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July 17, 2012 at 8:29 pm #20490
Register today for our webinar ‘Understanding Your Pathology Report’ with Dr. Martin Mihm. The webinar will take place on July 23, 2012 @ 1:30pm EST. Click on the link below to register now:
Dr. Martin C. Mihm, Jr. is an international consultant for pigmented lesions, lymphoma, and cutaneous inflammatory diseases. He is Director of Melanoma, Dermatology Department Brigham and Women’s Hospital, Associate Director, Melanoma Program Dana-Farber and Brigham and Women’s Cancer Center.July 19, 2012 at 10:45 pm #55541
And if you have any questions that would apply to most people here, please send them to me: firstname.lastname@example.orgJuly 23, 2012 at 7:18 pm #55542 The webinar was wonderful! Stay tuned for the archive to be posted tomorrow.July 23, 2012 at 9:57 pm #55543 It was very informative. That guy really knows his stuff and has obviously been a leader in the field for so many years, decades. Seems like a great person to get a consult from if you have any doubt about your pathology.July 23, 2012 at 10:22 pm #55544 Absolutely, he has worked with the best pioneers, DuPont Guerry, my doc and co-author, Wallace Clark of the Clark levels and many more. He is known all over the world. From my notes I thought it was fascinating what he said about insitu: if it were left and not excised it would take 10-15 years to become a tumor! Did he make you feel better about your pathology Cohanja?July 23, 2012 at 11:28 pm #55545 Well, we’ll see – I’m sending my material to him for consult. The issue I still have with my pathology is whether or not it’s VGP is not entirely straightforward. Dr Mihm definitely conveyed the importance in prognosis RGP vs VGP, so that was reinforced. What I don’t know is if my lesion was invasive RGP – or, probably more likely, early VGP. So, even though it was Clark II and thin (0.3mm), it still was probably VGP/tumorigenic. So, I don’t feel good about that, but I’ll see what his opinion is once he gets my material and takes a look.July 24, 2012 at 6:35 pm #55546Webbie73Participant Cohanja, if it is determined that you had VGP how does that change things? Would you be followed differently? I am still trying hard to wrap my brain around Vertical growth phase. my understanding of VGP is that the melanoma has the ability to metastize. Yet a person who is stage 1a is followed the same way whether VGP is absent or present.. At least that was my understanding. This is where I get confused. What is the difference? Maybe Catherine can help here.July 24, 2012 at 7:56 pm #55547 But Dr. Mihm emphatically stated that the Breslow depth is the most important factor for prognosis, and .3 is exceptionally low risk. I have to say my pathology report was much riskier after I saw his slides because I had mitosis and ulceration. Again, it was the depth that gave me my good prognosis, proved by 23 years of still being here.
If Cohanja’s pathology changed to VGP it would not change his follow up. You are correct. There is nothing but watch and wait for low risk folks and move on with life.July 24, 2012 at 8:58 pm #55548
I guess it wouldn’t change my follow-up, unless I opted for annual chest x-rays or something like that. But, after listening to Dr Mihm, he clearly stated the increased risk for metastasis for lesions exhibiting VGP. So, if I get definitive answer that I’m RGP, then I can rest easier about it. If I get answer that I’m definitely VGP, then I know my risk for spread down the line is higher and maybe I’ll get exams more often over the coming years, etc…based on that risk. But, he said that while some in the medical/scientific community still don’t buy into RGP vs VGP, he said it definitely is real and the cells in VGP changed to become able to spread.July 24, 2012 at 9:28 pm #55549 You are missing the point: Mihm stated the number one prognostic indicator is depth, and yours was .3. It wouldn’t matter if there was some VGP, although highly doubtful. Chest xrays show nothing but late stage disease so they are not useful for follow up according to my doctor. So back to the number one prognostic indicator, Breslow depth, this is what we all need to pay attention to. BTW, I had VGP, mitosis, ulceration etc, .76 lesion, but that depth is what gave me the good prognosis.July 24, 2012 at 10:15 pm #55550 I understand. But, I’d want to know if my particular lesion had the capacity for metastasis or not. Even if that would not change anything regarding treatment/follow-up, I’d want to know. So, hopefully, Dr Mihm can clarify when he takes a look.July 25, 2012 at 7:20 pm #55551Webbie73Participant Cohanja, knowing doesn’t make one bit of difference. I had RGP and VGP and knowing that does not change a darn thing…fear, worry or follow ups. It is what it is. I was ans still am stage 1a. The only thing knowing I had VGP did for me was let me know how lucky I was that my melanoma was caught when it was.July 25, 2012 at 8:27 pm #55552WorrywartParticipant I cannot get the webinar to work. It says ready, but when i hit play nothing happens. I’ll ask my hubby to look at it tonight, i’m sure it’s something i’m doing wrong.
cohanja – good luck w/ your 3rd opinion from dr mihm – i hope he says RGP!July 25, 2012 at 8:48 pm #55553
Actually, Mihm will be my 6th opinion:
1) did not comment on growth phase, 0 mitosis
2) RGP, 0 mitosis
3) VGP, 1 mitosis
4) early VGP
5) VGP, 0 mitosis, VGP due to dermal nest size only
6) Mihm . . ?
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