Home Forums Melanoma Diagnosis: Stages I &II Melanoma in situ, surgery, possible graft

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  • #21331
    Cherann
    Participant

    Hello. I am new to the forum. Well, I should be a lot more knowledgeable than I am. 12 basal , 2 squamas , over a period of 30 years. However every new one instills the same anxiety. But now in last 4 years have had 2 melanomas. First one was maybe stage 2, more than in situ, but they said not invasive. However after first diagnosis, Dr decided needde to be done by plastic surgeon. Was on side of nose, had to have flap, not from forehead, did it starting between eyes on bridge of nose and just zigzagged down. Looked horrible of course at the time. Looks great, a scar on side of nose, but not bad at all. Here is my new problem. Just diagnosed with superficial in situ, , close to area, but don’t know if it’s from original, just close enough. Dr, says superficial , of course concerned, but not like the other. Even suggesting a medicinal cream they use for melanoma.Or watching for awhile. But of course once they say the “word” you just want it gone. He is going to take off soon. Says it will be about 1 ml. Tip of nose. Maybe size of nickel.

    We all know we cringe at facial areas. He said I could have a skin graft maybe. I have heard a lot of negatives there. New territory to me. Ok , folks, my main question is, if I don’t have graft, can that depth pretty much fill in on it’s own, eventually. Providing they get it clean. He does Mohs. I have had little “craters” so to speak on areas like my arms that were that deep that ended up filling in. I can be patient if that can happen, rather than worry about grafts. Anybody with similiar situation. I never had to much anxiety until the melanomas started. I think I got used to the basal, after so many times. This is a new . It’s not just vanity, these are extremely serious. Wondering if anyone had good luck with one filling in , without doing graft. I don’t believe they can stitch much when on some areas such as nose.It will be on tip of nose area. I am sorry for long post, first time. I think forums are great and appreciate all info or reply posts. Thanks so much, Cherann 😯

    #61050
    Worrywart
    Participant

    Hi Cherann. I am not sure about whether or not the graft will fill in. I would ask an experienced PS that question. As for you first melanoma, it can’t be stage 2 adn not invasive, so it was probably radial growth phase stage I. If its in same area I’ll willing to bet this is a lentigo maligna. It has a high local recurrence rate.

    #61051
    cohanja
    Participant

    maybe it was level 2 (rather than stage 2)?

    #61052
    Cherann
    Participant

    It’s been 4 years,since that first, and now after getting your posts, I’m not sure. Maybe you can help me by explaining the difference between stage 2 and level 2 . The first one was more than in situ but they said they got clean margins. Had an extensive surgery for nose, but that may be where it was located. Noses seem harder to fix. I’m hoping I can forget the graft on this new one, I think I have a choice, and hoping the “wound will just fill in eventually. Like a bad scrape. Derm said would not be to deep and maybe 1 centimer in diameter. I realize I should know more after 30 years of this. I got used to basal cells always just got them off. Melanoma a whole different angry animal. So to speak. But I really would like to know why I was confused between level and stage. Really like info, more on top of things now. Thanks so much for answering and any info you can send. Cherann

    #61053
    Catherine Poole
    Keymaster

    Are you seeing a plastic surgeon? If not, you should. They are expert at these things. MOHs IS NOT to be used for melanoma, only basal and squamous. You may need a second opinion on this and be followed at a melanoma clinic of excellence. Keep in touch.

    #61054
    Worrywart
    Participant

    Cherann – It was probably level 2 (also known as Clarks level of invasion).

    Stage grouping

    Once the T, N, and M groups have been determined, they are combined to give an overall stage, using Roman numerals I to IV (1 to 4) and sometimes subdivided using capital letters. This process is called stage grouping. In general, patients with lower stage cancers have a better outlook for a cure or long-term survival.

    Stage 0

    Tis, N0, M0: The melanoma is in situ, meaning that it is in the epidermis but has not spread to the dermis (lower layer).

    Stage IA

    T1a, N0, M0: The melanoma is less than 1.0 mm in thickness. It is not ulcerated and has a mitotic rate of less than 1/mm2. It has not been found in lymph nodes or distant organs.

    Stage IB

    T1b or T2a, N0, M0: The melanoma is less than 1.0 mm in thickness and is ulcerated or has a mitotic rate of at least 1/mm2, OR it is between 1.01 and 2.0 mm and is not ulcerated. It has not been found in lymph nodes or distant organs.

    Stage IIA

    T2b or T3a, N0, M0: The melanoma is between 1.01 mm and 2.0 mm in thickness and is ulcerated, OR it is between 2.01 and 4.0 mm and is not ulcerated. It has not been found in lymph nodes or distant organs.

    Stage IIB

    T3b or T4a, N0, M0: The melanoma is between 2.01 mm and 4.0 mm in thickness and is ulcerated, OR it is thicker than 4.0 mm and is not ulcerated. It has not been found in lymph nodes or distant organs.

    Stage IIC

    T4b, N0, M0: The melanoma is thicker than 4.0 mm and is ulcerated. It has not been found in lymph nodes or distant organs.

    Stage IIIA

    T1a to T4a, N1a or N2a, M0: The melanoma can be of any thickness, but it is not ulcerated. It has spread to 1 to 3 lymph nodes near the affected skin area, but the nodes are not enlarged and the melanoma is found only when they are viewed under the microscope. There is no distant spread.

    Stage IIIB

    One of the following applies:

    T1b to T4b, N1a or N2a, M0: The melanoma can be of any thickness and is ulcerated. It has spread to 1 to 3 lymph nodes near the affected skin area, but the nodes are not enlarged and the melanoma is found only when they are viewed under the microscope. There is no distant spread.

    T1a to T4a, N1b or N2b, M0: The melanoma can be of any thickness, but it is not ulcerated. It has spread to 1 to 3 lymph nodes near the affected skin area. The nodes are enlarged because of the melanoma. There is no distant spread.

    T1a to T4a, N2c, M0: The melanoma can be of any thickness, but it is not ulcerated. It has spread to small areas of nearby skin or lymphatic channels around the original tumor, but the nodes do not contain melanoma. There is no distant spread.

    Stage IIIC

    One of the following applies:

    T1b to T4b, N1b or N2b, M0: The melanoma can be of any thickness and is ulcerated. It has spread to 1 to 3 lymph nodes near the affected skin area. The nodes are enlarged because of the melanoma. There is no distant spread.

    T1b to T4b, N2c, M0: The melanoma can be of any thickness and is ulcerated. It has spread to small areas of nearby skin or lymphatic channels around the original tumor, but the nodes do not contain melanoma. There is no distant spread.

    Any T, N3, M0: The melanoma can be of any thickness and may or may not be ulcerated. It has spread to 4 or more nearby lymph nodes, OR to nearby lymph nodes that are clumped together, OR it has spread to nearby skin or lymphatic channels around the original tumor and to nearby lymph nodes. The nodes are enlarged because of the melanoma. There is no distant spread.

    Stage IV

    Any T, any N, M1(a, b, or c): The melanoma has spread beyond the original area of skin and nearby lymph nodes to other organs such as the lung, liver, or brain, or to distant areas of the skin, subcutaneous tissue, or distant lymph nodes. Neither spread to nearby lymph nodes nor thickness is considered in this stage, but typically the melanoma is thick and has also spread to the lymph nodes.

    #61055
    Cherann
    Participant

    Thanks to all for the info. I really appreciate all the reply posts. Cherann. :)

    #61056
    Cherann
    Participant

    HI all. Happy to report my melanoma removal came back clean. Clean margins, DR says gone.

    For now at least, after so many skin cancers over the years, I have learned not to take it for granted that it will never happen again. My first mel, 4 years ago was a little invasive, not sure what class, was on side of nose by nostril, lost a good bit, but had great plastic surgeon, some reconstruction, With a scar barely noticable. This 2nd was malignant in situ. Bad thing was on nasal tip. Where they usually can only do slice surgery, leaving a crater, so to speak. Was pretty big , about size of nickel, and believe me , as some know , on face or nose that looks really big. Dr was not sure until 2 weeks after, about having skin graft. And now says seems to be filling in , although it can take some time and once looks more normal can stay very pink for up to a year. At this point I elect not to have a skin graft, which sometimes has it’s own issues. Once this fills in enough, I can cover “pink” with makeup, to me this a better choice than skin graft.

    However, it has only been 2 weeks, and things do change sometimes. For now I am happy with clean margins. Thankful for what I have for now, and diligent about the “watch”. Glad to have you all. If anyone else had good luck with “fill in on a slice surgery, I would like info. Seems no matter how many times we deal with this, whether, basil, squamous, melanoma. There is still always something to new to learn or hear about. Good health to all. Cherie

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