Home Forums Melanoma: Newly Diagnosed – Stages I & II concerned to confused… Learn to ask questions

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  • #21822
    brussell75
    Participant

    On Thursday my dermatologist called and said my SHAVE bx pathology report came back. She said that it is LEVEL II invasive malignant melanoma. Immediately I heard 2 and melanoma and that was it. After researching a lot I discovered that level II is not the same as stage II. Does this mean that I can relax now? I was concerned about the fact that she did a shave biopsy because everything I have read says not to do shave biopsy when melanoma is suspected. Anyway, I see the dermatologist March 10th. I feel like I can relax now knowing that my melanoma is a level II instead of stage II. Am I correct in assuming this?

    #63620
    Catherine Poole
    Keymaster

    A deep shave biopsy is fine actually better than a punch biopsy. Your doctor should spend more time with you to explain your pathology. I would suggest you get a copy of it and we can go over it here or on our helpline. Please also take some time and listen to our webinar on pathology: http://melanomainternational.org/webinar/2012/07/understanding-your-melanoma-pathology-2/

    The depth of your lesion or Breslow Level/Depth is the most important prognostic indicator. It does sound like you are low risk but need a little more explaining. We are here to help you.

    #63621
    brussell75
    Participant

    Thanks for your response. I feel much better now. I meant I see the ssurgeon on March 10th, not the dermatologist. I don’t see any need to see the surgeon now though since my cancerous spot was shaved off and so small. Whew!

    #63622
    TreeFrog
    Participant

    Hi there!

    I had a mel that was Stage 1, Level 2 invasion, probably much like yours, in 2011.

    In most such cases, you will need to see a surgeon to have a wider local excision (WLE) to remove a perimeter of skin from around the mel, as a precaution.

    Whether it’s your dermatologist, or the surgeon, that you see next, they will explain the pathology and any follow-up you need. If your Breslow depth (the actual thickness of the mel in mm) is low, the WLE and skin check-ups may be all you need.

    Best wishes,

    ~Wendy

    #63623
    brussell75
    Participant

    Thanks for the encouraging words. At this point I don’t see any reason to have any additional biopsies. I have systemic lupus and deal with so many doctors and procedures that to be honest, I’m tired of dealing with. I’m confident that the dermatologist removed plenty of skin during my biopsy. I see no need to see additional doctors to remove more skin and add extra bills to the stack I already have. I initially thought I was stage two instead of level two. No I know that it’s not serious and I’m much more relaxed.

    #63624
    Catherine Poole
    Keymaster

    A lot depends on your pathology report. Find out the depth and the mitotic factor. The biopsy is a test to see if it is melanoma. The follow up wide excision is to make sure all melanoma cells are removed. It is really a good idea to get the wide excision done. A shave biopsy isn’t as good as an excisional biopsy which truly can take the whole lesion. I understand your need to avoid more procedures but it is a good idea to go to the surgeon for follow up. Be sure to get that path report too,

    #63625
    cohanja
    Participant

    Even a level II melanoma, while thin, is still serious. Prognosis is good, but it’s still a serious matter.

    #63626
    Webbie73
    Participant

    I would suggest you follow through with the WLE. I had a stage 1 melanoma and when they did the WLE more melanoma was removed. It is worth the extra procedure and expense. It is your life.

    #63627
    Worrywart
    Participant

    First step, get a copy of your pathology report. The DEPTH is the most important characteristic, not clarks level. Who knows, the pathology report could have said – “Level II not fully excised” in which case you definitely want it all removed. I certainly wouldn’t take this dx lightly.

    #63628
    brussell75
    Participant

    My nerves have set in and now all I can do is look at every freckle and mole with suspicion. I saw my rheumatologist yesterday for a bi monthly lupus following up. She strongly recommend that I treat this aggressively due to my compromised immune system and my immunosuppressant drug therapy. I found another mole last night that is “flakey” like dry skin. It’s a little larger than a pencil eraser and is kind of blurry looking. It’s not dark in color like my melanoma. Instead, it is a grayish, green, brown color. I know I’m probably being paranoid but I just want to be safe. Should I wait until I see the surgeon on March 10th or should I see my dermatologist sooner?

    My original path report for my first mole came back as:

    Level II

    stage I

    2 mm

    This is all Greek to me and at this point I am wondering if they whole thing could have been removed during the shave biopsy. Do any of you think that having caught it so early, that there is any chance I could have lymph node involvement?

    I know this disease can be serious but after ready everyone’s stories, I feel as if I was a lucky one and have nothing to worry about. I would love to hear your OPINIONS because I realize that only my doctor can give me the facts. I just feel like I’m worried about something that is not as serious as it could have been.

    Thank you all!

    #63629
    TreeFrog
    Participant

    Hi Brussels,

    Your feelings are very normal, as in “not sure whether to be relieved or worried.” We all go through this, but the worried feeling does subside after a while. We decide with our doctors on what follow-up to do, and then we do it while going on with our lives.

    So, referring to your last paragraph, I would say you ARE a lucky one, and you have LITTLE to worry about (but follow-up is still very important).

    I’m not sure from what you’ve written if your melanoma was 2mm deep, or 2mm across. In any case, the standard treatment of Stage I melanomas is usually to get the wide excision done, and if the surgeon recommends it (depending on the depth of the lesion), sometimes a sentinel lymph node biopsy as well (at the same time), just to look at the first lymph node “downstream” from your melanoma and make sure it’s clear. Your surgeon will tell you whether this is recommended in your case or not.

    The great majority of Stage I folks never have another issue with melanoma, but since it’s such a serious disease if it advances, it’s worthwhile to have these follow-ups done. As for feeling suspicious of your other moles, that’s also a universal feeling and there’s no need to panic – make an appointment with your dermatologist for a full skin check, and when you go, point out anything that concerns you.

    Best wishes,

    ~Wendy

    #63630
    cohanja
    Participant

    It’s a funny thing, isn’t it, how we think about luck? I guess it’s all relative. When I think about most of the people I know around my age, very few have had to deal with a serious health issue such as this. Compared to most people who never get melanoma, I don’t feel lucky. But in the melanoma world, having caught it on the early side is not a guarantee, but still a lucky thing.

    #63631
    cohanja
    Participant

    One other thing – what you’re feeling is normal – cancer is a traumatic event, research shows that cancer diagnosis (and recurrence) can be considered a traumatic event. In certain cases, this trauma may lead to symptoms of post-traumatic stress disorder (PTSD). I’m not saying that’s what you’re experiencing, but it illustrates how it can impact people.

    #63632
    brussell75
    Participant

    Path report reads:

    -Melanoma, level II invasion, 0.2mm tumor thickness, non ulcerative

    Procedure: shave biopsy

    Specimen Laterality: left

    AJCC Classification: T1aNxMx

    Tumor Distance to nearest margin:

    Deep: 0.8 mm

    Lateral: present

    Histologic Type: Superficial spreading

    Mitotic index: 0

    Tumor infiltrating Lymphocytes: present, non-brisk

    Nevus: present

    Lymph-Vascular Invasion: not identified

    Perineural Invasion: not identified

    Regression: not identified

    Microsatellitosis: absent

    after seeing this, I’m no longer worried. I feel horrible for being so scared of something that is so insignificant. I see no reason to see further treatment that barely existed. I don’t know why my dermatologist would have recommended further treatment for something that is probably already gone after the shave biopsy.

    Thank you all for your kind words and talks!!!

    ;)

    #63633
    cohanja
    Participant

    Very similar to mine from 2011. Not no risk, but low risk. Stay vigilant, but not paranoid.

    Now if I could only follow my own advice :D

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