Home Forums Melanoma Diagnosis: Stages I &II Staging Melanomas

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  • #20775
    hillcountrygirl2
    Participant

    Hi Everyone,

    Just got back from having 2 bcc’s cut out today from my back. They were close to each other, not far from my melanoma, and not far from another bcc that was removed last year. My back is SO attractive….

    Anyway, you know how it goes–after check-ups and such, we all sort of think about melanoma again. I found this article (because I can’t stay off the net today!):

    https://www.propath.com/index.php?option=com_content&view=article&id=582:the-revised-ajcc-melanoma-staging-criteria&catid=33:dermatopathology-news&Itemid=171

    and it concerned me because it says that IF a thin melanoma (less than 1.0) can’t be determined to have mitosis, then Clark Level IV is considered and the staging is T1b. Then it goes on to say SNLB is recommended for T1b staged melanomas.

    SO, my first melanoma was .43, one mitosis, Clark IV. I guess, according to this article, that would be T1b. I KNOW it’s early and I have an almost 100 percent chance of no recurrence, and I KNOW that SNLB’s are not a piece of cake and haven’t been proven to increase survival, but this article kind of freaked me out. I had no SNLB, nor any discussion of having one. I have sort of coasted along with the happy news of my thin melanomas (I have had 2, the other came two years after the first and is in-situ) being sort of “taken care of”.

    In light of the fact that my back seems to be a skin cancer proving ground, and now I’m reading this, should I be doing anything else to be sure that I don’t get caught by surprise? I have check-ups every six months. That’s it. I did blood work in 2009, and it was fine. Nothing since then.

    Sorry for the long post. It’s been one of those days…..

    Thanks for any insight!

    Betsy

    #57602
    Catherine Poole
    Keymaster

    Betsy,

    I would continue to coast along with the thin melanoma as that is the number one prognostic indicator. I always use me as an example, as a .76 with 1 mitosis and regression and I hit my 24th year in January of NED. The SLNB wasn’t invented yet so I didn’t have a choice. But I think you can remain confident that recurrence is unlikely. Have a great Thanksgiving! (btw, you may have had some intense sun exposure on that spot on your back?)

    #57603
    cohanja
    Participant

    I thought it could occur anywhere, not just where you have had intense sun exposure? Is it more likely to occur where you’ve had sun exposure? Is there where you should monitor the most?

    #57604
    hillcountrygirl2
    Participant

    Catherine, I think that my problem was that I “tanned” and so, yes, I had intense sun exposure because wow, I thought that looked great (what a dummy!). But I don’t actually recall burning. I am trying to think positive about my thin melanoma (and your story encourages me!), but I have always struggled with the whole “am I doing enough” vs “I need to live my life”. I often read other patients on this forum with similar diagnoses as mine and they go every three months for example. My derm really wants me to go to a year, and I want to at least stick with six months (just having the two melanomas makes me wonder if I “make them”).

    Cohanja, I agree…I wonder just how much sun exposure means. I have heard so many stories of melanomas inside the ear, or on the buttocks….but my back has now had the melanoma and three bcc’s. So, something is going on! I have had most of my skin cancers on my back and on my legs, but also a squamous on my face! Oh, I would love to take back my “beautiful” tan from 1971-1990!!!

    I think, for my own peace of mind, I am going to have another round of bloodwork (like I had back with my first melanoma). If that all comes back A-OK, I’ll just go into my “live life” place until, of course, my next check-up! :-) I do love this forum, though, because it’s a place I can come to where people really “get it”.

    Cheers to all,

    Betsy

    #57605
    cohanja
    Participant

    Is there anything proven in bloodwork to show anything about melanoma? I didn’t think so, maybe I’m wrong.

    #57606
    hillcountrygirl2
    Participant

    There is the LDH test, but Catherine would be the first to say that an elevated LDH is extremely unlikely for someone with a thin melanoma like mine. They ordered it (bloodwork) when I first was diagnosed, along with a chest x-ray–probably just ‘because’ it looked like they were doing something, when in reality, melanoma is really one of those cancers in which tests like that don’t help at all when dealing with a thin one. I haven’t had any bloodwork since 2009, and I guess I would just like to hear those words, “all looks great” again!

    #57607
    Catherine Poole
    Keymaster

    The LDH is used by some docs for stage IV patients who are on therapy to check for elevation. There really isn’t any bloodwork to determine melanoma spread or presence.

    #57608
    CRody
    Participant

    I had 2 Stage IIB Invasive Malignant Melanomas, Breslow Depth 3.7 mm, Mitotic Index 6.0, excised from the bottom of my foot, with a clear SNLB of 2 nodes.

    My oncologist ordered (post surgery) Alkaline Phosphatase, AST, Bilirubin Total Serum, LDH and chest X-Ray. I don’t know if these were done to see if it had possibly metastasized to areas other than the lymph nodes or to see if I potentially had other melanoma sites, but I came back within the accepted range on all the tests, which, although I’m not sure I completely understand the tests, the results comfort me somewhat. Maybe the tests were done for a base line for future comparison.

    #57609
    hillcountrygirl2
    Participant

    I’m so glad for you that your bloodwork was all within acceptable levels. Even if it doesn’t really help in the treatment of melanoma, good bloodwork is a good thing! :-)

    It does seem odd to me that if you read people’s stories on this forum and elsewhere, many have bloodwork and chest x-rays after diagnosis, and yet, I know after reading about those tests that they are basically a waste of time. Melanoma is unique in that ‘wait and see’ is the usual treatment, along with vigilant early detection. I think we (possibly because we are impatient Americans!) want to “do” something no matter what when there is a medical diagnosis. I know that I certainly got familiar with superfoods and it just felt like I was being proactive when I started eating them.

    These new articles on thin melanomas with mitosis and/or the Clark’s IV level that mine had are just kind of upsetting to me. I know in my heart and head that I am in a very good place, but my emotions sometimes get the best of me and I want those tests myself…just to prove to me that I’m healthy! Human nature, perhaps.

    #57610
    cohanja
    Participant

    chest x-rays on early stagers can also sometimes lead to many false alarms. . there are a lot of benign “stuff” sometimes in the lungs

    #57611
    cohanja
    Participant

    “There really isn’t any bloodwork to determine melanoma spread or presence.” .. which is scary because I keep hearing people say over and over again how melanoma is “sneaky” and “unpredictable” and “doesn’t behave” etc. . . so it seems like you’re always waiting for the other shoe to drop and there isn’t anything you can do to really monitor for that..

    #57612
    HoolieB
    Participant

    hillcountrygirl2 wrote:

    (edit)

    These new articles on thin melanomas with mitosis and/or the Clark’s IV level that mine had are just kind of upsetting to me. I know in my heart and head that I am in a very good place, but my emotions sometimes get the best of me and I want those tests myself…just to prove to me that I’m healthy! Human nature, perhaps.

    Amen! Those damn emotions get in the way of clear thinking all the time. Please know you’re not alone with the “I know I’m fine…but” thoughts! :D

    #57613
    hillcountrygirl2
    Participant

    Thanks, HoolieB! Honestly, I can’t believe that all this stuff about Clark’s Level IV in a thin melanoma came out. I was SO happy with my .43 Breslow and had almost forgotten the Clark’s number (because everyone said not to worry about those anymore). Emotions!!!

    To me, the hardest thing about melanoma (early ones) and the easiest thing about them is the same…there is NO further treatment. SO great not to have to have any radiation or chemo, but so in my nature to want to be killing it with SOMETHING.

    Stupid melanoma.

    #57614
    YankeesGirl
    Participant

    Hi hillcountry,

    Your melanoma path report and mine are very similar.

    DX with (2) in-situ and (1) “early” Stage 1B this year

    I had a second opinion on the 1B from Dana Farber / Brigham & Women’s Boston

    Original path report from Rhode Island derma pathologist:

    .40mm / Clarks III/Early IV

    Radial Growth: Present

    Vertical Growth: Absent

    Mitoses: None in Dermis on sections examined

    Ulceration: None

    Regressive Changes: Not Observed

    Path Stage: T1A

    Second Opinion from Dana Farber / Brigham & Women’s Hospital

    .40mm / Clarks III

    Intraepidermal: Present

    Vertical Growth: Present

    Ulceration: Absent

    Regression: Absent

    Mitotic Rate: At least 1 per sq. mm

    RI suggested the SNLB. Boston disagreed and said risks outweighed the benefits. No significant benefit to survival rate. I sided with the Boston opinion. I am not looking back. I made my decision based on the educated experts opinions and hope that it was the right one. I still find it puzzling that Boston reported vertical growth and mitoses and RI did not. Would have made things much easier and clearer for me if both interpretations of the lesion were the same. Stay well.

    #57615
    cohanja
    Participant

    There’s definitely judgement/interpretation/subjectivity involved in pathology. . it definitely does not seem black or white. I had 6 opinions on my lesion, all a bit different, all from very reputable places:

    1) did not comment on growth phase, 0 mitosis

    2) RGP, 0 mitosis

    3) VGP, 1 mitosis

    4) early VGP

    5) VGP, 0 mitosis, VGP due to dermal nest size only

    6) RGP, 0 mitosis

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