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June 12, 2013 at 7:08 pm #21366
I’ve been recently diagnosed with melanoma (right now pT2a NX MX) and wanted to get a quick opinion on the course of action I’m looking to pursue. I’m going into a melanoma center of excellence next week for a consult to discuss a wide level excision and sentinel lymph node biopsy which I intend to pursue. I believe that this is a pretty standard course of action considering my path report (see below) but would welcome any thoughts (especially any insight on the microscopic description section which I do not understand and did not think to discuss with my dermatologist). Thanks in advance for any feedback.
Dermapathology Report Details
– Lower back: Superficial Spreading Malignant Melanoma
– Growth Phase: Radial and Vertical
– Mitotic Count: 0 per sq mm
– Tumor infiltrating lymphocytes: Present, non-brisk
– Greatest Thickness: 1.2mm
– Level of invasion: III / superficial IV
– Precursor legion: Not identified
– Ulceration: Absent
– Regression: Absent
– Micro satellites: Not identified
– Lymphovascular Invasion: Not identified
– Neural Invasion: Not identified
– AJCC Pathologic Stage: pT2a NX MX
– Note: The peripheral/lateral and deep edges of the specimen are negative in the histological planes of the section
– Re-excision with a wider margin of clearance is recommended
– Case reviewed in intradepartmental conference
Microscopic Description: A compound melanocytic proliferation of irregularly distributed singe and nested atypical melanocytes with upward migration (confirmed by MART-1 studies). Cytologically similar monomorphous melanocytes are present in the dermis showing no evidence of maturation. Ki-67/MART-1 double stain shows scattered dual positive dermal melanocytes. An adjacent compound nevus is present.June 12, 2013 at 7:32 pm #61292cohanjaParticipant
Sorry you’ve joined us. 0 mitotic count is a good thing. No ulceration is a good thing.June 12, 2013 at 8:17 pm #61293Catherine PooleKeymaster Where on your body was the lesion? You are just over the threshold for a SLNB at some cancer centers (.76-1.00). There’s nothing that sticks out that would make this high risk. You will be getting another reading on the pathology at the center of excellence?June 12, 2013 at 8:40 pm #61294 Thank you for your responses. The lesion was on my lower left back and I’ve been told that the lack of mitotic activity and ulceration was a positive thing. The breslow depth seemed to be the only major area of concern. The lab that conducted the pathological examination was CBLPATH and I’ve been told that my biopsy was examined by multiple individuals and a ultimately the diagnosis was finalized in a group setting (which sounds good in practice).
Re: the SLNB – My derm positioned the SLNB as an option to help me complete my staging but made it clear it was not a treatment – just a potential means to ease my anxiety and perhaps get me a better sense of whether or not additional treatment options might be worth considering. Do you think that a SLNB might be a little overkill in this scenario? I’m meeting with a couple of specialists at the Levine Cancer Institute in Charlotte, NC next week to get more info. Haven’t spoken with an oncologist yet – just my derm so far but will be speaking with the experts at Levine shortly.June 12, 2013 at 8:43 pm #61295
Also, I should have noted that the Levine Cancer Center is the new name of what used to be called the Blumenthal Cancer Center. Same facility and doctors, just a different name I believe.June 12, 2013 at 9:11 pm #61296cohanja wrote:
Sorry you’ve joined us. 0 mitotic count is a good thing. No ulceration is a good thing.
I agree w/ cohanja. Hope everything goes ok for you. This is the right place for questions, answers and a bunch of support.June 12, 2013 at 11:05 pm #61297
Thanks 7spider and cohanja – I’ve had this hanging over my head since my initial biopsy about three weeks ago and I’m cautiously optimistic at this point. I feel like I need to get past the SLNB (hopefully with a happy outcome), be much more deliberate about sun protection and skin monitoring, and then move on and live my life regardless of my prognosis. This really seems like a great forum – I’ve been lurking for a few weeks and the amount of info I’ve been able to digest has helped me get a better handle on my situation and potential outcomes. I genuinely appreciate everyone’s contributions here, be those that arise from technical expertise and/or words of encouragement and support.June 13, 2013 at 12:54 am #61298 Just to briefly share my thing. The lesion was .88mm on the back of my upper right arm, no ulceration, but I did have a little mitosis and was clarks level IV. Had the surgery in April 2012. They did the WLE and SLNB they tested 4 lymph nodes from under my arm. Everything came back negative. My skin checks since have been good, but I do pay more attention now when out in the sun. So this time for you is the most stressful, I know. Hopefully you’ll get good news and you can get on with things ASAP. If ya need anything let us know.June 17, 2013 at 10:14 pm #61299 Hey, just got back from my first meeting with an oncologist. They’re going to take a look at my pathology slides themselves but assuming that nothing dramatically changes they are recommending the WLE and SLNB like I had expected. I’m comfortable with this course of action however they’re not able to get me on the surgery calendar for about four weeks. Does this pose any additional risk for your perspectives? Looking atg my original path report I guess that I’m not considered “high risk” but at this point that’s my only major concern – that something could potentially spread in the next four weeks. Any thoughts would be greatly appreciated.June 17, 2013 at 10:17 pm #61300cohanjaParticipant I think that (four weeks) sounds about normal/average, I don’t think that is anything out of the ordinary. Also, since your path report said the peripheral/lateral and deep edges of the specimen are negative in the histological planes of the section, it sounds like they probably got it all w/ the biopsy, so there really is nothing left behind to spread anyway.June 17, 2013 at 11:42 pm #61301 Thanks cohanja, those are reassuring points.June 18, 2013 at 12:41 pm #61302cohanja wrote:
I think that (four weeks) sounds about normal/average, I don’t think that is anything out of the ordinary. Also, since your path report said the peripheral/lateral and deep edges of the specimen are negative in the histological planes of the section, it sounds like they probably got it all w/ the biopsy, so there really is nothing left behind to spread anyway.
I agree, I know it will be stressful waiting though. You are doing the right things and like cohanja said they probably got it on the biopsy, but when it gets to that size or depth its best to follow the protocol and do what they recommend. All the best to you, keep us up to date.July 5, 2013 at 8:21 pm #61303
Hey everyone, I have another quick question that I’m hoping you can help me with. I have my WLE and SLNB scheduled in about a week and a half but it looks like something may be growing back at the edge of my original melanoma biopsy site (looks like a small mole (1mm wide). Obviously, the WLE will catch this when its cut out if something was not picked up in the original biopsy but I wanted to know if this should be a cause for concern for me right now? Is this a sign of metastasis or could it be as simple as there was a group of cells that the original biopsy didn’t pick up? Just when I was starting to get comfortable waiting for my surgery I see this and its got me really worried again… I’ve left a message for my oncologist but have no idea if he or anyone else that is knowledgable about this would be around this late on a Friday, especially with it being a holiday weekend. My big concern is whether or not I should be doing something now or do I just need to wait until the surgery. Any guidance would be appreciated…July 6, 2013 at 11:43 am #61304Catherine PooleKeymaster I would call the doctor with your concern and have them take a look at it. A month is long time to be worrying about this. It is most likely nothing to worry about though. Get it checked. What type of biopsy was done?July 6, 2013 at 12:45 pm #61305itomParticipant Hi, my melanoma was .65 mm deep, Clark III, mitosis 2/mm2. I had an excisional biopsy and the peripheral margin was not clear. I had a dark spot appear on my biopsy site after a few weeks as well while I was waiting for the WLE and SLNB. When I asked the surgeon what he thought it was he said it could be melanoma since my margins were not clear. After the surgery they found some invasive melanoma but the depth was less than .65 so the depth wasn’t reported and thankfully my WLE and SLNB were clear. After the WLE another small brown spot appeared and the dermatologist said it was just another mole that grew back after it was cut out with the WLE and it was nothing to worry about. My point is since your margins are clear it’s unlikely melanoma from the original biopsy. It could be another mole that was cut during your biopsy or it could even be related to the stitching of your biopsy. But like Catherine said its best that your doctor looks at it because they may have seen something like it before and could tell you what it is from experience or if they are not sure maybe you’ll get in for surgery sooner.
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