Home Forums Melanoma Diagnosis: Stages I &II How to get another opinion

  • This topic is empty.
Viewing 15 posts - 1 through 15 (of 21 total)
  • Author
    Posts
  • #20751
    wpatterson4
    Participant

    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?

    #57405
    Catherine Poole
    Keymaster

    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.

    #57406
    cohanja
    Participant

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

    #57407
    cohanja
    Participant

    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

    #57408
    wpatterson4
    Participant

    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.

    #57409
    cohanja
    Participant

    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

    #57410
    cohanja
    Participant

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

    #57411
    wpatterson4
    Participant

    Cohanja,

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

    #57412
    cohanja
    Participant

    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.

    #57413
    wpatterson4
    Participant

    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.

    #57414
    Lisa P
    Participant

    What exactly is regression?

    #57415
    cohanja
    Participant

    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.

    #57416
    wpatterson4
    Participant

    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.

    #57417
    Lisa P
    Participant

    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)?

    #57418
    wpatterson4
    Participant

    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.”

Viewing 15 posts - 1 through 15 (of 21 total)
  • The forum ‘Melanoma Diagnosis: Stages I &II’ is closed to new topics and replies.