Forum Replies Created
sometimes can be seroma – pocket of fluid that sometimes develops in the body after surgery Thanks, did this occur already on Oct 19th? Is it available for replay? I can tell you that in my own experience I do believe that sometimes if/when I get “obsessed” or worried about a certain spot, I think I can feel “weird sensations” in it when I look at it or try to check it out in the mirror etc…. I think that is my mind playing tricks on me because of the fact that I’ve decided to be worried about it, and then I think I can feel something weird. Not saying that is what’s happening with you, just saying it’s a possibility, the whole mind/body connection thing Seems really similar to mine (5 years ago). My path report said “Severely atypical compound melanocytic proliferation consistent with at least melanoma in-situ arising in association with a compound dysplastic nevus with features suggestive of partial regression and with foci suspicious for early invasive melanoma extending to a depth of approximately 0.30 mm. The differential diagnosis would include melanoma in-situ arising within a compound dysplastic nevus that either has been irritated or undergone partial regression or a early superficially invasive melanoma arising within a compound dysplastic nevus with regression. I favor early invasive melanoma because some of the melanocytes within the papillary dermis demonstrate similar cytologic atypia to the ones seen in the epidermis. The atypical melanocytes extend to a depth of approximately 0.30 mm. The stage would be pT1a.” Funny thing is when the surgeon (who did the WLE) read it he was like “this guy is saying everything. . atypical and insitu and invasive.” I think it’s a bit of a CYA thing for the pathologist. But it’s also a bit of an art and not an exact science. If they treat it as the worst case scenario (a shallow 1a) in terms of WLE then that should give you peace of mind. I’m 4 1/2 years out from 1A surgery and my scar still feels funny sometimes from time to time, sometimes even a little pain. I think it’s normal, nerves were involved, it was a big chunk taken out. Might be some good info to read from this prior thread of posts It’s been a few years, but I was able to find this http://www.brighamandwomens.org/Departments_and_Services/dermatology/services/mihm/contactmihm.aspx I hope it turns out to be something other than melanoma. Hopefully a thin mel from 5 years ago would not be returning. Seems like it would be odd for it to be a node in the neck if the mel was on the calf. Waiting is the worst. I had 2 nodes removed from under left arm in 2011. I did not have any tube down my throat. It wasn’t too bad afterwards, I didn’t sleep on my left side for a while and my range of motion for that arm was limited for a while during healing but nothing too bad. I imagine depending on where nodes are taken from, recovery might differ (underarm, groin, or neck etc..), and how many nodes are taken. I did not experience any blockage of the lymph, maybe just a small seroma I think which eventually resolved. It does get a little better with time. I’m almost 4 years out, and I’m in a better place than I was at 1 year out. I’ve had 60 biopsies since the initial melanoma biopsy. I used to be sure every one of them would also be melanoma. None of them were. At this point the rate of biopsies has decreased, but when I do get one now, I actually assume it will be nothing to worry about. Took me a long time to get to that point. You will get there, just takes time. Enjoy your kids, think about the positives of your diagnosis (thin, radial growth, not ulcerated – pretty great prognosis) and enjoy life! Good for you for getting Mihm’s opinion, always nice to have the reassurance. Smart thing to do. Contact Mihm’s office first before sending your slides, 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
You might have better luck and a quicker response by sending an email directly to this person:
Assistant to Martin C. Mihm Jr., M.D.
Director, Melanoma Program
Department of Dermatology
Brigham and Women’s Hospital
41 Avenue Louis Pasteur
Alumnae Hall, Room 317
Boston, MA 02115
email@example.com Everything you’re feeling is totally “normal” in this circumstance I believe. I’ve experienced many of the same things as you (I was diagnosed 2011 stage I). I also know the whole “if caught early, risk is low” etc….and it’s relatively easy for me to remember that and believe that when I’m telling it to other people who have an early melanoma, but I don’t apply that same knowledge to myself, for some reason for me I don’t believe it and my panic and anxiety was very high thinking this is going to be really bad. I think naturally it’s just easier to believe it when you’re talking about it for someone else, but it’s harder to believe it for yourself. I also had been seeing a dermatologist on a regular basis for as long as I can remember (since my 20s) and I would always mention my history of sunburns etc…but the Dr never removed anything until the melanoma. Sometimes I think I’m unlucky, couldn’t he have removed it sometime earlier when it was becoming melanoma but not melanoma yet? But then sometimes I think I was lucky because even when he did remove it he didn’t think it was anything bad, he said he was 99% sure it would be nothing. So he could have left it alone and it could have been much worse for me. I go back and forth with my thoughts on that. After my diagnosis, I also looked at my skin and thought almost every other pigmented spot I had looked sinister. I never thought anything about them before the melanoma, but after the melanoma I thought every one of them looked bad. I also think that is a natural thing to happen in such a circumstance. I’ve had about 60 biopsies since the melanoma and not one of them turned out to be anything more than mildly atypical. So the only biopsy I truly needed was the first one, not the 60 subsequent ones. Some of that is my own demanding of things to be removed, some is a function of the Dr treating me differently now that I’ve had a melanoma. Point is I have to just trust myself and my Dr that we will be vigilant enough to catch anything that pops up that needs to be addressed, but I can’t keep getting biopsy after biopsy until I have no pigmented spots left. I also think that not every therapist is necessarily helpful for this very specific thing. A “general” therapist I do not find as helpful as one specifically trained and educated in dealing with cancer patients, medical diagnoses, etc…. someone who specializes in and focuses on working with people who are experiencing anxiety due to a diagnosis, especially a cancer diagnosis. It’s traumatic. People can experience symptoms of PTSD, they sometimes need help controlling their thoughts and where their mind goes, etc…. I think what you’re describing, what you’re experiencing, sounds “normal” to be in the sense that it’s pretty much how it went for me too and I do think everyone has a little bit different experience based on their individual personality, etc…but I think some things are pretty common to most people going through this – a level of worry, fearing the worst, etc… I do think it helps to “vent” on forums like this with others who “get it” I agree more should be done from a mental health standpoint. A cancer diagnosis is a traumatic event, and doctors/hospitals should be providing resources to newly diagnosed patients that direct them to where to go for psychological therapy when needed on dealing with such an event. I didn’t think so, but I’m able to get in. I’ll paste it:
NCCN: Forgo Lymph Node Biopsy in Thin Melanomas
March 16, 2015
HOLLYWOOD, Florida ― Sentinel lymph node (SLN) biopsy, the common staging procedure, is not recommended for patients with melanomas that are ≤0.75 mm thick, according to guidelines from National Comprehensive Cancer Network (NCCN).
It is a rare ― and “very strong” ― bit of advice in the NCCN guidelines, said Daniel Coit, MD, of the Memorial Sloan Kettering Cancer Center (MSKCC), in New York City.
“There aren’t many places in any of the guidelines where we say, ‘Not recommended,’ ” he told an audience here today at the National Comprehensive Cancer Network 20th Annual Conference.
Dr Coit, who is chair of the organization’s melanoma panel, explained that for these thin melanomas, only the variable of thickness is considered a reliable indicator for risk. Other indicators, such as ulceration, high mitotic rate, and lymphovascular invasion, are all uncommon in such thin melanomas.
“Thickness ought to be our primary determinant for performing sentinel lymph node biopsy,” he said.
SLN biopsy is neither inexpensive or inconsequential, Dr Coit emphasized.
If 120 patients with thin melanomas undergo SLN biopsy, then six patients (5%) will have positive nodes, he said.
As a result, all patients will be offered completion lymph node dissection (CLND) and be considered for adjuvant therapy and follow-up imaging and be closely followed.
However, only one patient of the six with a positive node will subsequently die (a death that cannot be prevented), and the other five will survive.
The cost of identifying that one unpreventable death, if you estimate the price of an SLN biopsy to be about $10,000 (which does not include the adjuvant therapy, ect) is $1.2 million.
The psychological cost is also “tremendous,” suggested Dr Coit, because the SLN procedure confers an element of risk to patients, leaving all 120 wondering if and when the “sword of Damocles” will fall.
The NCCN recommendation is similar to the American Society of Clinical Oncology (ASCO) and the Society of Surgical Oncology (SOS) guideline to skip SLN biopsy in patients with melanoma less than <1 mm thick that has no adverse features.
However, the procedure is controversial.
The 5-year follow-up of the landmark Multicenter Selective Lymphadenectomy Trial (N Engl J Med. 2006;355:1307-1317) failed to show a survival advantage from SLN biopsy. However, it did confirm that SLN biopsy was highly accurate in identifying positive nodes in patients with melanomas 1.2 to 3.5 mm thick and that SLN biopsy followed by CLND was associated with prolonged disease-free survival.
In many clinics, a positive sentinel lymph node biopsy automatically results in the more invasive CLND, pointed out Dr Coit. This is also what the NCCN recommends.
But this surgical practice is based on scant evidence, said Dr Coit.
The best evidence to date in support of this surgery is from a retrospective study done at MSKCC, he said. The study found that about 15% of patients who were candidates for CLND ― but were observed instead ― had a subsequent nodal basin failure (Ann Surg Oncol. 2014; 21:3117).
But there is no evidence that CLND improves survival in melanoma.
There is a lot of evidence that it results in morbidities.
Thus, the decision to have a CLND is based on emotions, said Dr Coit.
“This is an affair of the heart,” he said about the decision to perform the full dissection after a positive sentinel node biopsy.
Another surgical oncologist at the meeting agreed.
It is the most difficult discussion that I have with melanoma patients. Dr Tom Thompson
“It is the most difficult discussion that I have with melanoma patients,” said Tom Thompson, MD, of UT Surgical Associates of East Tennessee, in Morristown, who is not on the NCCN panel.
There is little or no evidence that the procedure is beneficial. “I can’t assure them of an improved outcome,” he told Medscape Medical News.
In Dr Coit’s practice, about 80% of melanoma patients with a positive sentinel node will not undergo a CLND, which defies NCCN guidance.
“There has to be discussion with the patient about the procedure,” he said.
The talk should review the risks for various complications, suggested Dr Coit. According to one retrospective study of melanoma patients (Ann Surg. 2008;247:687), there is significant morbidity in neck (8%), axilla (47%), and groin (48%) after CLND. Also, reoperation took place commonly in the axilla (9%) and groin (26%).
Overall, it’s time to dial back surgery on the lymph nodes in melanoma patients with localized disease, suggested Dr Coit.
However, the NCCN panel is “conservative,” he said, and thus uniformly recommends CLND when a sentinel node is positive.
“Fundamentally, this is an emotional decision,” he told the audience.
Dr Coit has disclosed no significant financial relationships.
National Comprehensive Cancer Network (NCCN) 20th Annual Conference. Presented March 12, 2015.
Medscape Medical News © 2015 WebMD, LLC
Send comments and news tips to