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    I was diagnosed a few days ago with melanoma. It was in the middle of my back. I’m just nervous about the pathology report and what it all means. The report says:

    Procedure: Shave Biopsy

    Histologic Type: Superficial Spreading

    Breslow’s Depth 1.5mm

    Clark Level 3


    Peripheral Margins: Not Involved

    Deep Margins: Not Involved

    Ulceration: Absent

    Mitotic Index: Absent

    Lympho Vascular Invasion: Absent

    Neurotropism: Absent

    Tumor-Infiltrating Lymphocytes: Non-Brisk

    Tumor Regression: None

    Lymph Nodes (if applicable) N/A

    Pathologic Stage: PT2A

    So now they sent the nodule for genetics testing. I’m waiting on that. They told me that if it was class 1 then they would do a wide excision in the office. If it is class 2 then I would go to a surgical oncologist and they would do the excision in the OR and check lymph nodes.

    The thickness scares me, the stage 2 scares me…. What do you all think?

    Catherine Poole

    Sorry for the delay on this response. The Breslow is the major risk factor here and the good news is there is no mitotic factor or anything else that would raise flags. Normally a Sentinel Node Biopsy would be done. That would provide the criteria for staging you. Anything over .76 is followed with a SNB. I’m guessing you mean they sent the skin sample or melanoma lesion to be tested for the BRAF mutation. Fortunately, if further cells are found in the lymph nodes, you may be offered supplemental treatment with the newest therapies. But I would ask about the SLNB now. Feel free to call our helpline (610-942-3432) or email: cpoole@melanomainternational.org for further help. Try not to worry. Much of your report looks good.


    Catherine, the lesion was sent to Castle. Does that mean they are checking for the BRAF mutation? So either way, I should ask for a sentinel node biopsy right?

    Catherine Poole

    It would be normal procedure to do a SLNB because of the depth of the lesion. Castle does a lot of genetic marker testing. The jury is out whether it is helpful since there are few therapies available to match their findings. BRAF testing is done because there are BRAF therapies available for those whose tumor is BRAF positive. May I ask where you are going for treatment? Did you pay out of pocket for the Castle testing?


    I had my biopsy at a local dermatologist and the pathology was performed by a dermatopathologist. For treatment I will go to Levines Cancer Center in Charlotte NC. Do you know any doctors there? I don’t know about the cost/insurance coverage of the Castle test. The dr. didnt say when they told me they were ordering it and I just assumed it was covered. I guess Ill soon see! I called and talked to the nurse at the dermatologists office today about the castle test because I had not heard from them and its been two weeks. Its finally back but she wasnt familiar with the report. All she could tell me was that it was class 2 and that the dermatologist would call me and go over it with me. I understand that class 2 is high risk for recurring so now Im anxious about that. Ill still go to Charlotte for treatment anyway.

    Catherine Poole

    Normally you pay out of pocket for the Castle Biosciences testing. It can be costly. What you need to know for is the genetics of the tumor, if it is BRAF positive or not. Much of the other testing doesn’t have a therapy to match it. Your next decision is to decide on adjuvant therapy or not. That you should discuss with an oncologist.

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