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  • #20467
    chrisjax
    Participant

    Hi,

    I got diagnosed about a month ago. Shock of my life, I am 29 and never thought that this would be a thing I would hear until much later in life. I had the full removal the day after they told me I had it. I did not get a SLNB done when they took the tumor. Is this normal, should it have been done, is there any way to check anymore. I know this is a little late in the game to ask but i was in a haze when it happened and did not question them much. I did go to a place the does specialize in melanoma though. Here is the path report on both the original and larger take out. Any feed back would be appreciated.

    first extensional biopsy.

    Malignant melanoma

    0.7 thick

    Clark IV

    Growth Phase vertical

    Ulceration none

    Mitotic rate less than 1

    Angiolymphatic invasion none

    Regression none

    Lymph host response none

    Stage t1b

    Full Removal

    0.4

    Clark 2

    No ulceration

    Mitosis less than one

    Path stage t1a

    So does this mean that it was t1a or t1b. On the web half the sights say clark does matter the other half say not anymore. As I am sure you can relate to you can drive yourself nuts looking up info on this stuff. Also what is the relapse risk? I have seen everything from 4% to 30 for this. Thanks

    Chris

    #55405
    Catherine Poole
    Keymaster

    The depth or BReslow level of your lesion is the number one prognostic indicator! Nothing else has as much importance according to all of the research. So you are in good shape with a .7 lesion, which makes you low risk for recurrence. Where was the original lesion? Sometimes that can add something to the prognosis, but the depth is number one. I know this whole business shakes your foundation, but over time you will heal and learn how important it is to live in the moment. My melanoma was .76, 22 years ago. I’ve had no further disease. I hope this helps you.

    #55406
    chrisjax
    Participant

    Thank you for the reply. It was on the back of my shoulder, closer to my arm than neck. That is great to hear. One of the problems seems to be that a lot of the people who are posting tend to be the ones that have had a relapse and I think that it was giving me a skewed view. Seeing 22 years is awesome.

    #55407
    cohanja
    Participant

    If the mitotic rate is <1, wouldn't it be 1a rather than 1b?

    #55408
    chrisjax
    Participant

    The Clark level 4 put it at t1b. I have seen that Clark level is not a factor as much as it use to be. Without that it would have been t1a.

    #55409
    Catherine Poole
    Keymaster

    Clarks Level has been replaced by the Breslow Level. Some say pathologists still have use for Clarks but it is widely disregarded as important. (Dr. Clark was my doc too and brilliant! But the depth is really the most important thing) Mitosis (cellular activity) has some bearing but recently I saw some research disregarding that as well) It is all ever changing except for the Breslow Level. Try to stick with websites with the HonCode designation for safe health info on the net. Otherwise, anyone can post anything and there is no scientific backing or moderating.

    #55410
    chrisjax
    Participant

    Would you think that asking for a SNLB would be a good idea at this point? I mentioned this to my derm the first day but he kind of waived it off and I was not thinking that much at the time.

    #55411
    chrisjax
    Participant

    Hey,

    Just got home from work and had a VM from the doc. The other three spots they took last week came back benign!!

    I really appreciate the responses to the posts above you all are a great help!

    Chris

    #55412
    chrisjax
    Participant

    Decided to go get a second opinion at Mayo. Lucky to live in a city with top level hospital. The derm there has set me up with a surgical Oncologist and they think that a SLNB is going to be a go. Have a meeting with him in early August. Don’t know if this is for a consult and then surgery or just doing the surgery. They took another spot off during the meeting with the derm. Waiting on the results now. Probably a week out.

    The original report said that the Mel extended to the periphery which I just assumed that since the WLE was shallower that the 0.7 was as deep as it got. The derm now said they can’t tell for sure. It could be 0.7 at the deepest still or they could be added together.

    Have any of you had the SLNB after the WLE or any situation similar. What is the recovery time from this. Can I go to work the day after?

    Sorry to be posting a lot; this is the only place that I really want to talk about it. I don’t want to tell family or friends yet.

    #55413
    Catherine Poole
    Keymaster

    I wouldn’t think a SLNB would be called for with a .7, no ulceration or mitosis. Did you say they are looking at the pathology slides again? Some folks have had the SLNB after the WLE. It isn’t a 100% diagnostic tool, but if it will make you feel better to do so, then you should. There is some lymphedema to deal with and a short post-op time of recovery. Please read up on it here on the website: http://www.melanomainternational.org/melanoma_info/sentinel_node_biopsy.html

    #55414
    Worrywart
    Participant

    If your melanoma possibly extended past the deep margin I would do the SNB, simply because if it is positive (doubtful) then you will be eligible for other treatments (although limited).

    #55415
    Catherine Poole
    Keymaster

    Actually watch and wait is the best follow-up we have for stage III disease if that should happen. So the SLNB promise is if there are micromets in the node, it will be removed. I would see what the new pathology report says before taking this on.

    #55416
    chrisjax
    Participant

    The doc said the main reasons were that the WLE had .4. since there is no way to tell if it went over and then down it could have been thicker but he thinks that it is unlikely since the first one extended to a peripheral instead of vertical margin.

    The way that he does them is anyone with enough risk factors gets one. He did say i still have a very low chance of positive but enough to go look. the things that we looked at was that I am 29 male with VGP and Clark IV. My personality is the type that says go aggressive and find out.

    Thank you for the link and responses. Do you think that the swelling and numbness is anything that would keep me from going back to work the next day? I work at a desk.

    Anyone had experience with Mayo?

    #55417
    Catherine Poole
    Keymaster

    MAYO has a great reputation for fine medicine. I’m not sure you want to go back to work the very next day, but see how you feel. The anesthesia can have its side affects.

    #55418
    abdorma
    Participant

    Hi ChrisJax,

    My husband has been going to Mayo (Rochester, MN) for about 18 months (Stage III C) and he is very happy (me too!) with the collaborative approach and with the oncology, surgical staff (he has had two surgeries) and dermatology group. He did not have WLE or SNB done there but since we live about 50 minutes away and did not like the approach of the oncology group he was referred to in the Twin Cities, decided to go to Mayo. They see alot of people with melanoma and have a very collaborative approach to handling the disease. They are quick to consult with other doctors so you feel like you are getting the views of more than one person about next steps.

    My guess is that you will soon get an appointment schedule that will likely say “Surgical Consult” and you will most likely meet with a surgeon. Then they will probably schedule the surgery for a later date. And it is surgery, albeit on an outpatient basis.

    Good luck to you. May they take only a few lymph nodes and may there be nothing of trouble in those lymph nodes!!!

    Ann

Viewing 15 posts - 1 through 15 (of 24 total)
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