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September 25, 2012 at 12:49 am #20642
I posted a few days ago:
Stage 1A SSM primary
Clark’s level 3-4
No regressive changes
No vascular invasion
Here’s where this gets interesting. I am scheduled to see a surgical oncologist in Providence tomorrow. I just received a phone call from my dermatologist who said that he received a call yesterday morning (Sunday) from the derma pathologist in Providence who read my biopsy. She told my derm that she was at a pathology conference at Harvard over the weekend and brought up my case. She proceeded to tell the conference members that I had a thin melanoma (no mitosis) but that the “cells looked more atypical”. She asked if this should be treated more aggressively with a sentinel lymph node biopsy, and the doctor that she presented this to said yes. I’m totally confused now because my derm said on Friday that I probably didn’t need a lymph biopsy based on the findings. I am also going to Dana Farber in Boston for a second opinion on Friday. My derm said that Boston requested “10 more cuts” to see if there is any mitosis. My derm shared this new info with the surgeon that I am meeting with tomorrow as well. Just as confused as I am??
Thanks for listening.September 25, 2012 at 2:09 am #56641cohanjaParticipant
I’m confused too. Most institutions use 1mm as the cutoff for the SNB unless you have other high risk factors. However, some institutions use .76mm. So, it seems to be based on thickness. I’m not sure what “cells looked more atypical” means or how that helps decide SNB or not. But, I’m not a doctor.September 25, 2012 at 2:31 am #56642Catherine PooleKeymaster This sounds based on hearsay rather than fact. I would listen to the second opinion at Dana Farber. There is no reason I can see from the report to recommend a SLNB.September 25, 2012 at 2:58 am #56643casey188Participant Two questions.Do you know the names of the two pathologists who read your slides? And do you have the path report? Just wondering if there is anything in the description clarifying what is atypical?? The head dermapathologist at RI Hospital is Dr. Leslie Bostom. Very good reputation and she is the head of the dermapathology Dept. at Brown Medical School. I would check into having Dr. Martin Mihm read your slides. He is one of the best with tricky lesions, and you can get a second opinion from him by going to drmihm.com. He is based in Boston. Hope this helps. From one Rhode Islander to another.September 25, 2012 at 3:05 am #56644cohanjaParticipant Can always send to Dr Mihm for another opinion: Contact them first before sending your slides, though, I think there is a form to also fill out with demographics, billing info, etc…
Martin C. Mihm Jr., M.D., F.A.C.P.
Cambridge, MA 02142
Phone-617-401-2231September 25, 2012 at 1:34 pm #56645
Funny thing is that the pathologist from RI shared her thoughts with Dr. Mihm at the pathology conference at Harvard over the weekend. Although Dr. Mihm did not read the actual slide, he said a SNB should be perfomed because of the atypical cells(?) that the path saw in the sample. How can he make a recommendation w/o seeing the specimen? I’m meeting with the surgeon at RI Hospital this am and Dana Farber on Friday. Dana has all of my slides and will have their own evaluation. I am so anxious to meet with them and hear their thoughts. Supposed to be a textbook case, right, with a .4mm with no mitosis? I guess when you’re dealing with melanoma their is no textbook. Thanks for your insight and support.September 25, 2012 at 10:17 pm #56646 Hello,
Met with surgeon at RI Hospital this morning. He told me that my specimen is being reviewed by Dr. Mihm in Boston. He requested a second opinion to confirm or eliminate the need for a sentinel node biopsy. Still weird due to the initial findings, but due diligence never hurts. I’ll see what the docs at Dana Farber say on Friday. Was very comfortable and confident in the RI surgeon. Spent nearly an hour with me discussing all of this.
Thanks and wishing you all good health!!September 25, 2012 at 11:29 pm #56647Webbie73Participant
Yankeesgirl, glad you feel confident with the surgeon. I also see 2 different doctors in that practice. You are in good hands. I still find it odd that they are considering a SNLB for a thin melanoma. Go figure. Have they gone over the side effects of a SNLB?September 26, 2012 at 12:10 am #56648 Hi Webbie,
Didn’t really review the side effects of SNLB…..still waiting to find out if this is needed or not. Have you had one? What should I know? Thanks.September 26, 2012 at 1:23 am #56649casey188Participant
Glad you had a good appointment. He does a good job with patient care and not just concerned with the procedure. Refreshing for a specialist. I have met some specialists that seem annoyed you are taking up their time. I hope you get clarification from Dr. Mihm that comes out in your favor!September 26, 2012 at 2:02 am #56650Webbie73Participant Yankeesgirl, I did not have a SNLB, my Breslow was only .45mm which is under the recommended level. Also, the percentage of them finding a node with cancer was extremely low and the risks of side effects were not worth the risk.September 26, 2012 at 3:36 am #56651 Thanks Casey188!
Yes Webbie. Mine is only .4mm, but something peculiar about the cells that prompted the dermopathologist to send to Dr. Mihm for evaluation. RI surgeon said he wants Dr. Mihm’s opinion regarding wether or not the node biopsy is necessary. I sure hope it isn’t. Thanks to my Rhody friends for staying with me on this. Have a good night.September 27, 2012 at 10:33 pm #56652
Dr. Mihm reviewed my specimen per the second opinion that my RI surgical oncologist requested. Initial .4mm, no mitosis, Clark’s 3-4. He concluded that he sees something called dermal mitosis which now puts me at a 1b as opposed to 1a (surgeon said very subtle changes between the two stages). Because of this dermal mitosis they are recommending a WLE and sentinel node biopsy. I am 40 yrs old; the surgeon said his opinion and the opinion of his team is to treat it aggressively on younger people.
Going to Dana Farber in Boston tomorrow to hear what their position is on this.
My derm followed up with me this afternoon and said this dermal mitosis is something new that they are seeing in thin melanomas. Can anyone relate?
Thanks for the support.September 27, 2012 at 11:47 pm #566537spiderParticipant
Hi again fellow Yankees fan. Yes I can relate. I’m also a 1b with similar readings as yours, except my breslow depth was .88. The reason for the SNLB for me was also dermal mitosis. The surgeon explained that the odds were very much in my favor that my nodes would be clear, but because of the mitosis I needed to have the procedure done. Had surgery in April, did the WLE and they wound up taking 4 lymph nodes from my armpit. After a stressful week of waiting on results got the all clear signal. WHEW !!! The healing went pretty well, still have some numbness on the back of my arm from nerves cut but it’ll be alright, kinda got used to it. I understand your worry and concern right now. Trust your DRS and do what they tell ya to do and I think you’ll be alright. Any other questions about the surgery or whatever, just fire away. Now back to the stress of watching the YANKEES game they’ve been killing me this last month or so.September 28, 2012 at 12:22 am #56654 Hi 7spyder,
Thanks for your reply! Our cases sound very similar. I am so happy that yours came back all clear!!! What a relief that must have been for you! I’m expecting to hear the same treatment approach (WLE and SNLB) in Boston tomorrow…then I can finally decide where to have the surgery, Providence or Boston. The RI surgeon said the lymph node bioposy would most likely be in the groin, as the melanoma is on my upper left thigh. Wondering what the recovery time will be? I know everyone is different but just trying to get a feeling. I know when I had my previous two in-situs removed I needed just a few days before I started to feel better. Anyway, I’m going to watch the game now too. The pitching needs to step it up (Pettitte looks good!) if we are going to get past the first round of the playoffs! Met Jeter last year at his annual fundraising event. Great guy! Thanks again 7spyder!
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