› Forums › General Melanoma Community › Oncologist?
- This topic has 66 replies, 6 voices, and was last updated 13 years, 9 months ago by
chalknpens.
- Post
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- July 20, 2012 at 5:14 pm
I saw my orthopedist today … told him of the open wound on my arm, going for closing stitches this afternoon, as third biopsy came back with clear margins. He asked me who my oncologist was. I said I didn't have one. He said I might want to get one.
When did you get an oncologist?
I saw my orthopedist today … told him of the open wound on my arm, going for closing stitches this afternoon, as third biopsy came back with clear margins. He asked me who my oncologist was. I said I didn't have one. He said I might want to get one.
When did you get an oncologist?
- Replies
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- July 20, 2012 at 5:47 pm
Based on your profile, it sounds like you are Stage II. You may want to ask about your mitotic rate. This is the rate at which cells in the tumor are dividing. A higher number indicates a more aggressive growth pattern.
Standard of care for Stage II is observation, so if you are seeing your dermatologist regularly that should be sufficient. If your mitotic rate is high you may want to consider a clinical trial for people who have no active disease. Several trails are being run for people who have had all of their tumor removed; these are called "adjuvant" studies. I don't know how many of those studies are available for Stage II patients.
If you want to look into a trial you will most likely need to work with a medical oncologist. If you are confident in your dermatologist, then ask him or her about the need for an oncologist.
Tim–MRF
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- July 20, 2012 at 5:47 pm
Based on your profile, it sounds like you are Stage II. You may want to ask about your mitotic rate. This is the rate at which cells in the tumor are dividing. A higher number indicates a more aggressive growth pattern.
Standard of care for Stage II is observation, so if you are seeing your dermatologist regularly that should be sufficient. If your mitotic rate is high you may want to consider a clinical trial for people who have no active disease. Several trails are being run for people who have had all of their tumor removed; these are called "adjuvant" studies. I don't know how many of those studies are available for Stage II patients.
If you want to look into a trial you will most likely need to work with a medical oncologist. If you are confident in your dermatologist, then ask him or her about the need for an oncologist.
Tim–MRF
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- July 20, 2012 at 5:47 pm
Based on your profile, it sounds like you are Stage II. You may want to ask about your mitotic rate. This is the rate at which cells in the tumor are dividing. A higher number indicates a more aggressive growth pattern.
Standard of care for Stage II is observation, so if you are seeing your dermatologist regularly that should be sufficient. If your mitotic rate is high you may want to consider a clinical trial for people who have no active disease. Several trails are being run for people who have had all of their tumor removed; these are called "adjuvant" studies. I don't know how many of those studies are available for Stage II patients.
If you want to look into a trial you will most likely need to work with a medical oncologist. If you are confident in your dermatologist, then ask him or her about the need for an oncologist.
Tim–MRF
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- July 20, 2012 at 6:12 pm
I was referred to an oncologist only when I progressed to Stage 3. That was in 1997, and I've gone through 7 oncologists since.
I looked at your profile, and I'm a bit confused. It states that your primary was between 2.0 and 4.0 mm. Yet you don't tell us if you had a sentinel node biopsy (SNB) to determine if the MM has spread to the lymph system. The SNB is the standard of care for primaries of this depth, and is a must for accurate staging. Could it be that the depth is really 0.2 to 0.4 mm? That would be more consistent with the Stage I that you report.
Best wishes,
Harry
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- July 20, 2012 at 6:12 pm
I was referred to an oncologist only when I progressed to Stage 3. That was in 1997, and I've gone through 7 oncologists since.
I looked at your profile, and I'm a bit confused. It states that your primary was between 2.0 and 4.0 mm. Yet you don't tell us if you had a sentinel node biopsy (SNB) to determine if the MM has spread to the lymph system. The SNB is the standard of care for primaries of this depth, and is a must for accurate staging. Could it be that the depth is really 0.2 to 0.4 mm? That would be more consistent with the Stage I that you report.
Best wishes,
Harry
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- July 21, 2012 at 9:07 pm
Hello Harry and Tim,
Thank you for answering my questionabout when to have an oncologist on the case.
I went back to my original biopsy, and will type here what I've read;
"Type; Superficial Spreaduing Lentiginous variant
Anatomic Level: II
Greatest thicknes: 0.3mm
Ulceration: absent
Radial Growth Phase: Present
Vertical Growth Phase: Absent
Precursor Lesion Present: Displastic Nevus
Margins: extending to the lateral and depe tissue edges
mitosis: 0 per square MM
Regression: present, partial
So, yes, I misread this the first time. What does anatomic level I mean?
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- July 21, 2012 at 9:10 pm
sorry – jittery fingers make typos
"Type; Superficial Spreading Lentiginous variant
Anatomic Level: II
Greatest thicknes: 0.3mm
Ulceration: absent
Radial Growth Phase: Present
Vertical Growth Phase: Absent
Precursor Lesion Present: Displastic Nevus
Margins: extending to the lateral and depe tissue edges
mitosis: 0 per square MM
Regression: present, partial
Question meant to say, What does anatomic Level II mean?
thanks
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- July 22, 2012 at 6:11 pm
thank you for your positive response! I appreciate learning the terms with all of you here.
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- July 22, 2012 at 6:11 pm
thank you for your positive response! I appreciate learning the terms with all of you here.
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- July 22, 2012 at 6:11 pm
thank you for your positive response! I appreciate learning the terms with all of you here.
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- July 22, 2012 at 6:14 pm
Natasha, thank you for responding here. i appreciate knowing that information about Clark's level and Anatomic level. I am learning so much from this message board.
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- July 22, 2012 at 6:14 pm
Natasha, thank you for responding here. i appreciate knowing that information about Clark's level and Anatomic level. I am learning so much from this message board.
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- July 22, 2012 at 6:14 pm
Natasha, thank you for responding here. i appreciate knowing that information about Clark's level and Anatomic level. I am learning so much from this message board.
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- July 22, 2012 at 11:42 pm
Yes ,absolutily ,Brelsow thickness is THE MOST IMPORTANT factor.
Mitosis , Clark and growth phase are important as well .Growth phase is in corellation with Breslow anywhere – cannot be deeper Breslow and radial growth phase , but can be 0.1 Breslow and vertical growth .
So , if tumor have not it's vertical growth phase ( growing deeper inside ) , it means tumor is not yet that aggresive and it is very good prognostic factor.
Regarding Subjectivism – any pathology is subjective ( that's why sometimes we have several pathology results on the same tumor with different results ). Most important – the closer to the realistic facts subjectivism is ,the more better and expierenced is pathologyst.
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- July 22, 2012 at 11:42 pm
Yes ,absolutily ,Brelsow thickness is THE MOST IMPORTANT factor.
Mitosis , Clark and growth phase are important as well .Growth phase is in corellation with Breslow anywhere – cannot be deeper Breslow and radial growth phase , but can be 0.1 Breslow and vertical growth .
So , if tumor have not it's vertical growth phase ( growing deeper inside ) , it means tumor is not yet that aggresive and it is very good prognostic factor.
Regarding Subjectivism – any pathology is subjective ( that's why sometimes we have several pathology results on the same tumor with different results ). Most important – the closer to the realistic facts subjectivism is ,the more better and expierenced is pathologyst.
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- July 23, 2012 at 12:31 pm
I am trying to say ,it is possible to have thin Breslow and radial growth. And Janner once replied on my post regarding this subject and agreed with that.
I was told I have 0.2 Breslow abd radial growth phase by group of pathologists in large hospiatl.
Ofcourse ,I was confused and asked for explanations.
In new studies , they proofed , tumor can have thin Breslow and still be in radial growth phase ,the same as some nevuses can exist in the skin with some thickness .
I see it's more and more patients who has thin Breslow ( usually 0.1-0.3 ) and still have radial growth phase.
It is a prignostic factor.
It is that my Docs said.
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- July 23, 2012 at 12:31 pm
I am trying to say ,it is possible to have thin Breslow and radial growth. And Janner once replied on my post regarding this subject and agreed with that.
I was told I have 0.2 Breslow abd radial growth phase by group of pathologists in large hospiatl.
Ofcourse ,I was confused and asked for explanations.
In new studies , they proofed , tumor can have thin Breslow and still be in radial growth phase ,the same as some nevuses can exist in the skin with some thickness .
I see it's more and more patients who has thin Breslow ( usually 0.1-0.3 ) and still have radial growth phase.
It is a prignostic factor.
It is that my Docs said.
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- July 23, 2012 at 12:43 pm
Can be confusing and also subjective. I have had 4 opinions on my lesion and all agree on the depth of approx 0.3mm . However, they all differ on growth phase. One says radial, no mitosis. One says vertical because of a single dermal mitotic figure identified. One says vertical because of dermal nest size, no mitosis identified. One doesn't comment on growth phase because it's subjective and not required. So, I have no idea if I'm radial or vertical. . and if vertical if because of mitosis or nest size. I also had one pathologist say that vertical growth phase ONLY because of nest size does not increase chances for spread, and only due to mitosis does it become a negative prognostic indicator. So, I really have no idea what is the real true information.
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- July 23, 2012 at 12:43 pm
Can be confusing and also subjective. I have had 4 opinions on my lesion and all agree on the depth of approx 0.3mm . However, they all differ on growth phase. One says radial, no mitosis. One says vertical because of a single dermal mitotic figure identified. One says vertical because of dermal nest size, no mitosis identified. One doesn't comment on growth phase because it's subjective and not required. So, I have no idea if I'm radial or vertical. . and if vertical if because of mitosis or nest size. I also had one pathologist say that vertical growth phase ONLY because of nest size does not increase chances for spread, and only due to mitosis does it become a negative prognostic indicator. So, I really have no idea what is the real true information.
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- July 23, 2012 at 12:43 pm
Can be confusing and also subjective. I have had 4 opinions on my lesion and all agree on the depth of approx 0.3mm . However, they all differ on growth phase. One says radial, no mitosis. One says vertical because of a single dermal mitotic figure identified. One says vertical because of dermal nest size, no mitosis identified. One doesn't comment on growth phase because it's subjective and not required. So, I have no idea if I'm radial or vertical. . and if vertical if because of mitosis or nest size. I also had one pathologist say that vertical growth phase ONLY because of nest size does not increase chances for spread, and only due to mitosis does it become a negative prognostic indicator. So, I really have no idea what is the real true information.
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- July 23, 2012 at 12:31 pm
I am trying to say ,it is possible to have thin Breslow and radial growth. And Janner once replied on my post regarding this subject and agreed with that.
I was told I have 0.2 Breslow abd radial growth phase by group of pathologists in large hospiatl.
Ofcourse ,I was confused and asked for explanations.
In new studies , they proofed , tumor can have thin Breslow and still be in radial growth phase ,the same as some nevuses can exist in the skin with some thickness .
I see it's more and more patients who has thin Breslow ( usually 0.1-0.3 ) and still have radial growth phase.
It is a prignostic factor.
It is that my Docs said.
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- July 23, 2012 at 12:42 pm
Radial & Vertical Growth Phases
The concept of Radial Growth Phase (RGP) and Vertical Growth Phase (VGP) was first introduced by Dr. Clark and colleagues and currently is widely accepted. Majority of malignant melanoma, except for some variants including nodular malignant melanoma, begin as intra-epidermal proliferation of malignant melanocytes (RGP). RGP sometimes remains confined for decades. RGP is almost always curable by surgical excision. Later, expansile nodules or aggressive infiltration of reticular dermis or subcutaneous fat (VGP) occurs. VGP is defined as dermal nests or expansile dermal nodule(s) composed of fully transformed malignant cells which exceeds the size of any junctional nest(s); i.e., tumorigenic and/or mitotic activity even if dermal nests are smaller than any junctional nests (mitogenic). The importance of VGP is that when a melanoma enters VGP it acquires the capacity to metastasize, in which the prognosis is directly related to depth of invasion.
In summary, three different clinical and histomorphological steps in tumor progression of malignant melanoma are as follows:
1. RGP-confined (confined to basement membrane- melanoma-in-situ)
2. RGP-confined, microinvasive (dermal nests are smaller than junctional nests and there is no mitosis present in dermis)
3. Vertical Growth Phase (VGP)
Note: Presence of large nest in Clark’s level II implies an incipient VGP. And involvement of Clark’s level III usually implies VGP. Guerry et al. in 1993 showed that 161 patients with RGP-confined without regression had median of 13.7 yr metastasis free survival. In another study by Taran & Heenan in 2001, only 5 of 1716 patients with Clark’s level 2 (with <1 mm thickness) developed metastatic disease; and all those five patients had established regression. Their conclusion from that study was that metastasis from Clark’s level 2 malignant melanoma occur rarely, if at all, in the absence of regression.
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- July 23, 2012 at 12:42 pm
Radial & Vertical Growth Phases
The concept of Radial Growth Phase (RGP) and Vertical Growth Phase (VGP) was first introduced by Dr. Clark and colleagues and currently is widely accepted. Majority of malignant melanoma, except for some variants including nodular malignant melanoma, begin as intra-epidermal proliferation of malignant melanocytes (RGP). RGP sometimes remains confined for decades. RGP is almost always curable by surgical excision. Later, expansile nodules or aggressive infiltration of reticular dermis or subcutaneous fat (VGP) occurs. VGP is defined as dermal nests or expansile dermal nodule(s) composed of fully transformed malignant cells which exceeds the size of any junctional nest(s); i.e., tumorigenic and/or mitotic activity even if dermal nests are smaller than any junctional nests (mitogenic). The importance of VGP is that when a melanoma enters VGP it acquires the capacity to metastasize, in which the prognosis is directly related to depth of invasion.
In summary, three different clinical and histomorphological steps in tumor progression of malignant melanoma are as follows:
1. RGP-confined (confined to basement membrane- melanoma-in-situ)
2. RGP-confined, microinvasive (dermal nests are smaller than junctional nests and there is no mitosis present in dermis)
3. Vertical Growth Phase (VGP)
Note: Presence of large nest in Clark’s level II implies an incipient VGP. And involvement of Clark’s level III usually implies VGP. Guerry et al. in 1993 showed that 161 patients with RGP-confined without regression had median of 13.7 yr metastasis free survival. In another study by Taran & Heenan in 2001, only 5 of 1716 patients with Clark’s level 2 (with <1 mm thickness) developed metastatic disease; and all those five patients had established regression. Their conclusion from that study was that metastasis from Clark’s level 2 malignant melanoma occur rarely, if at all, in the absence of regression.
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- July 23, 2012 at 12:47 pm
So, is this any Clark's level 2 <1 mm. . . whether RGP or VGP?
In another study by Taran & Heenan in 2001, only 5 of 1716 patients with Clark’s level 2 (with <1 mm thickness) developed metastatic disease; and all those five patients had established regression. Their conclusion from that study was that metastasis from Clark’s level 2 malignant melanoma occur rarely, if at all, in the absence of regression.
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- July 23, 2012 at 12:47 pm
So, is this any Clark's level 2 <1 mm. . . whether RGP or VGP?
In another study by Taran & Heenan in 2001, only 5 of 1716 patients with Clark’s level 2 (with <1 mm thickness) developed metastatic disease; and all those five patients had established regression. Their conclusion from that study was that metastasis from Clark’s level 2 malignant melanoma occur rarely, if at all, in the absence of regression.
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- July 23, 2012 at 12:47 pm
So, is this any Clark's level 2 <1 mm. . . whether RGP or VGP?
In another study by Taran & Heenan in 2001, only 5 of 1716 patients with Clark’s level 2 (with <1 mm thickness) developed metastatic disease; and all those five patients had established regression. Their conclusion from that study was that metastasis from Clark’s level 2 malignant melanoma occur rarely, if at all, in the absence of regression.
-
- July 23, 2012 at 12:42 pm
Radial & Vertical Growth Phases
The concept of Radial Growth Phase (RGP) and Vertical Growth Phase (VGP) was first introduced by Dr. Clark and colleagues and currently is widely accepted. Majority of malignant melanoma, except for some variants including nodular malignant melanoma, begin as intra-epidermal proliferation of malignant melanocytes (RGP). RGP sometimes remains confined for decades. RGP is almost always curable by surgical excision. Later, expansile nodules or aggressive infiltration of reticular dermis or subcutaneous fat (VGP) occurs. VGP is defined as dermal nests or expansile dermal nodule(s) composed of fully transformed malignant cells which exceeds the size of any junctional nest(s); i.e., tumorigenic and/or mitotic activity even if dermal nests are smaller than any junctional nests (mitogenic). The importance of VGP is that when a melanoma enters VGP it acquires the capacity to metastasize, in which the prognosis is directly related to depth of invasion.
In summary, three different clinical and histomorphological steps in tumor progression of malignant melanoma are as follows:
1. RGP-confined (confined to basement membrane- melanoma-in-situ)
2. RGP-confined, microinvasive (dermal nests are smaller than junctional nests and there is no mitosis present in dermis)
3. Vertical Growth Phase (VGP)
Note: Presence of large nest in Clark’s level II implies an incipient VGP. And involvement of Clark’s level III usually implies VGP. Guerry et al. in 1993 showed that 161 patients with RGP-confined without regression had median of 13.7 yr metastasis free survival. In another study by Taran & Heenan in 2001, only 5 of 1716 patients with Clark’s level 2 (with <1 mm thickness) developed metastatic disease; and all those five patients had established regression. Their conclusion from that study was that metastasis from Clark’s level 2 malignant melanoma occur rarely, if at all, in the absence of regression.
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- July 22, 2012 at 11:42 pm
Yes ,absolutily ,Brelsow thickness is THE MOST IMPORTANT factor.
Mitosis , Clark and growth phase are important as well .Growth phase is in corellation with Breslow anywhere – cannot be deeper Breslow and radial growth phase , but can be 0.1 Breslow and vertical growth .
So , if tumor have not it's vertical growth phase ( growing deeper inside ) , it means tumor is not yet that aggresive and it is very good prognostic factor.
Regarding Subjectivism – any pathology is subjective ( that's why sometimes we have several pathology results on the same tumor with different results ). Most important – the closer to the realistic facts subjectivism is ,the more better and expierenced is pathologyst.
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- July 22, 2012 at 11:51 am
The most important info is "Greatest thickness: 0.3 mm." This means it is a shallow Stage I. The anatomic level II is also known as Clark level, and is not as important as the thickness. A mitotic rate of 0 is very good.
You do not need an oncologist for this type of diagnosis. Follew-up with yor dermatologist is just fine.
Best wishes,
Harry
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- July 22, 2012 at 11:51 am
The most important info is "Greatest thickness: 0.3 mm." This means it is a shallow Stage I. The anatomic level II is also known as Clark level, and is not as important as the thickness. A mitotic rate of 0 is very good.
You do not need an oncologist for this type of diagnosis. Follew-up with yor dermatologist is just fine.
Best wishes,
Harry
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- July 22, 2012 at 6:12 pm
Thank you, Harry. I don't have the biopsy reports for the second site yet, but will ask for them next week, and now I will know how to read them accurately!
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- July 22, 2012 at 6:12 pm
Thank you, Harry. I don't have the biopsy reports for the second site yet, but will ask for them next week, and now I will know how to read them accurately!
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- July 22, 2012 at 11:48 pm
Thank you, all, for the responses here.
The dimensions i quoted are from the first melanoma site, on my back. I looked again at the biopsy for the second melanoma site, and it gives no dimensions, no level, no mitosis rate … just tells that it is an early melanoma of "severely atypical lentigninous junctional melanocytic proliferation consistent with early malignant melanoma in situ extending to the tissue edges;" … After the first surgery, the second biopsy read that 1/2 of the quadrants were clear, and the other half "residual atypical melanocyttic proliferation consistent with trailing edge of malignant melanoma in situ present at margin broadly throughout."
The neurologist who manages my multiple sclerosis suggests that I see the melanoma group at Dana Farber Cancer. I'll call them tomorrow to make an appointment, and ask them to decide whether I need an oncologist or not.
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- July 22, 2012 at 11:48 pm
Thank you, all, for the responses here.
The dimensions i quoted are from the first melanoma site, on my back. I looked again at the biopsy for the second melanoma site, and it gives no dimensions, no level, no mitosis rate … just tells that it is an early melanoma of "severely atypical lentigninous junctional melanocytic proliferation consistent with early malignant melanoma in situ extending to the tissue edges;" … After the first surgery, the second biopsy read that 1/2 of the quadrants were clear, and the other half "residual atypical melanocyttic proliferation consistent with trailing edge of malignant melanoma in situ present at margin broadly throughout."
The neurologist who manages my multiple sclerosis suggests that I see the melanoma group at Dana Farber Cancer. I'll call them tomorrow to make an appointment, and ask them to decide whether I need an oncologist or not.
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- July 23, 2012 at 8:46 pm
Thank you, all.
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- July 23, 2012 at 8:46 pm
Thank you, all.
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- July 23, 2012 at 8:46 pm
Thank you, all.
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- July 22, 2012 at 11:48 pm
Thank you, all, for the responses here.
The dimensions i quoted are from the first melanoma site, on my back. I looked again at the biopsy for the second melanoma site, and it gives no dimensions, no level, no mitosis rate … just tells that it is an early melanoma of "severely atypical lentigninous junctional melanocytic proliferation consistent with early malignant melanoma in situ extending to the tissue edges;" … After the first surgery, the second biopsy read that 1/2 of the quadrants were clear, and the other half "residual atypical melanocyttic proliferation consistent with trailing edge of malignant melanoma in situ present at margin broadly throughout."
The neurologist who manages my multiple sclerosis suggests that I see the melanoma group at Dana Farber Cancer. I'll call them tomorrow to make an appointment, and ask them to decide whether I need an oncologist or not.
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- July 22, 2012 at 6:12 pm
Thank you, Harry. I don't have the biopsy reports for the second site yet, but will ask for them next week, and now I will know how to read them accurately!
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- July 22, 2012 at 11:51 am
The most important info is "Greatest thickness: 0.3 mm." This means it is a shallow Stage I. The anatomic level II is also known as Clark level, and is not as important as the thickness. A mitotic rate of 0 is very good.
You do not need an oncologist for this type of diagnosis. Follew-up with yor dermatologist is just fine.
Best wishes,
Harry
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- July 21, 2012 at 9:10 pm
sorry – jittery fingers make typos
"Type; Superficial Spreading Lentiginous variant
Anatomic Level: II
Greatest thicknes: 0.3mm
Ulceration: absent
Radial Growth Phase: Present
Vertical Growth Phase: Absent
Precursor Lesion Present: Displastic Nevus
Margins: extending to the lateral and depe tissue edges
mitosis: 0 per square MM
Regression: present, partial
Question meant to say, What does anatomic Level II mean?
thanks
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- July 21, 2012 at 9:10 pm
sorry – jittery fingers make typos
"Type; Superficial Spreading Lentiginous variant
Anatomic Level: II
Greatest thicknes: 0.3mm
Ulceration: absent
Radial Growth Phase: Present
Vertical Growth Phase: Absent
Precursor Lesion Present: Displastic Nevus
Margins: extending to the lateral and depe tissue edges
mitosis: 0 per square MM
Regression: present, partial
Question meant to say, What does anatomic Level II mean?
thanks
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- July 21, 2012 at 9:07 pm
Hello Harry and Tim,
Thank you for answering my questionabout when to have an oncologist on the case.
I went back to my original biopsy, and will type here what I've read;
"Type; Superficial Spreaduing Lentiginous variant
Anatomic Level: II
Greatest thicknes: 0.3mm
Ulceration: absent
Radial Growth Phase: Present
Vertical Growth Phase: Absent
Precursor Lesion Present: Displastic Nevus
Margins: extending to the lateral and depe tissue edges
mitosis: 0 per square MM
Regression: present, partial
So, yes, I misread this the first time. What does anatomic level I mean?
-
- July 21, 2012 at 9:07 pm
Hello Harry and Tim,
Thank you for answering my questionabout when to have an oncologist on the case.
I went back to my original biopsy, and will type here what I've read;
"Type; Superficial Spreaduing Lentiginous variant
Anatomic Level: II
Greatest thicknes: 0.3mm
Ulceration: absent
Radial Growth Phase: Present
Vertical Growth Phase: Absent
Precursor Lesion Present: Displastic Nevus
Margins: extending to the lateral and depe tissue edges
mitosis: 0 per square MM
Regression: present, partial
So, yes, I misread this the first time. What does anatomic level I mean?
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- July 20, 2012 at 6:12 pm
I was referred to an oncologist only when I progressed to Stage 3. That was in 1997, and I've gone through 7 oncologists since.
I looked at your profile, and I'm a bit confused. It states that your primary was between 2.0 and 4.0 mm. Yet you don't tell us if you had a sentinel node biopsy (SNB) to determine if the MM has spread to the lymph system. The SNB is the standard of care for primaries of this depth, and is a must for accurate staging. Could it be that the depth is really 0.2 to 0.4 mm? That would be more consistent with the Stage I that you report.
Best wishes,
Harry
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