Home Forums Melanoma: Newly Diagnosed – Stages I & II New diagnosis…scared and anxious!

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  • #21989
    Bdeck1
    Participant

    Hey everyone,

    I was so happy to find this site after recently being diagnosed with Melanoma. I think I have read every research study and forum concerning Melanoma. I was slightly familiar with the diagnosis as I am a Physician Assistant. However, in the last few days, I feel as though I am now an expert.

    I went to the dermatologist about 1.5weeks ago. This was the first time I had seen a dermatologist for a skin exam. She was concerned about a mole on my back and did a shave biopsy. Exactly one week later she called me to tell me the bad news, it is SSM.

    To say I am terrified is an understatement. I have two small kids (18 months and 3 years). All I could think about is “I’m going to die from this”.

    Since I work in the medical field, I did obtain a copy of the pathology report.

    Malignant Melanoma, invasive, superficial spreading, arising in the context of a severely atypical compound melanocytic nevus

    Breslow: 0.70mm

    Clark level: 4

    Deep and peripheral margins: negative

    Mitotic: <1

    No lymphovascular or peri neural invasion.

    Tumor regression: not identified

    Growth phase: radial

    Ulceration: not identified

    Tumor infiltrating lymphocytes: present, non-brisk.

    Staging: pT1aNx

    From my research, this is a “good” (if anything with melanoma can be considered good) prognosis.

    But, I have so much anxiety over it. I am scheduled for a WLE. I have an initial consultation on June 12 with surgical oncologist.

    I read so many conflicting studies. Some say Clark’s level has no prognostic indications. While others say there are bad prognostic outcomes for Clark level four lesions and thin melanomas. If clark level is of no significance, why do they even report it?

    I also don’t understand how I can have a clark level 4 and a radial growth phase. I would assume there would have to be some vertical growth. You can find things that state that “radial growth phase lesions are unable to metastasize.” But if I have a clark 4, then it has spread into the reticular dermis where lymph channels sit…argh. So you see where this puts me? Compulsing.

    I feel bad for the surgeon who will have to deal with my questions.

    If anyone knows these answers and can clarify, I would appreciate it.

    Thanks!

    #64451
    TreeFrog
    Participant

    Hi Bdeck,

    Glad you found this forum … I certainly was glad to find it four years ago when I was diagnosed with a similar melanoma, .47mm Stage I. I have had no further issues.

    I know exactly how you feel as you “become an expert” in a quick hurry! I am sure others will post to help put your mind at ease. A Stage I diagnosis is something to be taken seriously, but not a panic situation. You’ll feel much better once the surprise wears off!

    You are correct, there is nothing especially alarming in the pathology – it’s all favourable in the context of melanoma (me, another armchair expert, speaking).

    Regarding the Clark level versus Breslow depth, all I can say is that research over many years has shown that the predictive value of the depth is far stronger than that of the Clark level. Many labs no longer routinely report Clark level. You are in a good spot with depth under .75mm.

    If the seeming discrepancy between the Clark level and the stated “radial” growth pattern bothers you, get a second opinion on the biopsy slides. Many on this forum recommend a second opinion as a matter of routine.

    The surgical oncologist may have more information that will help you out.

    Hope this helps!

    ~Wendy

    #64452
    Catherine Poole
    Keymaster

    Wendy is correct, most discount the Clarks Level as predictive of outcome and rely primarily on the Breslow level and mitotic value. Your report (which by the way is available to all patients and we recommend you have it) doesn’t have anything alarming. A little higher depth you may consider a SLNB. You might want to look at our info on pathology: http://melanomainternational.org/melanoma-facts/pathology/#.U38vZvldXVo

    Take it a day at a time if you feel you need further information, another pathology report can provide that and make sure an expert is looking at your biopsy.

    #64453
    Bdeck1
    Participant

    Thank you for responding. It does make me feel better to hear from people who have gone through what I am going through. My family doesn’t get it. My parents tell me not to worry and it is no big deal. That I should not worry until I have something to worry about. They say they know plenty of people with melanoma who are fine now. My mother in law stated, “no one dies from melanoma”. (Oh, boy! She is clueless.) But this IS something to worry about! It IS a big deal. My husband understands and is equally as worried as I am.

    Since my breslow depth is 0.7mm, what would you all do? Many doctors only suggest snb at 1mm and greater while I have heard others do snb for 0.75mm. Should I push for the snb or just follow whatever the surgeon recommends?

    #64454
    bon15
    Participant

    I was in the same position as you when diagnosed with a 0.72mm Clark level 4 melanoma in February 2012. Mine was also in the invasive radial growth phase and I also questioned this with the dermatopathologist who did the report, given the apparent contradiction.

    His reply was that my melanoma was “only” superficial Clark level 4 and that he had cut fifteen levels throughout the melanoma, none of which showed any mitotic activity, and he also judged that the largest nest of cells were at the junction of the epidermis and dermis rather than being within the dermis and therefore classified the grwth phase as invasive radial. He said that the decision re the cells was subjective and this often is the case

    .

    I was tempted to get a second opinion but the person who I would have gone to, a professor of dermatopathology, spoke very highly of my dermatopathologist. Anyway, pathology is an art as well as a science so even if you get a second opinion who is to say which one is correct. I was even told by my dermatologist sometime later that the dermatopathologist said someone else may have judged it to be severely atypical but he had a gut feeling it was melanoma.

    Anyway, I have been fine so far inspite of having a very anxious nature and going into regular meltdowns about this or other symptom! I would also add that I did not have an SLNB.

    I wish you all the best.

    #64455
    Bdeck1
    Participant

    Bon 15 – how were you able to talk to the pathologist? Did you call the derm in order to do that?

    #64456
    bon15
    Participant

    I didn’t talk to the dermatopathologist. I raised my concern with my dermatologist who then contacted the dermatopathologist with my questions who then kindly wrote a letter and sent it directly to me.

    I would mention that I from the UK and paid privately for my treatment rather than go through the NHS.

    #64457
    cohanja
    Participant

    I have actually talked directly with pathologists. A few I’ve directly emailed and a few I’ve talked to on the phone. Many times on the path report you get from the derm, it has the pathologist info on there.

    #64458
    Worrywart
    Participant

    Have your slides sent to an expert such as Dr Mihm. He will, as will many,speak with you directly on the phone. Once the slides are sent for a second opinion you will be able to speak directly to the pathologists (that has been my experience). Radial Growth phase is very low risk, but I agree, with .7 and clarks 4 that seems a bit unusual. So first things first – a second opinion on pathology. Then get the SNB if you feel it would put you at ease.

    Where was the mole? I take it it was in an area with ‘thin’ skin (due to clarks 4)?

    #64459
    Bdeck1
    Participant

    The mole was on my thoracic back. I’m a skinny (120lbs) person and my back is definitely not a thick area.

    As for the second opinion. How do you go about doing that? Does insurance pay for it? The facility (ochsner medical center) is a pretty big academic hospital. I do trust their opinion…and secretly I don’t want to hear any more bad news.

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