› Forums › General Melanoma Community › Update to : Dr told dad he has Stage IV melanoma on his thigh today!
- This topic has 18 replies, 6 voices, and was last updated 14 years, 5 months ago by
MichaelFL.
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- August 11, 2011 at 11:40 pm
So here's the update…thusfar. My dad has a superficial malignant spindle cell carcinoma invasive to Level IV. He's scheduled for a WLE Aug 24th & they'll do a SNB then, too. I was told this is a spreading type of cancer so now my question is, Should the surgery date be moved up??? They said that after the SNB and WLE they will send the biopsy to the Mayo Clinic. If need be the case they will schedule a full body PET Scan depending on the results, and he will then have to meet with Oncology. Please tell me your thoughts on all this,
So here's the update…thusfar. My dad has a superficial malignant spindle cell carcinoma invasive to Level IV. He's scheduled for a WLE Aug 24th & they'll do a SNB then, too. I was told this is a spreading type of cancer so now my question is, Should the surgery date be moved up??? They said that after the SNB and WLE they will send the biopsy to the Mayo Clinic. If need be the case they will schedule a full body PET Scan depending on the results, and he will then have to meet with Oncology. Please tell me your thoughts on all this,
Thank you all again for all your help, knowledge & experience.
Worried Daughter
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- August 12, 2011 at 12:21 am
Hi worried daughter..there is a huge difference between stage iv and level iv. Level 4 is the Clarks Level (the depth) and stage 4 is the extent the cancer has spread which you won’t know until after your dad has a pet scan. It bugs me that dermatologists don’t make that very clear as people are often confusing the two when first diagnosed. Best of luck to your dad! -
- August 12, 2011 at 12:21 am
Hi worried daughter..there is a huge difference between stage iv and level iv. Level 4 is the Clarks Level (the depth) and stage 4 is the extent the cancer has spread which you won’t know until after your dad has a pet scan. It bugs me that dermatologists don’t make that very clear as people are often confusing the two when first diagnosed. Best of luck to your dad! -
- August 12, 2011 at 12:28 am
Hi worried daughter..there is a huge difference between stage iv and level iv. Level 4 is the Clarks Level (the depth) and stage 4 is the extent the cancer has spread which you won’t know until after your dad has a pet scan. It bugs me that dermatologists don’t make that very clear as people are often confusing the two when first diagnosed. Best of luck to your dad! -
- August 12, 2011 at 12:28 am
Hi worried daughter..there is a huge difference between stage iv and level iv. Level 4 is the Clarks Level (the depth) and stage 4 is the extent the cancer has spread which you won’t know until after your dad has a pet scan. It bugs me that dermatologists don’t make that very clear as people are often confusing the two when first diagnosed. Best of luck to your dad! -
- August 12, 2011 at 1:08 am
I'm sorry you've had to join us but we will try and help you as much as possible. Already said is the difference between staging and levels. A level tells the level of skin that the original biopsy has invaded. You need to get ahold of the pathology report and tell us the Breslow (depth) , if it's ulcerated and the mitosis rate.
It's good that they will be sending the biopsy to another site to be read again. It's customary to take a few weeks till the wide excision is scheduled. The other info is very important so your dad will know if he has to have a Sentinal Node Biopsy done at the same time. That's when they inject radioactive dye into the original site and follow the dye. They then remove the first node and often another or two that are close by. That would usually be done before a PET scan. If they find cells within those nodes then they do the scan. Until those steps are done they base staging off of the Breslow and the most they could stage without the other info is either stage 1 or 2.
Where is your hometown? In your profile you list DE. Would that be for Delaware? If so we can give you recommendations in either Philly or at Hopkins.
Many of us here have been mislead in the beginning with the difference between staging and levels. Stage IV would mean that the cells have already traveled to distant areas of the body. Stage 3 the cells are in the nodes or there is an intransit tumor. None of this can be figured out by an original biopsy.
Let us know more info,
Linda
Stage IV since 06
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- August 12, 2011 at 1:08 am
I'm sorry you've had to join us but we will try and help you as much as possible. Already said is the difference between staging and levels. A level tells the level of skin that the original biopsy has invaded. You need to get ahold of the pathology report and tell us the Breslow (depth) , if it's ulcerated and the mitosis rate.
It's good that they will be sending the biopsy to another site to be read again. It's customary to take a few weeks till the wide excision is scheduled. The other info is very important so your dad will know if he has to have a Sentinal Node Biopsy done at the same time. That's when they inject radioactive dye into the original site and follow the dye. They then remove the first node and often another or two that are close by. That would usually be done before a PET scan. If they find cells within those nodes then they do the scan. Until those steps are done they base staging off of the Breslow and the most they could stage without the other info is either stage 1 or 2.
Where is your hometown? In your profile you list DE. Would that be for Delaware? If so we can give you recommendations in either Philly or at Hopkins.
Many of us here have been mislead in the beginning with the difference between staging and levels. Stage IV would mean that the cells have already traveled to distant areas of the body. Stage 3 the cells are in the nodes or there is an intransit tumor. None of this can be figured out by an original biopsy.
Let us know more info,
Linda
Stage IV since 06
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- August 12, 2011 at 1:10 am
Dear Worried Daughter,
Your dad is lucky to have you as an advocate. Although a Clarks Level IV is not the ideal prognosis, it certainly is not the end of the world. A "superficial" spreading type of melanoma (as opposed to nodular) normally takes a bit longer to invade the skin layers, however, that is not the case with your father's. As far as the date being moved up, my husband had a Clarks level IV 2.2mm ulcerated primary, and the snb was not done for two months. And even then, the SNB only showed micro mets. My husband had a CT of the chest/abdomen/pelvis after the positve SNB. He had his first PET last month – 2.5 years after diagnosis. The time frame for testing/staging is by all means acceptable. I pray that he has the SNB and it is negative, and he will get to do a "watch and see" approach.
Best wishes for you both, and please keep us posted.
Maria
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- August 12, 2011 at 1:10 am
Dear Worried Daughter,
Your dad is lucky to have you as an advocate. Although a Clarks Level IV is not the ideal prognosis, it certainly is not the end of the world. A "superficial" spreading type of melanoma (as opposed to nodular) normally takes a bit longer to invade the skin layers, however, that is not the case with your father's. As far as the date being moved up, my husband had a Clarks level IV 2.2mm ulcerated primary, and the snb was not done for two months. And even then, the SNB only showed micro mets. My husband had a CT of the chest/abdomen/pelvis after the positve SNB. He had his first PET last month – 2.5 years after diagnosis. The time frame for testing/staging is by all means acceptable. I pray that he has the SNB and it is negative, and he will get to do a "watch and see" approach.
Best wishes for you both, and please keep us posted.
Maria
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- August 12, 2011 at 4:37 am
You know, I really hate that doctors use Clark's Level when talking to patients. It's no longer used in staging and is considered obsolete (unless Clark Level I). It is so often confused with stage that it seems doctors would learn this and give you the important info, the depth! It would still be useful to know the depth, but at least you have the WLE/SNB scheduled. I still suggest getting a copy of the pathology report for your own records. Waiting until the 24th is considered clinically acceptable (within 90 days) even though waiting can be hard on the patient.
Best wishes,
Janner
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- August 12, 2011 at 4:37 am
You know, I really hate that doctors use Clark's Level when talking to patients. It's no longer used in staging and is considered obsolete (unless Clark Level I). It is so often confused with stage that it seems doctors would learn this and give you the important info, the depth! It would still be useful to know the depth, but at least you have the WLE/SNB scheduled. I still suggest getting a copy of the pathology report for your own records. Waiting until the 24th is considered clinically acceptable (within 90 days) even though waiting can be hard on the patient.
Best wishes,
Janner
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- August 12, 2011 at 4:21 pm
Hello All,
I have the Pathology Report: Malignant melanoma, spindle cell superficial spreading type, invasive to level IV, and measured thickness of o.55mm, present @ lateral margin. The Ki-67 stain shows limited but definate positivity of the dermal component. The lesion has no mitoses per mm2. There is a non-brisk host response. There is no evidence of regression or microsatellites. The lesion is present at the lateral margin. A reexision with a 1 to 1.5cm margin is recommended.
Okay, with this new info, what do you think of his status/condition?
Thank you,
Worried Daughter
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- August 12, 2011 at 4:21 pm
Hello All,
I have the Pathology Report: Malignant melanoma, spindle cell superficial spreading type, invasive to level IV, and measured thickness of o.55mm, present @ lateral margin. The Ki-67 stain shows limited but definate positivity of the dermal component. The lesion has no mitoses per mm2. There is a non-brisk host response. There is no evidence of regression or microsatellites. The lesion is present at the lateral margin. A reexision with a 1 to 1.5cm margin is recommended.
Okay, with this new info, what do you think of his status/condition?
Thank you,
Worried Daughter
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- August 12, 2011 at 4:52 pm
As many have already stated, this is Clarks Level IV, not stage four. Therefore, based on the pathology, HE IS STAGE 1, NOT STAGE 4.
Clark Levels:
The Clark level refers to how deep the tumor has penetrated into the layers of skin. This system was originally developed by W. H. Clark, MD back in 1966. Clark levels are officially defined as follows:
- Level I: confined to the epidermis (top-most layer of skin); called "in situ" melanoma; 100% cure rate at this stage
- Level II: invasion of the papillary (upper) dermis
- Level III: filling of the papillary dermis, but no extension in to the reticular (lower) dermis
- Level IV: invasion of the reticular dermis
- Level V: invasion of the deep, subcutaneous tissue
No mitosis is good, The Breslow depth (.55 mm in his case) is also considered fairly thin. The term: "The lesion is present at the lateral margin" just means that one of the side margins is not clear of melanoma cells. This happens at times during biopsy. If one is going to have a margin not clear, it is better to have a side margin not clear, than the depth margin. The term- "A reexision with a 1 to 1.5cm margin is recommended"-this is standard protocol.
Does it say anything about ulceration? Sounds like he is stage 1a or 1b. The ulceration will tell you if he is stage 1A or 1B.
Again, HE IS STAGE 1, NOT STAGE 4.
Michael
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- August 12, 2011 at 4:52 pm
As many have already stated, this is Clarks Level IV, not stage four. Therefore, based on the pathology, HE IS STAGE 1, NOT STAGE 4.
Clark Levels:
The Clark level refers to how deep the tumor has penetrated into the layers of skin. This system was originally developed by W. H. Clark, MD back in 1966. Clark levels are officially defined as follows:
- Level I: confined to the epidermis (top-most layer of skin); called "in situ" melanoma; 100% cure rate at this stage
- Level II: invasion of the papillary (upper) dermis
- Level III: filling of the papillary dermis, but no extension in to the reticular (lower) dermis
- Level IV: invasion of the reticular dermis
- Level V: invasion of the deep, subcutaneous tissue
No mitosis is good, The Breslow depth (.55 mm in his case) is also considered fairly thin. The term: "The lesion is present at the lateral margin" just means that one of the side margins is not clear of melanoma cells. This happens at times during biopsy. If one is going to have a margin not clear, it is better to have a side margin not clear, than the depth margin. The term- "A reexision with a 1 to 1.5cm margin is recommended"-this is standard protocol.
Does it say anything about ulceration? Sounds like he is stage 1a or 1b. The ulceration will tell you if he is stage 1A or 1B.
Again, HE IS STAGE 1, NOT STAGE 4.
Michael
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- August 12, 2011 at 5:09 pm
If it does not say anything about ulceration, it most likely means it was not ulcerated. That would make him stage 1A.
This is a excellent prognosis as far as melanoma goes. Five-year survival is about 95% for stage 1B. I am stgae 1B, and almost three years ount from diagnosis.
Michael
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- August 12, 2011 at 5:09 pm
If it does not say anything about ulceration, it most likely means it was not ulcerated. That would make him stage 1A.
This is a excellent prognosis as far as melanoma goes. Five-year survival is about 95% for stage 1B. I am stgae 1B, and almost three years ount from diagnosis.
Michael
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