Home Forums Melanoma: Newly Diagnosed – Stages I & II Newly Diagnosed – In Situ or Stage I – unsure

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  • #21374
    CMConn
    Participant

    Thank you MIF for such a wonderful resource! I came across this website and forum last night and read so many posts and responses. It was so helpful and reassuring to know that others have the same feelings (fear, shock, how can I enjoy summer and the great outdoors now, what next, what if, what now) as me. It has certainly been a very stressful 30+ days and one that so many are also faced with when being diagnosed with melanoma.

    My journey started on April 30, 2013 when I finally made it a point to get in to see my doctor and have her look at a mole/sore on my left hip that I had been watching and playing with (a little) over the last six months. It certainly did not look like a typical melanoma but something about it made me want to finally have it looked at. My doctor told me that she didn’t think it looked like anything to worry about as it didn’t fit all the ABC, etc., criteria; thus, we could either watch it over the next couple months, or go ahead and remove it via a punch biopsy so that we know for sure. We decided on the punch biopsy. I finally received the results and diagnosis on Friday, May 10, 2013. It was, in fact, melanoma.

    Pathology/Diasnosis:

    Malignant Melanoma, Invasive, Superficial Spreading Type

    Maximum Tumor Thickness (Breslow thickness): 0.43 mm

    Anatomic Level: TJ (?) or T1 (melanoma present in but does not fill and expand papilary dermis)

    Ulceration: Not present

    Satellite Nodules: Not identified

    Tumor Infiltrating Lymphocytes: Non-brisk

    Tumor Regression: Not identified

    Peripheral Margins: Positive

    – Deep Margin: Negative by approximately 1.5 mm

    Biopsy Specimen: 0.4 x 0.4 x 0.2 cm

    Microscopic Description: Sections demonstrate a predominantly junctional melanocytic neoplasam with focal atypical melanocytes within the dermis. The epidermal component is nested, lentiginious and pagetoid and displays severe cytologic atypia. Foci of pagetoid upward migration are seen. The melanocytes within the dermis are rhabdoid in appearance with prominent nucleoli. The intradermal component is small and no mitotic figures are seen. The lesion appears to be asymmetric. The confluency and pagetoid upward migration of the melanocytes is highlighted with Melan-A. The intradermal melanocytes do display patch expression of HBM45. No K1-67 expression is seen within the intradermal melanocytes.

    Hmmm…I’m still not sure what all that description means – good or bad?

    Thereafter, on May 24, 2013,I was scheduled for my first surgery – a wide excision as well as a lymph node, left groin, sentinel lymph node biopsy (to be on the safe side). Those results came back on May 28, 2013 with the diagnosis being: skin with healing biopsy site negative for residual melanoma and a final margin widely negative and the lymph node negative for metastic melanoma. Yes, it was a big sigh of relief.

    With those results and clear margins, on May 29, 2013, I went back into surgery for the local flap closure. It’s amazing how good it looks today. The excision and flap were not painful at all, the biopsy site was definitely sore for a few days.

    What now…I’m currently waiting for my referral to UCSF and I’m very anxious to have them look over my entire body – no one has done that yet – ugh (I do have sun damage on my shoulders, chest) and everything looks suspicious now. Yes, I’m fearful that they will find something else. Today I’m dealing with the what nows and what ifs. How do I enjoy the great outdoors. How much can I be in the sun if I’m protected with sunscreen (no I won’t be sunbathing). I still have so many questions. I also don’t know if I am considered in situ or stage 1 – my plastics doctor said “in situ” while my general surgeon said “it was somewhat invasive; however, if you had to pick a melanoma this is the one to have.”

    I would certainly appreciate and welcome any comments, suggestions or bits of encouragement. It has been certainly been a stressful month and while I tend to be a very positive person, this has certainly been a challenge. I know I need to get out there and live life to the fullest and I’m hoping that I will get there again soon it’s just been a struggle! For those of you who are dealing with these same issues, I wish you peace and healing. This is certainly no fun.

    Cindy

    #61347
    cohanja
    Participant

    Sorry you’ve joined us. Your subject “In Situ or Stage I – unsure”, this would be Stage I. In Situ is confined to the epidermis, yours has some depth (0.43 mm) into the papillary dermis, so it’s Stage I. You went above & beyond by getting the node biopsy, but the negative result gives peace of mind (I did the same thing, even though node biopsy was not clinically called for with our depth, we both did it anyway). I also thought after my diagnosis (about 2 years ago) that every thing else on my body looked suspicious, and I had lots and lots of subsequent biopsies, none of which turned out to be anything more than mildly dysplastic/atypical.

    #61348
    Catherine Poole
    Keymaster

    As Cohanja points out, having a SLNB for .43 melanoma is above and beyond and not clinically indicated. You can rest easy that you’ve taken an aggressive approach to a low risk melanoma. This also points out the need to ignore the ABCD’s (E’s) of melanoma and go for CHANGE as indicator of potential melanoma. It is also important that you paid attention to this change. The only other thing you could do at this point is to have UCSF give you another opinion on the pathology. I’m glad our forum has been helpful to you. Glad you are healing well.

    #61349
    CMConn
    Participant

    Thank you for your responses. I have a follow-up appointment with my plastics doctor today. The flap looks great and physically I feel really good – jumping back into my normal routine of work and the gym and life feels great. I’m still waiting to get an appointment to have a complete skin exam of my entire body. I hope to feel better mentally once that has occurred – the waiting, as many others know, is so hard. Trying to stay positive but sometimes the biggest battle is the mind.

    Thank you again for such a wonderful resource!

    P.S. Catherine, I read your book this last weekend – a good read! :P

    #61350
    7spider
    Participant

    Good luck, with everything. You’ve definetly come to the right place for help, support and info. Really good, helpful and considerate people and across these boards.

    #61351
    Lisa P
    Participant

    Congratulations on getting through your ordeal and coming out the other side. One thing you may want to consider is having “grid photography” done. It isn’t too terribly expensive and can be a lifesaver (literally) down the road as your docs will have a baseline to look at when trying to identify whether a mole has changed or recently appeared. Best of luck to you! Lisa

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