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Old 05-21-2010, 02:59 AM   #1
KimB
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Join Date: Jan 2010
Posts: 8
Question I want to know: Surgery to remove chest skin

I am going to have a surgery to remove a skin from my right chest where three skin tumors are located. After 6 rounds of TCH, the tumors are almost invisible. I'm happy about that. I've already had radiation. My doctors don't want to give me more radiation, so that surgery is must. Now the question is how extensive the surgery should be. My surgeon thinks that just removing the skin surounding each tumor is good enough. I asked the other surgeon the second opinion. He thinks that since many skin tumors are involved with lymph system, it's better to remove the large portion of skin covering the chest. This more extensive surgery requires skin graft (flap). Are there anyones who were in my kind of situation? What did you do? How was the surgery using flap? Did you recover from it very much? Please let me hear your experiences.

Kim
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Diag July 2008,
Aug 2008: Right Lumpectomy with Sentinel Lumph Node Biopsy, IDC Stage IIA, no lymps, 2.8cm, Grade 3, ER- PR- HER2- (CEP17, FISH1.7), Ki-67 60%,
Sep 2008-Feb 2009: AC(6)+T(6) dose den,
March-May2009: Rad 28+5,
Oct 2009: Reg Recu (a skin tumor right on scar line),
Nov 12, 2009: PET CT no mets found,
Nov 2009: Right Modi Radi Mastectomy, 0.7cm, Grade 3, 1/10 lymp posi, ER-, PR-, HER2+++, Ki-67 90%
Dec 2009: 3 skin tumors app on the right chest,
Jan 2010: Taxotele(6x) +Carboplatin(6x) +Herceptin(1yr) every 3 wks,
Ap 19, 2010: PET CT no mets found,
April 29, 2010: finished Chemo, continue Herceptin till Dec 2010,
May 6, 2010: MRI (brain) clear.
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Old 05-21-2010, 04:46 AM   #2
Delaney
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Re: I want to know: Surgery to remove chest skin

Hi Kim,
Am in a similar situation I think. Waiting (till Thurs) for biopsy results on small lumps near scar line. Judging by the grave faces in the room, think I know the result. Dont know anything about cost of surgery as am covered by insurance. Wishing you all the best. Did they change your stage because of this?
Delaney,
dx 2008 er-pr-/her2+ extensive nodes involved, mastectomy, a/c taxol, tyverb for year clinical trial.
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Old 05-21-2010, 08:33 AM   #3
Karen Wheel
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Re: I want to know: Surgery to remove chest skin

Sorry - haven't had any experience with it ---
I'm pulling for you! Thinking of you - let us know how this goes!

Karen
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Karen Wheelhouse Age: 46
Facebook id: Karen Wheel
2-09 – Age 44 -Biopsy-Cancer
3-09 – Right Quadrantectomy. Clear margins.
3 lymph nodes taken - all clear
Tumor results: Stage 1, 1.5 cm, Her2 +++
Est positive 80% - Prog 10% - Ki67 postive 30%
4-09 – Became a vegan! pH balance of body - cancer can't grow in neutral pH!
4-09 Started Herceptin & Chemo (9 weeks of Navelbine *)
* FYI - when coupled with Herceptin has the same results as more toxic chemo. No brainer!
8-09 - 30 RADS
9-09 - Said NO to hormone therapy
4-10 Finished Herceptin!!!!


7-10 PET Scan & other exams .... All clear! YIPPEE!!!!
11-10 Breast, organ Ultrasounds and lung x-rays all clear no changes ... NED!

2-25-2011 --- 2 years from surgery and NED!!!!!!
7-2011 Clear bone scan and full body and head MRI! NED! NED! NED! ;-)[/SIZE]
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Old 05-21-2010, 10:00 AM   #4
ElaineM
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Wink Re: I want to know: Surgery to remove chest skin

Have you considered seeing a good dermatologist? A dermatologist might be able to remove the small skin tumors plus a small amount of skin around the tumors.
Dermatologists can remove various kinds of skin cancers.
There are also drug trials for skin mets. The University of Washington Tumor Group has one with Abraxane and 5 Fu cream. There is another one using Tykerb and Pazopinib. I think this is called the Apply Trial or Apply Study. Your oncologist might be able to find out more information about these for you.
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Old 05-21-2010, 03:51 PM   #5
Faith in Him
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Re: I want to know: Surgery to remove chest skin

I'm not quite in the same situation but did have a rash on my breast after lumpectomy. At the time they surgeon did talk about removing a large portion of my skin on the chest wall. It was later decided to do a mascetomy and then hyperthermia rads and Xeloda/Tykerb. The rads completely wiped out the rash on the chest wall but also some of my skin. I have just had a tram flap to cover my large wound. It has been a long process but I have not seen the rash is over a year.
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DX 02/01/07
2.5 cm, Er/Pr-, Her2+++
18/20 Nodes
03/07 CT & Bone scan - Clear
AC x 4, Taxol x 4, Added Herceptin
Radiation until 09/07
Herceptin every 3 weeks until 06/08
01/10/08 local recurrence -IBC
01/28/08 CT & Brain MRI - clear
02/08 - Navelbine & Herceptin
05/08 -MRM
05/08 - Gemzar & Herceptin - didn't work
09/08 - Hyperthermia rads
03/09 - Tykerb/Xeloda
05/10 - Tram flap to fix wound
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Old 05-22-2010, 12:37 AM   #6
SoCalGal
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Re: I want to know: Surgery to remove chest skin

Hi Kim,
I had skin lymph involvement in JAN 2003, and they were going to remove my skin with very wide margins, and do a split skin graft with skin from my leg. In surgery, it did not turn out "do-able" this way, they could not ensure clear margins while I was under - some were clear but very close! SO - I woke up from surgery, and I wound up wearing temp skin (cadaver skin) for 7 days while waiting for path report to confirm clear margins. The report confirmed clear margins, SO - exactly one week later, I went back into surgery and they did a latissimus dorsi flap. There was NOT a lot of pain involved at all, and I recovered quickly from this surgery. I remember the doc coming into my room, shocked to see me dressed, up and about. I already had a HUGE surgery in JUNE 2002, so I was in no great state of mind for more surgery. I had also had radiation to the area years before surgery, so there were concerns about the condition of the radiated tissue.

That was 7 long years ago, with NO FURTHER SKIN INVOLVEMENT TO DATE! From what I understood, it's important to be aggressive with the margins when skin is in question, since there is the lymph system and skin covers our whole body. If your two opinions don't agree, I'd get a third - the tie breaker. Or ask your oncologist. You don't have your history with your signature, so it's hard to say any more than my experience. Hope this helps! Flori
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1996 cancer WTF?! 1.3 cm lumpectomy Er/Pr neg. Her2+ (20nodes NEGATIVE) did CMF + rads. NED.
2002 recurrence. Bilateral mastectomy w/TFL autologous recon. Then ACx2. Skin lymphatic rash. Taxotere w/Herceptin x4. Herceptin/Xeloda. Finally stops spreading.
2003 - Back to surgery, remove skin mets, and will have surgery one week later when pathology can confirm margins.
‘03 latisimus dorsi flap to remove skin mets. CLEAN MARGINS. Continue single agent Herceptin thru 4/04. NED.
‘04 '05 & 06 tiny recurrences - scar line. surgery to cut out. NED each time.
1/2006 Rads again, to scar line. NED.

3/07 Heartbreaking news - mets! lungs.sternum. Try Tykerb/Xeloda. Tykerb/Carbo/Gemzar. Switch Oncs.
12/07 Herceptin.Tykerb. Markers go stable.
2/8/08 gamma knife 13mm stupid brain met.
3/08 Herceptin/tykerb/avastin/zometa.
3/09 brain NED. Lungs STABLE.
4/09 attack sternum (10 daysPHOTONS.5 days ELECTRONS)
9/09 MARKERS normal!
3/10 PET/CT=manubrium intensely metabolically active but stable. NEDhead.
Wash out 5/10 for tdm1 but 6/10 CT STABLE, PET improving. Markers normal. Brain NED. Resume just Herceptin plus ZOMETA
Dec 2010 Brain NED, lungs/sternum stable. markers normal.
MAR 2011 stop Herceptin/allergy! Go back on Tykerb and switch to Xgeva.
May-Aug 2011 Tykerb Herceptin Xgeva.
Sept 2011 Tykerb, Herceptin, Zometa, Avastin.
April 2012 sketchy drug trial in NYC. 6 weeks later I’m NED!
OCT 2012 PET/CT shows a bunch of freakin’ progression. Back to LA and Herceptin.avastin.zometa.
12/20/12 add in PERJETA!
March 2013 – 5 YEARS POST continue HAPZ
APRIL 2013 - 6 yrs stage 4. "FAILED" PETscan on 4/2/13
May 2013: rePetted - improvement in lungs, left adrenal stable, right 6th rib inactive, (must be PERJETA avastin) sternum and L1 fruckin'worsen. Drop zometa. ADD Xgeva. Doc says get rads consultant for L1 and possible biopsy of L1. I say, no thanks, doc. Lets see what xgeva brings to the table first. It's summer.
June-August 2013HAPX Herceptin Avastin Perjeta xgeva.
Sept - now - on chemo hold for calming tummy we hope. Markers stable for 2 months.
Nov 2013 - Herceptin-Perjeta-Avastin-Xgeva (collageneous colitis, which explains tummy probs, added Entocort)
December '13 BRAIN MRI ned in da head.
Jan 2014: CONTINUING on HAPX…
FEB 2014 PetCT clinical “impression”: 1. newbie nodule - SUV 1.5 right apical nodule, mildly hypermetabolic “suggestive” of worsening neoplastic lesion. 2. moderate worsening of the sternum – SUV 5.6 from 3.8
3. increasing sclerosis & decreasing activity of L1 met “suggests” mild healing. (SUV 9.4 v 12.1 in May ‘13)
4. scattered lung nodules, up to 5mm in size = stable, no increased activity
5. other small scattered sclerotic lesions, one in right iliac and one in thoracic vertebral body similar in appearance to L1 without PET activity and not clearly pathologic
APRIL 2014 - 6 YRS POST GAMMA ZAP, 7 YRS MBC & 18 YEARS FROM ORIGINAL DX!
October 2014: hold avastin, continue HPX
Feb 2015 Cancer you lost. NEDHEAD 7 years post gamma zap miracle, 8 years ST4, +19 yrs original diagnosis.
Continue HPX. Adding back Avastin
Nov 2015 pet/ct is mixed result. L1 SUV is worse. Continue Herceptin/avastin/xgeva. Might revisit Perjeta for L1. Meantime going for rads consult for L1
December 2015 - brain stable. Continue Herceptin, Perjeta, Avastin and xgeva.
Jan 2016: 5 days, 20 grays, Rads to L1 and continue on HAPX. I’m trying to "save" TDM1 for next line. Hope the rads work to quiet L1. Sciatic pain extraordinaire :((
Markers drop post rads.
2/24/16 HAP plus X - markers are down
SCIATIC PAIN DEAL BREAKER.
3/23/16 Laminectomy w/coflex implant L4/5. NO MORE SCIATIC PAIN!!! Healing.
APRIL 2016 - 9 YRS MBC
July 2016 - continue HAP plus Xgeva.
DEC 2016 - PETCT: mets to sternum, lungs, L1 still about the same in size and PET activity. Markers not bad. Not making changes if I don't need to. Herceptin/Perjeta/Avastin/Xgeva
APRIL 2017 10 YEARS MBC
December 2017 - Progression - gonna switch it up
FEB 2018 - Kadcyla 3 cycles ---->progression :(
MAY30th - bronchoscopy, w/foundation1 - her2 enriched
Aug 27, 2018 - start clinical trial ZW25
JAN 2019 - ZW25 seems to be keeping me stable
APRIL 2019 - ONE DOZEN YEARS LIVING METASTATIC
MAY 2019 - progression back on herceptin add xeloda
JUNE 2019 - "6 mos average survival" LMD & CNS new single brain met - one zap during 5 days true beam SBRT to cord met
10/30/19 - stable brain and cord. progression lungs and bones. washing out. applying for ds8201a w nivolumab. hope they take me.
12/27/19 - begin ds8401a w nivolumab. after 2nd cycle nodes melt away. after 3rd cycle chest scan shows Improvement, brain MRI shows improvement, resolved areas & nothing new. switch to plain ENHERTU. after 4th cycle, PETscan shows mostly resolved or improved results. Markers near normal. I'm stunned but grateful.
10/26/20 - June 2021 Tucatinib/xeloda/herceptin - stable ish.
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Old 05-22-2010, 10:15 PM   #7
KimB
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Join Date: Jan 2010
Posts: 8
Re: I want to know: Surgery to remove chest skin

Flori,

You have been through a lot. I am encouraged by reading your whole experience. Your and all other ladies' experiences are real, and that is what I wanted to hear.

I am going to talk with my oncologist about this. and you are right, there is a time when we need to be aggressive with our treatment. I feel much better now.

Thank you.

Kim
__________________
Diag July 2008,
Aug 2008: Right Lumpectomy with Sentinel Lumph Node Biopsy, IDC Stage IIA, no lymps, 2.8cm, Grade 3, ER- PR- HER2- (CEP17, FISH1.7), Ki-67 60%,
Sep 2008-Feb 2009: AC(6)+T(6) dose den,
March-May2009: Rad 28+5,
Oct 2009: Reg Recu (a skin tumor right on scar line),
Nov 12, 2009: PET CT no mets found,
Nov 2009: Right Modi Radi Mastectomy, 0.7cm, Grade 3, 1/10 lymp posi, ER-, PR-, HER2+++, Ki-67 90%
Dec 2009: 3 skin tumors app on the right chest,
Jan 2010: Taxotele(6x) +Carboplatin(6x) +Herceptin(1yr) every 3 wks,
Ap 19, 2010: PET CT no mets found,
April 29, 2010: finished Chemo, continue Herceptin till Dec 2010,
May 6, 2010: MRI (brain) clear.
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