cost.

I have started some inquiries with doctors I have worked over the years here and hope to get that one name of a competent expert for total work-up/chemo etc. here in Thailand.

Much more important to find the right person, than the right hospital.

Thank you for any advise from anybody and Merry Christmas.....My ghosts come at night.....Scary stuff..... MS>

[Sheryl]

There are certainly some well-qualified oncologists here, the problem as mentioned is that few will have expertise in melanoma.

An additional consideration is that some of the state of the art treatments for melanoma may not be available here...partiuclarly immunotherapies and targeted molecular therapies. Conventional chemo has not had a good success rate in melanoma and there are newer and more promising approaches.

While I can certainly understand your situation and preference to be cared for here, would that be worth foregoing treatments with better chance of success (and in some cases, less toxic)? This may be a non-issue if in your particular case standard chemotherapy is considered the best approach but you won't know that unless you consult specialists in melanoma who have available to them the full range of approaches. If you consult someone in Thailand they will advise treatment only from within the range of what is available here.

This is why I really advise travelling abroad to at least get expert advice on best course of treatment. Then you can contact Wattanaosth, Bumrungrad etc to see if they are able to provide the recommended tretament and if so, return here for the actual treatment, following treatment plan advised by melanoma specialist abroad.

To get an idea what I mean click on "taregted therapy" and "immunotherapy" here as well as on "chemotherapy" http://www.melanoma.org.au/understanding-melanoma/treatment-options/

[moonseeker]

There are certainly some well-qualified oncologists here, the problem as mentioned is that few will have expertise in melanoma.

An additional consideration is that some of the state of the art treatments for melanoma may not be available here...partiuclarly immunotherapies and targeted molecular therapies. Conventional chemo has not had a good success rate in melanoma and there are newer and more promising approaches.

While I can certainly understand your situation and preference to be cared for here, would that be worth foregoing treatments with better chance of success (and in some cases, less toxic)? This may be a non-issue if in your particular case standard chemotherapy is considered the best approach but you won't know that unless you consult specialists in melanoma who have available to them the full range of approaches. If you consult someone in Thailand they will advise treatment only from within the range of what is available here.

This is why I really advise travelling abroad to at least get expert advice on best course of treatment. Then you can contact Wattanaosth, Bumrungrad etc to see if they are able to provide the recommended tretament and if so, return here for the actual treatment, following treatment plan advised by melanoma specialist abroad.

To get an idea what I mean click on "taregted therapy" and "immunotherapy" here as well as on "chemotherapy" http://www.melanoma.org.au/understanding-melanoma/treatment-options/

Thank you so much. It is great to have somebody like yourself confirming and re-enforcing my thoughts. Have a great weekend. MS>

[Tolley]

There is no treatment for stage 2 melanoma.

You would not be eligible for any trials or immunotherapy drugs.

For stage 2 melanoma it is usually three monthly checks of lymph glands via ultrasound.

I am assuming you already had a sentinel node biopsy that was negative?

If melanoma is found in the lymph glands then a lymph node dissection is done and again even thou you are then staged as 3 you are still excluded from most trials and therapies.

Stage 2 melanoma is a watch and wait and hopefully nothing ever happens and you continue on with your life.

For the moment only follow up check ups are required of the lymph nodes.

[Sheryl]

Sometimes adjuvant therapy is recommended for Stage II if the lymoph nodes are positive, and there are clinical trails being done on treatments that might prevent recurrence.

However iIam not certain this is only Stage II as first post talked bout scans to check for metastases and post # 3 referred to having to wait for staging so it sounds like not fully staged yet.

[Tolley]

Sometimes adjuvant therapy is recommended for Stage II if the lymoph nodes are positive, and there are clinical trails being done on treatments that might prevent recurrence.

However iIam not certain this is only Stage II as first post talked bout scans to check for metastases and post # 3 referred to having to wait for staging so it sounds like not fully staged yet.

The only approved treatment for stage 2 or 3 is interferon which does not increase overall survival and has very toxic side effects.

It is not recommended by most melanoma centres of excellence.

Some of the new immune therapy drugs should be available for stage 3 in the near future.

However it should be noted that even these new so called wonder drugs only help about 30 percent of people and not necessarily for long periods of time.

Melanoma is a serious and deadly disease and is rising rapidly throughout the world.

In fact research has shown that even things like frequent air travel can increase your risk of melanoma. Air line crews have double the risk of contracting melanoma according to one study.

Further there has been some linkage with EMFs exposure and melanoma.

So it is not just sunshine that you have to be careful with.

[moonseeker]

Sometimes adjuvant therapy is recommended for Stage II if the lymoph nodes are positive, and there are clinical trails being done on treatments that might prevent recurrence.

However iIam not certain this is only Stage II as first post talked bout scans to check for metastases and post # 3 referred to having to wait for staging so it sounds like not fully staged yet.

Thank you all. Correct. Still waiting for results of "wide excision" and staging. Surgeon remarked Stage 2-B, but with worries as cancer cells present in all blood vessels of initial biopsy. She seemed very concerned and certainly has experience and a great reputation. Clark Level IV., 1.4 mm. No mention of ulceration or other criteria. MERRY CHRISTMAS. MS>

[Tolley]

Sometimes adjuvant therapy is recommended for Stage II if the lymoph nodes are positive, and there are clinical trails being done on treatments that might prevent recurrence.

However iIam not certain this is only Stage II as first post talked bout scans to check for metastases and post # 3 referred to having to wait for staging so it sounds like not fully staged yet.

Thank you all. Correct. Still waiting for results of "wide excision" and staging. Surgeon remarked Stage 2-B, but with worries as cancer cells present in all blood vessels of initial biopsy. She seemed very concerned and certainly has experience and a great reputation. Clark Level IV., 1.4 mm. No mention of ulceration or other criteria. MERRY CHRISTMAS. MS>

You probably need to consider moving close to where there are some good melanoma centres if at all possible.

[Sheryl]

Stage IIB, as I'm sure you know, warrants very aggressive treatment. And there are, defintely, clinic trials for it udnerway.

It may be more than stage IIB, that cannot be determined in the course of excision but rather requires scans to rule out metastasis.

I am a little confused by the statement "cancer cells present in all blood vessels of initial biopsy". Do you perhaps mean all lymph nodes rather than blood vessels?

Regardless, my original advice stands: get to a state of the art melanoma treatment center ASAP.

[Sheryl]

A post advocating quack treatments has been removed.

This is a very serious and potentially life-threatening condition, and attempts to deter the OP from seeking proven medical therapies will not be tolerated.

[moonseeker]

Stage IIB, as I'm sure you know, warrants very aggressive treatment. And there are, defintely, clinic trials for it udnerway.

It may be more than stage IIB, that cannot be determined in the course of excision but rather requires scans to rule out metastasis.

I am a little confused by the statement "cancer cells present in all blood vessels of initial biopsy". Do you perhaps mean all lymph nodes rather than blood vessels?

Regardless, my original advice stands: get to a state of the art melanoma treatment center ASAP.

Thank you very much Sheryl for your expert advise. Fully agreed. Weird, that it mentions blood vessels. I immediately asked the experienced dermatologist and could feel she was lost for words and could not answer me. Also surprising the rest of the report. Mentioning only thickness and CL. Will PM you. I am in touch with 2 centers in Europe and Australia and will decide asap after receiving report and probably doing a first PET or CT. I have quite a bit of medical knowledge and hands on experience myself and am fully aware how this might end. Not a nice thought I might add ;-). I am very grateful to hear different opinions that make sense and often there is that one connection that actually helps. You have done it before..... Thanks again and MERRY CHRISTMAS. MS>

[Sheryl]

Answered your PM.

[Tolley]

Stage IIB, as I'm sure you know, warrants very aggressive treatment. And there are, defintely, clinic trials for it udnerway.

It may be more than stage IIB, that cannot be determined in the course of excision but rather requires scans to rule out metastasis.

I am a little confused by the statement "cancer cells present in all blood vessels of initial biopsy". Do you perhaps mean all lymph nodes rather than blood vessels?

Regardless, my original advice stands: get to a state of the art melanoma treatment center ASAP.

Thank you very much Sheryl for your expert advise. Fully agreed. Weird, that it mentions blood vessels. I immediately asked the experienced dermatologist and could feel she was lost for words and could not answer me. Also surprising the rest of the report. Mentioning only thickness and CL. Will PM you. I am in touch with 2 centers in Europe and Australia and will decide asap after receiving report and probably doing a first PET or CT. I have quite a bit of medical knowledge and hands on experience myself and am fully aware how this might end. Not a nice thought I might add ;-). I am very grateful to hear different opinions that make sense and often there is that one connection that actually helps. You have done it before..... Thanks again and MERRY CHRISTMAS. MS>

I am surprised that they didn't do a Sentinel node biopsy with the wide excision.

If you had a WE already then a sentinel node biopsy is problematic because the drainage patterns would not be the same after the WE.

In which case you would need ultrasound follow up of the nearby lymph glands depending on the location of the tumour ie groin or arm

Regardless at stage 2 where you are at now there are not really any trials.

If you go to stage 3 then you may be eligible for some trials but most of the trials are for stage 3c or stage 4 where you never want to be.

Anyway plenty of people have been stage 2 and never had any other trouble after the initial excision nor have they needed further treatment.

Hopefully you are one of those.

[moonseeker]

Stage IIB, as I'm sure you know, warrants very aggressive treatment. And there are, defintely, clinic trials for it udnerway.

It may be more than stage IIB, that cannot be determined in the course of excision but rather requires scans to rule out metastasis.

I am a little confused by the statement "cancer cells present in all blood vessels of initial biopsy". Do you perhaps mean all lymph nodes rather than blood vessels?

Regardless, my original advice stands: get to a state of the art melanoma treatment center ASAP.

Thank you very much Sheryl for your expert advise. Fully agreed. Weird, that it mentions blood vessels. I immediately asked the experienced dermatologist and could feel she was lost for words and could not answer me. Also surprising the rest of the report. Mentioning only thickness and CL. Will PM you. I am in touch with 2 centers in Europe and Australia and will decide asap after receiving report and probably doing a first PET or CT. I have quite a bit of medical knowledge and hands on experience myself and am fully aware how this might end. Not a nice thought I might add ;-). I am very grateful to hear different opinions that make sense and often there is that one connection that actually helps. You have done it before..... Thanks again and MERRY CHRISTMAS. MS>

I am surprised that they didn't do a Sentinel node biopsy with the wide excision.

If you had a WE already then a sentinel node biopsy is problematic because the drainage patterns would not be the same after the WE.

In which case you would need ultrasound follow up of the nearby lymph glands depending on the location of the tumour ie groin or arm

Regardless at stage 2 where you are at now there are not really any trials.

If you go to stage 3 then you may be eligible for some trials but most of the trials are for stage 3c or stage 4 where you never want to be.

Anyway plenty of people have been stage 2 and never had any other trouble after the initial excision nor have they needed further treatment.

Hopefully you are one of those.

Thank you kindly. Merry Christmas. MS>

[Tolley]

Stage IIB, as I'm sure you know, warrants very aggressive treatment. And there are, defintely, clinic trials for it udnerway.

It may be more than stage IIB, that cannot be determined in the course of excision but rather requires scans to rule out metastasis.

I am a little confused by the statement "cancer cells present in all blood vessels of initial biopsy". Do you perhaps mean all lymph nodes rather than blood vessels?

Regardless, my original advice stands: get to a state of the art melanoma treatment center ASAP.

Thank you very much Sheryl for your expert advise. Fully agreed. Weird, that it mentions blood vessels. I immediately asked the experienced dermatologist and could feel she was lost for words and could not answer me. Also surprising the rest of the report. Mentioning only thickness and CL. Will PM you. I am in touch with 2 centers in Europe and Australia and will decide asap after receiving report and probably doing a first PET or CT. I have quite a bit of medical knowledge and hands on experience myself and am fully aware how this might end. Not a nice thought I might add ;-). I am very grateful to hear different opinions that make sense and often there is that one connection that actually helps. You have done it before..... Thanks again and MERRY CHRISTMAS. MS>

I am surprised that they didn't do a Sentinel node biopsy with the wide excision.

If you had a WE already then a sentinel node biopsy is problematic because the drainage patterns would not be the same after the WE.

In which case you would need ultrasound follow up of the nearby lymph glands depending on the location of the tumour ie groin or arm

Regardless at stage 2 where you are at now there are not really any trials.

If you go to stage 3 then you may be eligible for some trials but most of the trials are for stage 3c or stage 4 where you never want to be.

Anyway plenty of people have been stage 2 and never had any other trouble after the initial excision nor have they needed further treatment.

Hopefully you are one of those.

Thank you kindly. Merry Christmas. MS>

Just a final note.

From what you have said your tumour was 1.4mm and non ulcerated which in fact makes you stage 1b which is much better that stage 2b.

:Providing your lymph nodes are clear Stage IB: The 5-year survival rate is around 92%. The 10-year survival is around 86%..

Merry Xmas the odds are on your side

[Sheryl]

Thickness is irrelevant if there is spread to a lymph node or if there are other small tumors on or under the skin nearby. Which appears to be the case (I have seen the actual path report).

There were also atypical melanocytes in the blood, hence concern that it has already metastasized in which case regardless of thickness of the main lesion it is Stage IV.

This is why a series of CT, PET scans etc have been ordered.

[Tolley]

Thickness is irrelevant if there is spread to a lymph node or if there are other small tumors on or under the skin nearby. Which appears to be the case (I have seen the actual path report).

There were also atypical melanocytes in the blood, hence concern that it has already metastasized in which case regardless of thickness of the main lesion it is Stage IV.

This is why a series of CT, PET scans etc have been ordered.

There is a melanoma forum that might be helpful as it has a lot of experts posting on there.

It would be quite unusual for such a small melanoma that wasn't ulcerated to be at stage 4 although not unheard of.

Intransit mets make it stage 3 I think as does as any lymph node involvement.

I wouldn't be hanging around Thailand with that sort of diagnosis I would head to Australia asap.

http://www.melanoma.org/find-support/patient-community/mpip-melanoma-patients-information-page

[moonseeker]

For anybody, who is in need of a highly qualified Oncologist not too far away. Super nice Dr. and Team. Takes his time and happy to give 2nd. opinions and up to date options. On top of that very affordable. Just say hello from "Swiss-Melanoma".

http://www.tuckermedical.com/about-dr-steven-tucker/