Dr told dad he has Stage IV melanoma on his thigh today!

PLEASE make sure that a Sentinel Node Biopsy (SNB) will be performed at the time of the tumor removal (WLE – wide local excision).  If the lesion is deeper than 1mm which is very possible with a Clark's Level IV lesion, the SNB must be done PRIOR to the WLE.  They are often done in the same surgical setting, but the SNB has to be done before all the extra tissue is removed with the WLE so the lymphatic drainage paths are not altered.   At this point in time, and without any other biopsies or scans, your father cannot be labeled stage IV, only Clark's Level IV.

Janner

PLEASE make sure that a Sentinel Node Biopsy (SNB) will be performed at the time of the tumor removal (WLE – wide local excision).  If the lesion is deeper than 1mm which is very possible with a Clark's Level IV lesion, the SNB must be done PRIOR to the WLE.  They are often done in the same surgical setting, but the SNB has to be done before all the extra tissue is removed with the WLE so the lymphatic drainage paths are not altered.   At this point in time, and without any other biopsies or scans, your father cannot be labeled stage IV, only Clark's Level IV.

Janner

Dear Worried Daughter,

It's not possible that the pathology report could have come back as STAGE IV from just a skin biopsy. It's common for people to mistake Stage IV with Clark's Level IV, as has been mentioned already.

My husband's surgeon could not call his case Stage IV even after removing several cancerous lymph nodes from his armpit, because he would still have had to prove spread to a DISTANT area. It took us another 6 weeks to get the definitive Stage IV diagnosis, and only after taking a sample from a tumor on his liver and having it tested.

Have your mom (or ask yourself) for a copy of the pathology report if you aren't sure. It will tell you there the answer you seek.

Very best of luck to you and your family, and yes, a very BIG second to get your father in with a melanoma specialist (not just an oncologist) ASAP.

Michelle, wife of Don

Dear Worried Daughter,

It's not possible that the pathology report could have come back as STAGE IV from just a skin biopsy. It's common for people to mistake Stage IV with Clark's Level IV, as has been mentioned already.

My husband's surgeon could not call his case Stage IV even after removing several cancerous lymph nodes from his armpit, because he would still have had to prove spread to a DISTANT area. It took us another 6 weeks to get the definitive Stage IV diagnosis, and only after taking a sample from a tumor on his liver and having it tested.

Have your mom (or ask yourself) for a copy of the pathology report if you aren't sure. It will tell you there the answer you seek.

Very best of luck to you and your family, and yes, a very BIG second to get your father in with a melanoma specialist (not just an oncologist) ASAP.

Michelle, wife of Don

You mention that once you have the tumor removed, you will see a melanoma specialist. You really should see one first. The biopsy by another Dr. is fine. But at this point, a WLE is next in line. And if the Breslow depth is more than 1.0, or there is high mitosis, then a SNB is needed too. It is imperative that the SNB be done prior to the WLE. So if a general surgeon does any more removing of tumor or tissue, it could cause inaccuracies in properly determining if the melanoma has spread to the lymph nodes. Once a diagnosis is made through a biopsy, a melanoma specialist is your very next step. Maybe this is the only surgeon so far that has been willing to operate on your dad, and maybe a melanoma specialist/surgeon might have to work with your dad's condition or work with this other surgeon to get the job done. But the melanoma specialist needs to be consulted with before any other surgeries are done.

You mention that once you have the tumor removed, you will see a melanoma specialist. You really should see one first. The biopsy by another Dr. is fine. But at this point, a WLE is next in line. And if the Breslow depth is more than 1.0, or there is high mitosis, then a SNB is needed too. It is imperative that the SNB be done prior to the WLE. So if a general surgeon does any more removing of tumor or tissue, it could cause inaccuracies in properly determining if the melanoma has spread to the lymph nodes. Once a diagnosis is made through a biopsy, a melanoma specialist is your very next step. Maybe this is the only surgeon so far that has been willing to operate on your dad, and maybe a melanoma specialist/surgeon might have to work with your dad's condition or work with this other surgeon to get the job done. But the melanoma specialist needs to be consulted with before any other surgeries are done.

All melanoms are spreading types.    They spread two ways.  The most common first path is thru the Lymph system.  In this path the first lymph node (called the sentinel lymph node) is the most likely locatioin for melanoma to show up outside the primary tumor.  From the leg the groin is often where the first spread is found. They can also show up "in transit" from the primary location.   They have to be deeper to get to the blood supply to be spread thru the blood.  Once they reach the blood supply they can go anywhere.  If the Sentinel node is cancer free, then it is most likely that the rest of the node group will be to.  If the first node has obvious melanoma then they will likey take additiional nodes to try getting all the ones with cancer and at least a few ones that mel has not yet reached.  A coupl of weeks to wait for the SNB and WLE is standard and not likel;y to be any problem..  My local surgeon waited 3 months.  That is too lonog.for the WLE and he never did a SNB. 

   In my case I wish they had done a PET before removing the hugh groin node I found and the local surgeon wanted to wait 4 additional months after his 3 month delay for the WLE!  My entire left groin lit up like the 4th of July, but less enjoyabl, after his 7 month delay.  Local surgeon was going to delay the removal of the node I FOUND another 2 months!   Glad I got to the University of Virginia when I did.

All melanoms are spreading types.    They spread two ways.  The most common first path is thru the Lymph system.  In this path the first lymph node (called the sentinel lymph node) is the most likely locatioin for melanoma to show up outside the primary tumor.  From the leg the groin is often where the first spread is found. They can also show up "in transit" from the primary location.   They have to be deeper to get to the blood supply to be spread thru the blood.  Once they reach the blood supply they can go anywhere.  If the Sentinel node is cancer free, then it is most likely that the rest of the node group will be to.  If the first node has obvious melanoma then they will likey take additiional nodes to try getting all the ones with cancer and at least a few ones that mel has not yet reached.  A coupl of weeks to wait for the SNB and WLE is standard and not likel;y to be any problem..  My local surgeon waited 3 months.  That is too lonog.for the WLE and he never did a SNB. 

   In my case I wish they had done a PET before removing the hugh groin node I found and the local surgeon wanted to wait 4 additional months after his 3 month delay for the WLE!  My entire left groin lit up like the 4th of July, but less enjoyabl, after his 7 month delay.  Local surgeon was going to delay the removal of the node I FOUND another 2 months!   Glad I got to the University of Virginia when I did.