What are you doing for patients with mid-level and deep melanomas?
I have had several young patients lately with mid-level (over 0.75 mm) or deep melanoma (over 4mm depth). Different oncologists expect me to treat their patients quite differently. After the dermatologists locally excise the lesion, and refer the patient to an oncologist for exam and CT scans, then I see the patient.
One oncologist expects all of his patients to undergo lymph node dissection. These patients have had no palpable or CT visualized lymphadenopathy, their patients’ melanomas have been in the mid back, or one on the mid posterior thigh. He also wants his patients to undergo lymphoscintigraphy (which I have had a very difficult time getting the radiologists to perform, as they say it had been done many years ago and abandoned as not helpful according to them). Another oncology group only wants their patients to have lymphadenectomy if there are palpable or enlarged lymph nodes seen on CT.
How are others treating similar patients with deep or mid-level melanomas? Is patient age a factor in the decision? Any one doing routine lymph node dissections? Any one with a positive experience from lymphoscintigraphy to find a lymph node region to dissect?