Stage III Melanoma: Risks of Skipping Chemotherapy

Diagnosed with stage III melanoma?

Hello, my mother was diagnosed with stage III melanoma six months ago.
It originated from a black mole on the sole of her foot and has metastasized to the lymph nodes in the popliteal fossa, where the doctor said the entire lymph node was black.
Since the surgery, my mother has only returned for follow-up appointments to check the surgical wound, which has healed.
The dermatologist has been urging her to undergo chemotherapy, but my mother insists on not doing anything, believing that since the necessary tissue has been removed, she has given up on treatment.

I have read many articles, and I understand that once the lymph nodes are invaded, it officially progresses to stage III.
If she does not undergo chemotherapy, is it just a matter of time before it progresses to stage IV? If my mother insists on not having chemotherapy and gives up treatment, based on common clinical responses, how long might it take to reach stage IV? When she progresses to stage IV, what changes or symptoms can we expect in her body? If symptoms arise and she still refuses chemotherapy, what kind of symptoms might develop? As the sole caregiver, I can only prepare for the worst-case scenario...
Thank you, doctor.

Junyi, 30~39 year old female. Ask Date: 2019/08/27

Dr. Wu Yuxin reply Dermatology

The uncertainty surrounding cancer is significant, and one should not make judgments based solely on that.
It is advisable to consult with an oncologist for further insights.

Reply Date: 2019/08/27

More Info

Understanding Stage III Melanoma: Risks of Skipping Chemotherapy
Stage III melanoma is a serious condition characterized by the spread of cancer cells to nearby lymph nodes. In your mother's case, the melanoma originated from a mole on her foot and has metastasized to the lymph nodes behind her knee. This progression indicates that the cancer is more advanced and requires careful management to prevent further spread.

Chemotherapy is often recommended for patients with Stage III melanoma, particularly when there is lymph node involvement. The rationale behind chemotherapy is to eliminate any remaining cancer cells that may not have been removed during surgery. While your mother may feel that the surgical removal of the affected lymph nodes is sufficient, the reality is that melanoma can be aggressive and has a high potential for recurrence and metastasis if not adequately treated.

If your mother chooses to forgo chemotherapy, the likelihood of the disease progressing to Stage IV melanoma increases significantly. Stage IV melanoma is characterized by the spread of cancer to distant organs, such as the lungs, liver, or brain. The timeline for this progression can vary widely among individuals, but without treatment, it is not uncommon for patients to experience a decline in health within months to a couple of years, depending on the aggressiveness of the cancer.

As melanoma progresses to Stage IV, patients may experience a range of symptoms, including:
1. Fatigue: A common symptom as the body struggles to fight the cancer.

2. Weight Loss: Unintentional weight loss can occur due to the body's increased metabolic demands and decreased appetite.

3. Pain: Depending on where the cancer spreads, patients may experience localized pain, especially if the cancer affects bones or organs.

4. Skin Changes: New moles or changes to existing moles can occur, and the skin may develop lesions or rashes.

5. Respiratory Issues: If the cancer spreads to the lungs, symptoms may include shortness of breath or a persistent cough.

6. Neurological Symptoms: If the cancer spreads to the brain, symptoms may include headaches, seizures, or changes in cognitive function.

It is crucial to understand that the decision to skip chemotherapy can lead to a more aggressive disease course, and the symptoms associated with Stage IV melanoma can significantly impact your mother's quality of life.
As the primary caregiver, it is essential to have open and honest discussions with your mother about her treatment options. Encourage her to speak with her oncologist about her concerns and the potential consequences of not undergoing chemotherapy. It may also be beneficial for her to seek a second opinion or consult with a palliative care specialist, who can provide support and guidance on managing symptoms and improving her quality of life, regardless of her treatment choices.

In conclusion, while the surgical removal of the affected lymph nodes is a critical step in managing Stage III melanoma, chemotherapy plays a vital role in reducing the risk of recurrence and progression to Stage IV. The decision to pursue or decline treatment should be made with careful consideration of the potential risks and benefits, and it is essential to keep an open dialogue with healthcare professionals to ensure the best possible outcomes for your mother.

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