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October 28, 2012 at 2:41 pm #20719
I was browsing the internet and came across this article which, although I find upsetting because of its flippant nature, does raise interesting questions in respect of Breslow depth and mitotic rate particularly of relevance to stage 1.
My melanoma is stage 1a with a 0.72mm depth. Probably totally irrationally, since diagnosis 8 months ago I have tried to reassure myself with the fact that my depth is the right side of 0.75mm which used to be the cut off for “thin” melanomas before this was changed to 1mm. Having read this article, however, I am taken back to when my WLE was done and I questioned why my sample was recorded in the path report with measurements that did not correlate with a 1cm excision margin. The response was that the excised tissue would have shrunk somewhat between being taken out and being analysed, particularly because it would have been 3 days before my sample would have arrived at the path lab (even though, as far as I am aware, it was placed in formalin straight away). I am now thinking if this can happen to an WLE, surely the same thing happens with an initial biopsy and this is reinforced by this article. What is the point of giving a sense of preciseness to a Breslow depth reading by measuring to the second decimal pace, when the actual sample has probably shrunk! I realise this would not matter if everyone’s biopsies shrunk to the same degree as all measurements would then be relative, but if the amount of shrinkage can depend on the patient’s age or the amount of time before the specimen is “fixed” then where does this leave the accuracy of any individual depth measurement?October 28, 2012 at 4:28 pm #57233hillcountrygirl2Participant
Wow, what an article. It addresses a lot of my questions as well…and, I guess, kind of keeps them as questions. I always wondered about my Clark’s IV…it’s very discounted, but still, that seemed not good to me even with my thin Breslow. Now I have to wonder, just how small was my Breslow number? I know not to worry because even if there is shrinkage, the statistics are for people with those numbers (they have shrinkage as well). Statistically you and I have an almost 100 percent chance of living long lives and dying of something else!October 28, 2012 at 5:02 pm #57234 My melanoma was also Clarks IV and I now wonder whether in some cases sample shrinkage can possibly explain the discrepancy between a relatively thin Breslow depth and Clarks IV if, as in my case, the week long gap between the initial punch biopsy (melanoma fully removed by the 6mm punch) and carrying out the pathology report led to greater than average shrinkage (as my dermatologist admitted had happened with the WLE) and the melanoma actually started off deeper.October 28, 2012 at 5:42 pm #57235cohanjaParticipant So, this is saying due to shrinking that the Breslow stated might be underestimated, and the WLE margins stated in pathology might appear less than 1cm margins?October 29, 2012 at 6:35 pm #57236 I wouldn’t take this essay as gospel, his references were pretty outdated. Not sure he needed the comedy routine to do this overview. Like to see a one page synopsis by an expert on these issues.October 29, 2012 at 7:43 pm #57237cohanjaParticipant What it says to me is we just don’t know. Even the best scientists can postulate and hypothesize, but nobody knows for sure, nobody can say with certainty how any of this stuff works.October 29, 2012 at 9:39 pm #57238 Catherine, the author of the essay seems like an expert to me….
Is Assistant professor (“Oberarzt”) at the Center of Dermatology and Andrology of the University of Giessen. He is member of the editorial board of the journal “Dermatopathology: Practical and Conceptual”, Historian of the International Society of Dermatopathology, Director (together with Carlos Diaz, M.D.) of the Center for Dermatopathology, Freiburg, Germany, member of the Executive Committee of the European Society of Dermatopathology, Member of the editorial board of the journal, “American Journal of Dermatopathology”. He took part to the organization of the 15th Congress of the German Society of Dermatopathology (ADH) in Freiburg (together with M. Braun-Falco).October 29, 2012 at 11:12 pm #57239casey188Participant
He was one of the derms who weighed in on an article I posted awhile back about the usefulness of reporting mitosis. He thought it wasn’t very useful. I agree with his take on reporting one single mitosis and how misleading it is. I am of the opinion that if you look long and hard, a mitosis can be found. Also the way the data is collected varies widely among different pathologists. Kind of ridiculous in my opinion, and I now discount that part of my second opinion from Dr. Mihm. Nothing against him, but he said I had one single mitosis in radial growth phase. Hence the other issue about how there doesn’t seem to be a distinction of whether the mitosis is in the dermis or the epidermis. And to throw the folks with thin Mel’s and a possible observed single mitosis into stage 1b is even more ludicrous. Just my opinion, but then again a lot of this seems to come down to opinion.October 30, 2012 at 5:55 pm #57240 I looked at his references and they were from the most part terribly outdated, from the 1990’s. It is true that the experts don’t agree on many aspects of melanoma pathology and it is an art not an exact science. If it were a shorter piece I would send to our experts but they are extremely busy folks.
So my conclusion remains the same: mitosis is important, breslow is even more important and nodular is riskier because it skips the radial growth phase.October 30, 2012 at 6:17 pm #57241Webbie73Participant
You say nodular is riskier because it skips radial growth phase and goes to vertical growth phase. So how important is vertical growth phase?October 31, 2012 at 11:55 am #57242 VerticaL Growth Phase means the melanoma was starting to grown down through the skin layers. Mine was in this phase (23 years ago) and I was told it just warranted closer surveillance than a radial growth phase which is just growthing outward not inward.
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