What happens if my oncologist and surgeon disagree about Melanoma treatment

When Your Oncologist and Surgeon Disagree About Melanoma Treatment

This is a thoughtful question, and it's actually more common than you might think. Here's how to navigate this situation constructively.

Why Disagreements Can Happen

Melanoma treatment often involves multiple specialists—surgeons, medical oncologists, dermatologists, and sometimes radiation oncologists. They may have different perspectives based on:

• Their specialty's focus: A surgeon might emphasize surgical options first, while an oncologist might prioritize systemic therapy (drugs that work throughout the body)
• Different interpretations of your specific situation: Stage, biomarkers (like BRAF mutations), and other individual factors can be weighted differently
• Evolving treatment approaches: According to the NCCN Guidelines for Patients: Melanoma, treatment options for melanoma have expanded significantly, and newer approaches like immunotherapy and targeted therapy are increasingly used alongside or instead of surgery

For example, the NCCN Guidelines note that for resectable (removable) melanoma with satellite or in-transit recurrence, options include surgery, neoadjuvant systemic therapy (treatment before surgery), T-VEC injections, or systemic therapy—and the "best" choice depends on your individual case.

What You Should Do

1. Ask for clarification in writing Request that both doctors explain their reasoning in detail. Ask:

• "What are the pros and cons of your recommended approach?"
• "What would you do if I chose the other option?"
• "How do these approaches compare in terms of outcomes for someone in my situation?"

2. Request a joint consultation Ask if your oncologist and surgeon can meet together (with you present) to discuss your case. This often resolves disagreements and helps them reach consensus. Many cancer centers facilitate these "tumor board" discussions.

3. Seek a second opinion According to the NCCN Guidelines, getting a second opinion is encouraged. Contact an NCCN Cancer Center or another major melanoma treatment center. A third expert can help clarify which approach aligns with current evidence-based guidelines.

4. Understand the evidence Ask both doctors: "What does the current research show about this choice?" The NCCN Guidelines represent consensus from leading melanoma experts, so asking whether their recommendation aligns with these guidelines can be helpful.

Key Questions to Ask Both Doctors

• "Are you recommending this based on NCCN Guidelines for melanoma treatment?"
• "What is the evidence supporting your approach versus the alternative?"
• "What are the success rates for each option in someone with my stage and biomarkers?"
• "If we start with one approach and it doesn't work as expected, what's the backup plan?"
• "How will we measure whether the treatment is working?"

Remember: You're in Control

According to the NCCN Guidelines, you have an important role in your care. In fact, you're more likely to get the care you want by asking questions and making shared decisions with your care team. You don't have to choose between them immediately—take time to understand both perspectives fully.

If after discussion and a second opinion you still feel uncertain, you can also ask: "If I had to choose between these two approaches, which would you recommend and why?" This often helps clarify which doctor has stronger conviction about their recommendation.

---

This information is for educational purposes only. Always consult your healthcare team for personalized medical advice and decisions.