Home Forums Melanoma: Newly Diagnosed – Stages I & II Newly diagnosed: stage 1b

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  • #20562
    wm_I
    Participant

    I (male, 50+ years old) was diagnosed with malignant melanoma in May this year (shave biopsy), had my WLE and SNLB in June. Here is my first biopsy report from May:


    Diagnosis:

    Right calf – MALIGNANT MELANOMA, PRIMARY CUTANEOUS (SEE BELOW)

    Note: The lesion approaches, but does not extend to the margins of the tissue specimen. It is recommended that a full thickness re-excision of the area with a zone normal skin be performed.

    Breslow thickness: approximately 1.27 mm

    Clark level: IV

    Mitoses/mm squared >1

    Ulceration: no

    Histologic subtype: superficial spreading

    Micro satellite metastasis*: no

    Regression: no

    Angiolymphatic invasion: no

    Neurotropism: no

    Tumor infiltrating lymphocytes: non brisk

    Vertical growth phase: present

    T classification: T2a

    *Microscopic satellites are defined as any discontinuous nest of metastatic cells more than 0.05 mm in diameter that are clearly separated by normal dermis (not fibrosis or inflammation) from the main invasive component of melanoma by a distance of at least 0.3 mm.

    Gross description: Received in formalin labeled with the patient’s name and “R calf” is a shave biopsy of skin measuring 12 x 10 x 2 mm. The specimen is trisected and entirely submitted in 1 cassette.


    Here is an extract from my WLE and SLNB pathology report:

    (1) Skin with biopsy site changes and scar, completely excised, no residual melanoma seen.

    (2) Sentinel lymph node, right groin, excisional biopsy: one lymph node, no tumor seen (0/1).


    My melanoma is classified as stage 1b. I was told to see my oncologist doctor again in 1 year after my surgery (that is in June 2013; I should bring my chest x-ray at that time), should have appointments with my dermatologist every 3 months.

    I had the first appointment with my dermatologist just a few days ago. My whole body was examined – no suspicious moles were found. I was advised to wear shirts with long sleeves, long pants, avoid sun between 9 am and 4 pm, use sunblock, watch my diet to make my immune system strong, check my body regularly and exercise. No additional tests were recommended. My dermatologist says that the best test is the PET scan, but he does not recommend it at the present time.

    In addition, I have regular appointments with my primary care physician. He normally orders blood tests (various versions) every few months. My vitamin D level was discovered to be low in March 2012 and I take vitamin D (2000 units daily) since that time.

    I would like to add that my scars (both WLE and in the groin area) are healing well. My melanoma was probably caused by the UV rays and burnt skin when I was young, although I was never really a beach goer and never used any tanning salons. Nobody in my family (siblings, parents, grandparents) had ever skin cancer.

    I would like to ask a few specific questions.

    (1) What else should I do besides watching my diet, eating healthy food, exercising, checking my body, be cautious with sun, and seeing my dermatologist every 3 months?

    (2) Is there any blood test specific for melanoma patients at stage I available? When I enter the word “melanoma” in a search window at the website of LabCorp (http://www.labcorp.com), a few tests pop up, but my understanding is that those tests are not given to patients in stage I. Any comments on that?

    (3) My understanding is that the only blood test remotely associated with melanoma is the lactate dehydrogenase (LDH) test. My LDH level is 174 IU/L (normal level according to LabCorp is 0 to 255) However, this test is not melanoma specific. Is the serum S100-B test used in US? See

    http://www.ncbi.nlm.nih.gov/pubmed/9349333” class=”bbcode_url”>http://www.ncbi.nlm.nih.gov/pubmed/9349333 or http://archopht.jamanetwork.com/article.aspx?articleid=415557” class=”bbcode_url”>http://archopht.jamanetwork.com/article.aspx?articleid=415557.

    (4) What is the best way to examine my lymph nodes (ultrasound? palpation?). I do not really feel any lymph nodes under my skin when using my fingers. Should I have an ultrasound test done?

    I would be thankful for any comments or suggestions. Thank you.

    W.M.

    #56056
    Catherine Poole
    Keymaster

    Welcome to our forum. You sound like you have an excellent prognosis! I would agree, no pet scans, just good skin and lymph node exams (by palpation) regularly. There is no blood test to determine a spread by melanoma, the LDH is only useful as a tool for metastatic stage IV melanoma and normally when you are undergoing therapy. All looks good and sounds like you have a good doc following you. Be sure to examine your own skin too and those you love.

    #56057
    Worrywart
    Participant

    You are obviously an informed patient who has educated himself and taken control of your situation. The path report doesn’t raise any red flags. Live life and enjoy it, and do everything in moderation. You should get to know your groin lymph nodes, since your mel was on your leg. If you can’t feel anything, then just make sure things stay same. Change is something to always look for. It gets better with time!

    #56058
    wm_I
    Participant

    Hello,

    Catherine & Worrywart – thank you for your replies. I am over 3 months after my shave biopsy and not quite 3 months after my WLE and SLNB. I was a wreck (mentally) during the first 5-6 weeks after the initial diagnosis in May. I feel better now and am back to my normal (almost!) everyday routine.

    #56059
    krissy424
    Participant

    Welcome to the Forum, Wm_I.

    I was diagnosed with SSM, stage 1a, Breslow .55, Clark II, in June of 2012. Mole on my upper back that had changed over 6 + month period. No doubt sun exposure.

    I came to the Melanoma International Foundation looking for a forum to help me understand the disease melanoma, a forum that only promoted info with sound scientific backing and not a bunch of mainstream junk that has little to do with treating the disease and/or staying disease free. That is exactly what you will find here. Catherine and the others here understand my disease better than my family or real life friends. It’s so wonderful to know these folks have worked through so many of the same emotional issues in dealing with melanoma and can help me whenever I ask. I’ve always been the care-taker of all my family not the one who needs a shoulder.

    Again, Welcome!

    Kris Rooney (also known as Gram)

    Morro Bay, CA.

    #56060
    Jackie62
    Participant

    Welcome to the forum! I, too, am stage 1b (1.1 Breslow, non-ulcerated, negative biopsy of three lymph nodes) diagnosed in November 2011. For me the hardest part now is just the uncertainty of waiting and watching and hoping there won’t be a recurrence. I know our prognoses are very good and I try to put melanoma way in the back of my brain and just consciously count my blessings every day.

    Sounds like you’re doing all the right things and you’ve found a great place to get good, accurate information. I’ve learned so much here and I’ve been impressed with how much the members here understand and support each other. Best wishes for continued quick recovery.

    Jackie

    #56061
    wm_I
    Participant

    Kris and Jackie – thank you!

    I, too, think about my diagnosis and what the near and distant future may bring, but I also try to stay busy with my work and hobbies. Best wishes!

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