Home Forums Melanoma: Stage III Misdiagnosis?

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    Yes, Catherine! This new pathologist is a melanoma specialist (for lack of a better word). He works exclusively at the Melanoma Clinic at CPMC in San Francisco and only views melanoma slides. I had NO IDEA there were special pathologists for this sort of thing, or I would have gone to the melanoma center to begin with (it’s far from home). I thought it was OK to go once for a consult and have them direct my treatment to a doc at home. I’m glad I went up there!

    I’ve been wondering what to think if it comes back nevus. Three “general” pathologists saw it as melanoma. Here’s what the melanoma pathology report says (from the Melanoma Pathologist):

    “In the sentinel lymph node, there is a small focus of melanocytes seen on melon-A?HMB-45 stains which is very close to the subcapsular sinus of the lymph node. This focus is not seen on H&E slides, and the cells are not large. I cannot be certain if this is metastatic melanoma or a nodal nevus. Having the original biopsy available to review may be helpful.”

    My original biopsy site slides are there now, and I should receive a call Monday.

    Should I send the slides for yet another opinion to one of the aforementioned places? At this point, I’m concerned about time getting away from me. My original diagnosis was Jan 29, WLE/SNB Feb 7. Results Feb 14, and I’ve been getting other opinions–now it’s almost April.



    OK, the doctor reading my slides for the 2nd opinion is DR. John Moretto, MD in San Francisco. According to his profile, he is a board-certified in dermopathology and anatomic pathology. He graduated from Stanford in 1990.

    Catherine, have you heard of him? Should I trust his judgement if he renders a different opinion, or send the slides to a 3rd pathologist (dermopathologist)?

    I feel like I’m running out of time and if I have more in my nodes it will spread. :(



    Actually to me, if a melanoma pathologist, who’s been seeing this stuff all the time for decades, says he’s not sure, that would be, to me, encouraging news. Especially when I see the phrase “..and the cells are not large.” My experience with Rachel’s pathology showed her melanoma was, “grade 3, poorly differentiated” displaying large, mis-shapened cells.

    My understanding is, the lower the tumor “grade”, the more the cells appear as normal cells (highly differentiated) and, typically, the cancer, if that’s what it is, is less aggressive. Rachel’s cancer was very aggressive.

    So to me that says the stuff he’s looking at does not appear all that abnormal to him really but it’s odd that it’s where it is in the node so he wants to see the slides from the original tumor to make a comparisons before he says anything definative. He’s being careful, sure, and accurate. That’s also encouraging to me…it’s good to be sure.

    I hope this helps. I know this is very stressful for you.




    The surgeon just called. They’ve had 6 board-certified dermopathologists plus all the docs on the tumor board at the Melanoma Clinic look at my lymph node slides, repeatedly. Everyone was stumped, so they hired a Dermopathology melanoma sub-specialist doctor, who is also stumped. The few, tiny cells look for all the world like a harmless nevus, but they don’t like where they’re located. Based on my age and family history of melanoma, they recommend that I have the lymph node dissection. He doesn’t want me to be regretful later IF this is melanoma. So I’m having the surgery tomorrow in San Francisco and will stay overnight. I’m a little bummed I couldn’t get a definitive diagnosis, but this process has taught me that a dermopathologist is SOOOOO important!


    With a family history of melanoma, I can understand why they want to do the dissection.

    For me, the worst part of that surgery was dealing with the drain. But that’s just a temporary situation. Ask the surgeon if they can get you a post-mastectomy bra to wear after the surgery. Mine had shoulder straps that opened/closed with velcro plus a zipper in between the girls for easy-on-easy-off. It also had velcro along the bottom to which a pouch that housed the drain was attached. If your surgeon won’t get you one, buy some stretchy camis that have a shelf bra. You’ll just need to use paper tape to secure the drain to your body — the stretchy fabric will keep it from bouncing around.

    Good luck to you! I hope the rest of your nodes are fine. Sending prayers your way.

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