How to get another opinion

[wpatterson4]

All,

I want to get another opinion on my melanoma. Seeing as how I got cheated badly when I did this before, I think I need some advice before I proceed to send the slides to another lab. I’ve seen others on this board mention Dr. Mihm.

Can anyone help me?

[Catherine Poole]

Do you just want another opinion on your pathology? Then by all means go to http://www.drmihm.com and you can have your slides sent for his evaluation. If you want a complete exam etc, that would be different. Where do you live? I can suggest some places for you.

[cohanja]

Is this on your melanoma from 2011? Not another new one, right?

[cohanja]

Can always send to Dr Mihm for another opinion: Contact them first before sending your slides, though, I think there is a form to also fill out with demographics, billing info, etc…

Martin C. Mihm Jr., M.D., F.A.C.P.

SKADA

One Broadway

Suite 14

Cambridge, MA 02142

Phone-617-401-2231

[wpatterson4]

Catherine,

I live in Mississippi. I sent Dr. Mihm an email via his website. Nobody has replied just yet. I don’t want a physical exam or anything like that. A re-evaluation of my slides with an opinion (ie, prognosis) is what I’m looking for.

Same melanoma.

Thanks to both of you for the help.

[cohanja]

You might have better luck and a quicker response by sending an email directly to this person:

Rolanda Flammia

Assistant to Martin C. Mihm Jr., M.D.

Director, Melanoma Program

Department of Dermatology

Brigham and Women’s Hospital

41 Avenue Louis Pasteur

Alumnae Hall, Room 317

Boston, MA 02115

Phone-617-264-5910

Fax-617-264-3021

E-mail- rflammia@partners.org

[cohanja]

Not sure you’ll get “prognosis” on another opinion path report. I didn’t get that, but I got another opinion on the pathology.

[wpatterson4]

Cohanja,

Thanks for the tip. I wonder if Dr. Mihm’s report would reveal the actual percentage of regression my melanoma had.

[cohanja]

I don’t know if he states % or not, but I know he addresses it. This is my exact report from Mihm from July:

DIAGNOSIS

A: Malignant melanoma, superficial spreading type, invasive to level II and a measured thickness of 0.3 mm. Close to lateral margin.

Comments:

A: This lesion, in my opinion is definitely a malignant melanoma. It is microinvasive and it is in radial growth phase. I find no mitoses, no evidence of true ulceration or regression. I consider the lesion to be a pT1a. I would suggest a re-excision with 1.0 cm. margin. Thank you for the opportunity to review this interesting case and please accept my warm personal regards.

[wpatterson4]

Sounds good to me. I think if he wrote that much for yours, he would definitely have something to say about the severe regression that mine unfortunately toted.

[Lisa P]

What exactly is regression?

[cohanja]

Regression: An attribute that may be either absent or present in the radial growth phase (which is adjacent to the vertical growth phase). Regression is evidence of destruction (probably by immune factors) of some of the melanoma cells in the radial growth phase. Immunologically mediated regression of this sort is a weakly negative factor.

[wpatterson4]

Lisa P wrote:

What exactly is regression?

It’s something you don’t want to see in the same sentence with “prominent” or “extensive” on a pathology report. Up until about ten years ago, extensive regression was thought to be a very ominous sign that indicates a lesion with greater potential for metastasis.

For some reason, the issue is ignored by a lot of people who should be interested. It wasn’t even taken into consideration when the 2009 staging criteria were being decided. No one really even agrees on how to measure it. I do know of one respectable study on the matter that has taken place in the last couple of years, but it only included lesions with a vertical growth phase. The conclusion was that lymphovascular invasion was more prevalent in lesions showing “complete regression” of the radial growth phase.

Some melanomas are completely erased by regression. Those are nearly guaranteed to metastasize.

[Lisa P]

Thanks for the info. So, am I correct in assuming that regression can result in the visible melanoma/pigmentation disappearing from sight, but heading downward (vertically)?

[wpatterson4]

http://pubmedcentralcanada.ca/pmcc/articles/PMC3062088/” class=”bbcode_url”>http://pubmedcentralcanada.ca/pmcc/articles/PMC3062088/

This is the best study on regression I’ve seen. Alas, as I mentioned earlier, only vertical growth phase lesions are included.

” In complete regression melanoma cells are absent in the overlying epidermis; whereas in partial regression they are present in the epidermis.9 RGP regression is common, particularly in thin lesions. The incidence of regression in melanomas of all thicknesses has been estimated at about 10–35%, and as up to 58% in melanomas with thicknesses of <0.75 mm.3,18"

“RGP regression has been shown to be associated with an adverse clinical outcome, both in lesions without and with an adjacent VGP.9 The presence of complete regression in the RGP of lesions with VGP was associated with poorer survival in a prognostic model published by Clark et al.4 The extent of regression in thin melanomas also has been associated with poorer prognosis.”

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