ILP DECISION

I'll cut to the chase; Dave is not having the Isolated Limb Perfusion.  After a long discussion with Dr. Ross' PA about the pros and cons of ILP, Dave felt the scale tipping toward yes. Then Dr. Ross came in, asked Dave questions about the sequence of events that brought him here (going back to his first tumor), gave him a skin exam, and said he didn't think any further treatment was necessary at this point.  He said it's rare for a patient to go 7 years without a recurrence as Dave did, and considering it was so close to the original spot, and the PET, CT and MRI scans show no evidence of the disease, he believed it would be better to wait and see rather than over- treat.

Some thoughts were repeating themselves in our minds: if Dave did not have the ILP, and he gets another recurrence, would he regret his decision, would he regret not being more aggressive, and would he be constantly worrying?  Would he be a happier person if he had the ILP just because it seems to be the best possible treatment available?  Dr. Ross said he would do the ILP if Dave really really wanted him to, but the fact of the matter is, if Dave gets a recurrence in his arm, he would still have the surgery and ILP options.  If he gets a recurrence anywhere other than his arm, the ILP would not have prevented that anyway.  Dave is a very healthy 65-year old, he is in the 1% of the melanoma population that went over 5 years without a recurrence, and the ILP does carry risks.  Why not carry on, live a healthy life and be vigilant about monitoring?

Dr. Ross performs more ILPs than anyone else in the USA, sees thousands of patients, and since he felt ILP was probably too aggressive, Dave was happy to comply with his recommendation.

Dr. Ross did recommend having a sentinel lymph node biopsy done, which is scheduled for tomorrow instead of the ILP.  This is really more of a double check - the scans showed nothing, but a biopsy will be even more accurate.

If you want more detail, here is a good explanation of a sentinel node biopsy:
http://www.cancer.gov/cancertopics/factsheet/detection/sentinel-node-biopsy

Dr. Ross noted the dermatologist and the surgeon in Chattanooga (from Dave's first tumor) both thought Dave's tumor looked like a secondary site, but could not find a primary site.  That leads to two possible conclusions: 1) The primary site 'regressed' yet a distal site was formed, or 2) The first tumor actually was the primary site although it didn't look or act like one.  Both scenarios are very unusual, and that coupled with the fact Dave went 7 years without a recurrence leads Dr. Ross to believe there is a chance Dave could go another very long time without another recurrence.  So again, he recommends the sentinel node biopsy and after that, structured monitoring.

Oh what a relief it is.