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January 19, 2013 at 8:18 pm #20947anniegParticipant
What a crazy three weeks it has been! After total shock, fear, and relief, I’m calming down and need to decide what to do next.
I noticed a tiny bump at the site of a previously removed basal cell carcinoma on my bicep. My amazing dermatologist, who has been checking my skin for 6 years and educating me about changes to watch for, biopsied the spot when I went in to have it checked. It turned out to be a stage 1a, .55 mm Breslow thickness, Clark’s level III, superficial spreading melanoma. No ulceration was seen. The mitotic rate was less than one per sq. mm.
My plastic surgeon (who previously removed a basal cell carcinoma from my upper lip) did a wide excision and sentinel node biopsy (at my request). My pathology reports are thankfully all clear. Everything is healing nicely without complication. I’m glad I did the SNB for my peace of mind, although I realize melanoma can do some bizarre, unexpected things.
I’ve checked out the lab that did my pathology and feel confident about the competence of the lab, my surgeon, and dermatologist. However, my surgeon did discuss that if I’d like a referral to an oncologist, he could do that for me. He explained that I’m most likely fine with our plan of 6 month skin checks and vigilance on my part about looking for skin changes. We talked about PET scans to detect distant spread, we talked about the fact that I’m 63. I think I’m fine with watching and waiting. With the great therapy of walking my dog and talking with friends, I can sleep at night now. But, there is a tiny little voice asking me if I should go a step further? Do people with a 1a staging do more? This has happened so fast, I haven’t had much time to do research.January 19, 2013 at 10:30 pm #58610Catherine PooleKeymaster
That is a difficult decision for you to make. You could have a sentinel node biopsy done if you really wanted to go a step further. But you are below the usual threshold for this procedure. You seem to have a low risk lesion. If anything, the step least harmful to your body would be to have your slides sent to an expert for another opinion. We’ve discussed various dermatopathologists on this board, but one of the easiest is through http://www.drmihm.com. That would the best way to make sure nothing was missed. Keep walking the dogs, I too know that benefit!January 19, 2013 at 11:27 pm #58611cohanjaParticipant From what you initially wrote, it seems that you’ve already had a sentinel node biopsy done (you’re not crazy, I asked for one too and mine was Stage 1A 0.3mm – and I’m glad I did it for some peace of mind even though it’s not a 100% guarantee of anything). As far as what else to do besides skin exams, that’s a tough question I think for 1A patients, especially <0.75mm, like you and me. For about a year, I didn't have anything, any scans, etc. just physical exams, palpate lymph nodes, blood work, etc. . finally after a year, I asked for a chest xray. My doctor told me over and over again about the potential for false positives. Well he was right. I had the chest xray which showed nodules in the left lung. But because we did the xray, had to take it a step further now that we saw those nodules and did CT scan which showed them to be calcified granulomas from a prior infection. Point is doing the chest xray then caused me to have a lot of unnecessary radiation from the CT scan, etc. . . I guess now I have this baseline so I know in case I have any future scans, not to worry about these particular lung nodules. But I think standard protocol for you or me would not to have scans without any symptoms, and just to get skin exams, general physicals, etc. . unless you have symptoms or have palpable nodes, etc. . . ultimately, it's a decision between you and your doctor, I do know some places would do annual chest xrays, even on stage 1A's.January 20, 2013 at 2:53 pm #58612Catherine PooleKeymaster Watch and wait and live your life! That is a great way to deal with this disease. I had a .76, no sentinel node biopsy, just follow up with palpating lymph nodes. That was 24 years ago! Sorry I missed that you had SNB in your first paragraph and you seem confident in the pathology. Chest xrays really aren’t terribly indicative of a spread of melanoma and my oncologist stopped them early on. Blood work doesn’t show anything related to melanoma normally either. So live in the moment and do point out anything to your doctor that bothers you as well.January 21, 2013 at 2:25 am #58613krissy424Participant Annieg,
My path report reads pretty much the same as yours. I’m 60, female in California. My lesion was on my upper back.
A1 -Superficial spreading, radial growth, Breslow .55 Clark II. No ulceration, no mitosis.
I had the initial biopsy June 15 with the wide excision following 17 days later. With the depth of my lesion, .55 it was recommended I watch my skin with no other follow up. After educating myself about melanoma I’m very comfortable with my choice. I post here to learn more about the disease and to take an active part in educating people and spreading awareness.
I remember well the emotional shell-shock those first couple of weeks. It’s normal to feel fearful and lost. This forum can be an awesome place to gain info and even to vent with people who have been there and can offer encouragement and support. You should have an excellent prognosis.
KrisJanuary 21, 2013 at 12:27 pm #58614WorrywartParticipant
Watch and wait is really all you can do. No reason to see an oncologist they treat active disease. I would get a second opinion on pathology but that is about it.January 24, 2013 at 5:16 pm #58615anniegParticipant I want to thank each of you for your responses. It helps me to know that you’ve walked this path and that you’re sharing insights gained from your experiences. I wish you all the best!
AnnieJanuary 27, 2013 at 5:42 am #58616krissy424Participant
We are here to support you regardless of the path you choose, Annie.
Keep in touch. We are able to answer questions you may have about melanoma.
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