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38yo Husband Just Diagnosed with (probably) Stage IV Melanoma… PLEASE HELP

Forums General Melanoma Community 38yo Husband Just Diagnosed with (probably) Stage IV Melanoma… PLEASE HELP

  • Post
    thebunches
    Participant

    My husband got the phone call from the dermatologist this morning… the area that was biopsied from his abdomen is melanoma. "Leaning more toward Stage IV", the dermatologist said.

    My husband is a hypochondriac. He blows things way out of proportion. So I called the derm office myself to find out exactly what they said. They've referred us to a surgical oncologist (best one in the area, they said). SurgOnc will be calling us in 1-2 days to schedule consult.

    My husband got the phone call from the dermatologist this morning… the area that was biopsied from his abdomen is melanoma. "Leaning more toward Stage IV", the dermatologist said.

    My husband is a hypochondriac. He blows things way out of proportion. So I called the derm office myself to find out exactly what they said. They've referred us to a surgical oncologist (best one in the area, they said). SurgOnc will be calling us in 1-2 days to schedule consult.

    I am NOT a hypochondriac. I typically down-play things, ESPECIALLY because he gets so worked up about EVERYTHING. But this has me quite concerned.

    My husband's melanoma is just (so far) in the one spot… from what we understand. I have so many questions… is he going to die? He's only 38 years old. I thought melanoma deaths were mostly related to older people, like in their 70's and 80's? My grandfather had multiple melanomas, but he also had other severe health problems, including dementia, Parkinson's, etc. I thought he died of ALL those things combined. Even so, if he did die of the melanoma, he lived until he was 75.

    Am I going crazy here!?!?! We just had a little girl. She's not even 2 years old yet. I'm only 29 and my husband could be DYING?!?! We have two teenage daughters as well…whom we haven't told yet (we're still reeling from the news this morning). I don't know what to do! I'm just praying & trying to entrust all of this to God. We have no answers until we meet with the SurgOnc.

    Any help anyone can provide would be MUCH appreciated. Thank you.

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  • Replies
      Janner
      Participant

      HOLD YOUR HORSES HERE!!!!

      Let me ask you a few questions.  Has he just had a biopsy on the skin?  That's the only testing done so far?  If so, he is NOT stage IV and not dying any time soon.  He is most likely CLARK'S LEVEL IV.  This just described the layer of skin the lesion has invaded.  Clark's Level is not the most prognostic factor, however.  To be able to help you more, we'd need the Breslow depth.  This is the depth in millimeters that the lesion has invaded.  This is, to date, the best prognostic indicator for melanoma.  I'd suggest you get a copy of your pathology report.  If you post it here, we can help you figure out the important bits.  But please don't put your husband in a grave yet, it's unlikely he is stage IV.  If you go to my website (linked below in my signature), choose the Newly Diagnosed button.  Scroll to the bottom of the screen and I include a description of Clark's Level versus Stage.  It is often confused in the newly diagnosed since both use Roman numerals.  Take a deep breath….

      Best wishes,

      Janner

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      Janner
      Participant

      HOLD YOUR HORSES HERE!!!!

      Let me ask you a few questions.  Has he just had a biopsy on the skin?  That's the only testing done so far?  If so, he is NOT stage IV and not dying any time soon.  He is most likely CLARK'S LEVEL IV.  This just described the layer of skin the lesion has invaded.  Clark's Level is not the most prognostic factor, however.  To be able to help you more, we'd need the Breslow depth.  This is the depth in millimeters that the lesion has invaded.  This is, to date, the best prognostic indicator for melanoma.  I'd suggest you get a copy of your pathology report.  If you post it here, we can help you figure out the important bits.  But please don't put your husband in a grave yet, it's unlikely he is stage IV.  If you go to my website (linked below in my signature), choose the Newly Diagnosed button.  Scroll to the bottom of the screen and I include a description of Clark's Level versus Stage.  It is often confused in the newly diagnosed since both use Roman numerals.  Take a deep breath….

      Best wishes,

      Janner

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      Carol Taylor
      Participant

      Hi Friend,

      First, you need some good information. Don't address "dying" right now, OK? You haven't even seen anybody yet, you really, at this point don't know exactly what you're dealing with. 

      For now, you need to make sure, sure, that this surgical onc is a melanoma specialist.  That is vital!   "Surgical Onc" who's one of the best in the area, doesn't clear up for me if they're talking about your geographical area or the area of melanoma.  My guess is "geographical."  If that's the case, ask and make sure it's also melanoma…if not, please get a referral to a melanoma specialist and make sure that all oncs and derms you deal with from this point on are specialists…that will make a crucial difference for your husband!

      While writing this I saw Janner has posted. She'll give you great advice! I'll also refer you to the Melanoma Prayer Center I write and administrate on Facebook though you can read it (notes too) and play the music videos without being on Fb, just click link to it after my name.

      Get yourself together for now and for your children.

      Lord, in Your mercy, calm our friend here and open the doors for her husband that need opening so that he can get the best treatment possible for whatever he is actually dealing with. See them through this time. Amen.

      Grace and peace,

      Carol

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      Carol Taylor
      Participant

      Hi Friend,

      First, you need some good information. Don't address "dying" right now, OK? You haven't even seen anybody yet, you really, at this point don't know exactly what you're dealing with. 

      For now, you need to make sure, sure, that this surgical onc is a melanoma specialist.  That is vital!   "Surgical Onc" who's one of the best in the area, doesn't clear up for me if they're talking about your geographical area or the area of melanoma.  My guess is "geographical."  If that's the case, ask and make sure it's also melanoma…if not, please get a referral to a melanoma specialist and make sure that all oncs and derms you deal with from this point on are specialists…that will make a crucial difference for your husband!

      While writing this I saw Janner has posted. She'll give you great advice! I'll also refer you to the Melanoma Prayer Center I write and administrate on Facebook though you can read it (notes too) and play the music videos without being on Fb, just click link to it after my name.

      Get yourself together for now and for your children.

      Lord, in Your mercy, calm our friend here and open the doors for her husband that need opening so that he can get the best treatment possible for whatever he is actually dealing with. See them through this time. Amen.

      Grace and peace,

      Carol

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      Kim K
      Participant

      YOU CANNOT DETERMINE STAGE IV FROM A SKIN BIOPSY ALONE.  I can almost garuantee that the derm is saying stage when they really mean Clark level 4.  THEY ARE NOT THE SAME THING.  I am not yelling but bolding so you can rest assured.

      I am a veterinarian and was told the same thing so many years ago.  I also freaked and asked how do they know I am a stage IV just from a biopsy?!  They don't.  Period.

      The Clark level only tells you the level of invasion into the skin layers, not if it has spread.  Your husband will need to be further staged most likely by having a sentinal node biopsy done.  You can google the proceedure and look it up on the archives here.

      I promise you will get past the deer in the headlights stage, albeit longer for your husband.  This is by far the best site for information and support.

      Whatever happens, don't let anyone do a wide excision prior to the sentinal node biopsy.  The time waiting will not make that much difference at this point. (other than making you feel better to get any remaining junk outta there).  A few weeks won't make much difference at this point.

      Lastly,  get a copy of your pathology report and post it here word for word.  We will make sense of it for you, the info will be accurate.  NOT ALL Dr.s do the right thing when dealing with mel.  You need to make sure your doctor is well versed as this is no basal cell carcinoma…. My derm did a wide excision and did not even mention a sentinal node biopsy which he should have.  Then sent me to a medical onc instead of a surgical one.  This was at a skin cancer derm's office.  Youdda think derms would be well versed in one of the few deadly skin diseases and not botch the job.  This guy should have retiered long ago.  He also did a piss poor skin exam.

      Fortunately since that experience (and after the shock wore off), I have become my best advocate and very versed in this disease.  Almost 8 years after my  diagnosis at 2A, I progressed to stage IV.  Because of my years on this site and knowlege I gained, I was invited to my own tumor board discussion, a first ever for my hospital.

      I am currently NED (disease free – as we are "never cured") as of July '10.  I am 42 and a single mom of a 3 & 5 y/o.  This disease scares the living $hit out of you.  Again I promise it will get better with time.  It really does.

      Sorry you had to join us, glad you found us.

      Sending cyber hugs and support from Hawaii,

      Kim

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      Kim K
      Participant

      YOU CANNOT DETERMINE STAGE IV FROM A SKIN BIOPSY ALONE.  I can almost garuantee that the derm is saying stage when they really mean Clark level 4.  THEY ARE NOT THE SAME THING.  I am not yelling but bolding so you can rest assured.

      I am a veterinarian and was told the same thing so many years ago.  I also freaked and asked how do they know I am a stage IV just from a biopsy?!  They don't.  Period.

      The Clark level only tells you the level of invasion into the skin layers, not if it has spread.  Your husband will need to be further staged most likely by having a sentinal node biopsy done.  You can google the proceedure and look it up on the archives here.

      I promise you will get past the deer in the headlights stage, albeit longer for your husband.  This is by far the best site for information and support.

      Whatever happens, don't let anyone do a wide excision prior to the sentinal node biopsy.  The time waiting will not make that much difference at this point. (other than making you feel better to get any remaining junk outta there).  A few weeks won't make much difference at this point.

      Lastly,  get a copy of your pathology report and post it here word for word.  We will make sense of it for you, the info will be accurate.  NOT ALL Dr.s do the right thing when dealing with mel.  You need to make sure your doctor is well versed as this is no basal cell carcinoma…. My derm did a wide excision and did not even mention a sentinal node biopsy which he should have.  Then sent me to a medical onc instead of a surgical one.  This was at a skin cancer derm's office.  Youdda think derms would be well versed in one of the few deadly skin diseases and not botch the job.  This guy should have retiered long ago.  He also did a piss poor skin exam.

      Fortunately since that experience (and after the shock wore off), I have become my best advocate and very versed in this disease.  Almost 8 years after my  diagnosis at 2A, I progressed to stage IV.  Because of my years on this site and knowlege I gained, I was invited to my own tumor board discussion, a first ever for my hospital.

      I am currently NED (disease free – as we are "never cured") as of July '10.  I am 42 and a single mom of a 3 & 5 y/o.  This disease scares the living $hit out of you.  Again I promise it will get better with time.  It really does.

      Sorry you had to join us, glad you found us.

      Sending cyber hugs and support from Hawaii,

      Kim

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      thebunches
      Participant

      Thank you both fo your answers and even just BEING here. It helps so much to know that someone else is here and knows what we're talking about.

      He has only seen the derm, only gotten a biopsy of the skin. The nurse there said it was "less than 1 on the scale". I have no idea what that means. (Maybe the Breslow depth?) She also said it is "not rapidly progressing and is very concentrated".

      The Surg Onc's website says they are melanoma specialists (thank God).

      The derm office is sending me copies of his entire chart including path reports, so we're waiting to get those. Hopefully today. I will post it as soon as it gets here.

      Carol, thank you for your quick prayer. Honestly, I think that's all I've been doing all day (that and researching everything I can get my hands on about melanoma). My husband is going nuts…I just have to take home SOME kind of "fact" information. I am "the rock" in our household, and if I don't have something solid to tell him (for the rest of the night, the week, and probably for the next however-many years), he'll sink with little chance of hope.

      Janner, thank you for your quick reply and help to "rein it in". I have been trying very hard to keep a handle on myself and my emotions since this morning…especially because if I lose it, the rest of the family will essentially go to h*ll in a handbasket. ("If Shay can't handle it, how can I" mentality)

      Hugs and Many Thanks…I'll report as soon as I have something.

      –Shay Bunch

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      thebunches
      Participant

      Thank you both fo your answers and even just BEING here. It helps so much to know that someone else is here and knows what we're talking about.

      He has only seen the derm, only gotten a biopsy of the skin. The nurse there said it was "less than 1 on the scale". I have no idea what that means. (Maybe the Breslow depth?) She also said it is "not rapidly progressing and is very concentrated".

      The Surg Onc's website says they are melanoma specialists (thank God).

      The derm office is sending me copies of his entire chart including path reports, so we're waiting to get those. Hopefully today. I will post it as soon as it gets here.

      Carol, thank you for your quick prayer. Honestly, I think that's all I've been doing all day (that and researching everything I can get my hands on about melanoma). My husband is going nuts…I just have to take home SOME kind of "fact" information. I am "the rock" in our household, and if I don't have something solid to tell him (for the rest of the night, the week, and probably for the next however-many years), he'll sink with little chance of hope.

      Janner, thank you for your quick reply and help to "rein it in". I have been trying very hard to keep a handle on myself and my emotions since this morning…especially because if I lose it, the rest of the family will essentially go to h*ll in a handbasket. ("If Shay can't handle it, how can I" mentality)

      Hugs and Many Thanks…I'll report as soon as I have something.

      –Shay Bunch

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        lhaley
        Participant

        Everyone has given you good advice. Less than 1mm is the Breslow and very unlikely that it has spread.  THis is scary. Take a deep breath and somehow you will have to wait till you get more info. 

        So sorry that you've had to join us.

        Linda

        Original mel was in 1979!!

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        lhaley
        Participant

        Everyone has given you good advice. Less than 1mm is the Breslow and very unlikely that it has spread.  THis is scary. Take a deep breath and somehow you will have to wait till you get more info. 

        So sorry that you've had to join us.

        Linda

        Original mel was in 1979!!

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      CarolA
      Participant

      Oh, yes, take a deep breath, exhale…take another one, exhale.    And, also, quit reading about melanoma and scaring yourself.    Know why I take liberty of saying that?   I did the same thing six years ago—-I heard "IV" (it was Clarks Level IV) and accepted the shovel that (I thought) came with it, certain it was Stage IV.    Oh how I remember those two weeks before I saw the surgeon, the panic, the crying, the unknown that I feared so much, the awful stories I read, the inability to truly comprehend melanoma staging.   I'm so sorry that you are in this position now, young, a young child—I would suggest that you shouldn't involve the older children in this until you have the medical plan in motion.   The word cancer is SO frightening (I dont' have to tell you that).    Once a definite plan is made, appointment, time, procedure, then you will have to formulate the proper words to inform the teenagers because there will be a wait after those for the actual diagnosis and plan.   And don't let those words scare you, because there will be a diagnosis and a plan (which could be as simple as very low staging with monitoring through semi-annual md appts).  

      Go to Janner's site, and read, and re-read Newly Diagnosed first.    Know that the pathology report is not that hard to secure from the doctor (I thought it was questioning his work or something).    It is not a big deal to secure it.    Post it here.   people here are not doctors, but, after six years, I know how experienced some are in explaining path reports.   The Breslow depth will determine a lot of what is to come next for your husband.   But the you can step out of the complete panic you are in now.   Really, you can.   He is NOT Stage IV.    There is much ahead medically:    tests, blood work, appointments—that much I think we will all agree is in his future.    One step at a time.  Try to get that path report for your sanity and his. 

      Yep, you've come through the doors to a pretty crappy cancer:  melanoma.    But you are in a good place here.    We've all experienced this first-hand.    I am still Stage III after six  years.   There are probably many, and MANY that do not participate on this board (they probably dont' know of it!!), but many that DO and are managing, surviving and who went through the frightening first days that you and your husband are travelling.    Hang in there. you can do this, he will do this, and once the plan is made, you will feel more in control. 

      CarolA – Stage III

      Amherst, NY  

       

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      CarolA
      Participant

      Oh, yes, take a deep breath, exhale…take another one, exhale.    And, also, quit reading about melanoma and scaring yourself.    Know why I take liberty of saying that?   I did the same thing six years ago—-I heard "IV" (it was Clarks Level IV) and accepted the shovel that (I thought) came with it, certain it was Stage IV.    Oh how I remember those two weeks before I saw the surgeon, the panic, the crying, the unknown that I feared so much, the awful stories I read, the inability to truly comprehend melanoma staging.   I'm so sorry that you are in this position now, young, a young child—I would suggest that you shouldn't involve the older children in this until you have the medical plan in motion.   The word cancer is SO frightening (I dont' have to tell you that).    Once a definite plan is made, appointment, time, procedure, then you will have to formulate the proper words to inform the teenagers because there will be a wait after those for the actual diagnosis and plan.   And don't let those words scare you, because there will be a diagnosis and a plan (which could be as simple as very low staging with monitoring through semi-annual md appts).  

      Go to Janner's site, and read, and re-read Newly Diagnosed first.    Know that the pathology report is not that hard to secure from the doctor (I thought it was questioning his work or something).    It is not a big deal to secure it.    Post it here.   people here are not doctors, but, after six years, I know how experienced some are in explaining path reports.   The Breslow depth will determine a lot of what is to come next for your husband.   But the you can step out of the complete panic you are in now.   Really, you can.   He is NOT Stage IV.    There is much ahead medically:    tests, blood work, appointments—that much I think we will all agree is in his future.    One step at a time.  Try to get that path report for your sanity and his. 

      Yep, you've come through the doors to a pretty crappy cancer:  melanoma.    But you are in a good place here.    We've all experienced this first-hand.    I am still Stage III after six  years.   There are probably many, and MANY that do not participate on this board (they probably dont' know of it!!), but many that DO and are managing, surviving and who went through the frightening first days that you and your husband are travelling.    Hang in there. you can do this, he will do this, and once the plan is made, you will feel more in control. 

      CarolA – Stage III

      Amherst, NY  

       

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      thebunches
      Participant

      Okay, got the reports from the derm!

      Malignant Melanoma

      Thickness: 1.0 mm

      Clark's Level: IV

      Growth Phase: Vertical

      Ulceration: Not Identified

      Mitotic Rate: <1/mm2

      Angiolymphatic Invasion: Not Identified

      Features of Regression: Not Identified

      Lymphocytic Host Response: Non-Brisk

      Pathologic Stage: T1a

      Microscopic:

      Atypical Melanocytes are present within the epidermis and the papillary and reticular dermis. There is confluent melanocytic proliferation at the dejunction. Atypical spindle melanocytic proliferation is seen within deep dermis along with fibroplasia. Speail immunohistochemical stains melan A and S-100 helps to identify melanocytes and outline their distribution. Melana stain demonstrates pagetoid proliferation of melanocytes. Multiple levels are examined.

      Comment:

      The lesion extends to the base of the specimen. Reexcision for clear margins is recommended.

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      thebunches
      Participant

      Okay, got the reports from the derm!

      Malignant Melanoma

      Thickness: 1.0 mm

      Clark's Level: IV

      Growth Phase: Vertical

      Ulceration: Not Identified

      Mitotic Rate: <1/mm2

      Angiolymphatic Invasion: Not Identified

      Features of Regression: Not Identified

      Lymphocytic Host Response: Non-Brisk

      Pathologic Stage: T1a

      Microscopic:

      Atypical Melanocytes are present within the epidermis and the papillary and reticular dermis. There is confluent melanocytic proliferation at the dejunction. Atypical spindle melanocytic proliferation is seen within deep dermis along with fibroplasia. Speail immunohistochemical stains melan A and S-100 helps to identify melanocytes and outline their distribution. Melana stain demonstrates pagetoid proliferation of melanocytes. Multiple levels are examined.

      Comment:

      The lesion extends to the base of the specimen. Reexcision for clear margins is recommended.

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        Janner
        Participant

        Thickness is 1mm, but the bottom margin is not clear.  That means it could be a bit deeper.  Often when they reexcise the area, they find no more evidence of melanoma.  However, it is possible it was deeper.  Your husband WILL need a SNB (sentinel node biopsy).  This is typically done with lesions 1.0mm or deeper.  They will inject some radioactive dye into the biopsy site and trace it to the first lymph node (sentinel node) in the chain.  Then they will remove that node(s) and perform a pathology on it looking for additional melanoma cells.  Immediately after they do the SNB, they will do the WLE (wide local excision).  THESE PROCEDURES MUST BE DONE IN THIS ORDER.  Once you remove a large chunk of skin, the drainage paths to the sentinel node might change.  His staging won't be complete until after the results of these procedures are complete.  Right now, he is stage IA until the rest of his staging is complete.  The other items on his path report is basically what you'd like to see.  No other factors are considered high risk.  Just for comparison, I had a .88mm lesion (similar depth) removed almost 10 years ago.  I'm still here kicking and still stage I. 

        Take a deep breath.  Not stage IV, stage I for now.  He will need further surgery to remove the sentinel node and to get wide margins around the lesions.  Typically 1cm margins would be taken although the scar will be much longer to close the wound.  These are standard procedures.  After those take place, you'll be able to plan your strategy.  If he is still stage I, then he will basically receive no more treatment – just skin monitoring from a dermatologist.  If he has a positive sentinel node, you address that when you get there.  No need to jump ahead at this point in time.

        This is not a death sentence.  I had a stage I lesion removed 19 years ago as well (.58mm).  I basically treat it as a chronic disease.  I require regular maintenance (visits to the derm), I practice sun safety, but other than that I live my life as normally as possible.  If caught early, this is a manageable disease.  Please just take this one step at a time – researching too much can cause incredible anxiety (speaking from experience here).  Feel free to ask anymore questions you have here, there are plenty of people with many years of experience here at all stages.  We've all been there before!

        Best wishes,

        Janner

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        Janner
        Participant

        Thickness is 1mm, but the bottom margin is not clear.  That means it could be a bit deeper.  Often when they reexcise the area, they find no more evidence of melanoma.  However, it is possible it was deeper.  Your husband WILL need a SNB (sentinel node biopsy).  This is typically done with lesions 1.0mm or deeper.  They will inject some radioactive dye into the biopsy site and trace it to the first lymph node (sentinel node) in the chain.  Then they will remove that node(s) and perform a pathology on it looking for additional melanoma cells.  Immediately after they do the SNB, they will do the WLE (wide local excision).  THESE PROCEDURES MUST BE DONE IN THIS ORDER.  Once you remove a large chunk of skin, the drainage paths to the sentinel node might change.  His staging won't be complete until after the results of these procedures are complete.  Right now, he is stage IA until the rest of his staging is complete.  The other items on his path report is basically what you'd like to see.  No other factors are considered high risk.  Just for comparison, I had a .88mm lesion (similar depth) removed almost 10 years ago.  I'm still here kicking and still stage I. 

        Take a deep breath.  Not stage IV, stage I for now.  He will need further surgery to remove the sentinel node and to get wide margins around the lesions.  Typically 1cm margins would be taken although the scar will be much longer to close the wound.  These are standard procedures.  After those take place, you'll be able to plan your strategy.  If he is still stage I, then he will basically receive no more treatment – just skin monitoring from a dermatologist.  If he has a positive sentinel node, you address that when you get there.  No need to jump ahead at this point in time.

        This is not a death sentence.  I had a stage I lesion removed 19 years ago as well (.58mm).  I basically treat it as a chronic disease.  I require regular maintenance (visits to the derm), I practice sun safety, but other than that I live my life as normally as possible.  If caught early, this is a manageable disease.  Please just take this one step at a time – researching too much can cause incredible anxiety (speaking from experience here).  Feel free to ask anymore questions you have here, there are plenty of people with many years of experience here at all stages.  We've all been there before!

        Best wishes,

        Janner

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      rbruce
      Participant

      Slow down, talk to the Dr's, get informed.  There is light out there for us with Melanoma.  Everyday, new therapies are evolving and people are getting through this.  I too was recently diagnosed with Melanoma and freaked out and my wife would tell you I am the hypochondriac in our family as well.  I went through all the testing and mine had spread to my lungs, "oh crap" I thought….then….I started reading posts here and elsewhere of the advances in Melanoma therapies and of all the survivors and their stories.  I joined a cancer support group at my local hospital and everyday I put one foot in front of the other and move on.  I am scheduled for another PET/CT scan next week to see if anything has changed and to use as a baseline for treatment.  We are reviewing the various treatments out there to find the one that will be best for me. 

      I will pray for you and your husband for strength, courage and hope as the waiting can bring needless worry. 

      "trust in the Lord with your heart and lean not on your own understanding, In all your ways acknowledge him and he shall direct thy path"  Proverbs 3, 5-6

      God Bless.

      Robert

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      rbruce
      Participant

      Slow down, talk to the Dr's, get informed.  There is light out there for us with Melanoma.  Everyday, new therapies are evolving and people are getting through this.  I too was recently diagnosed with Melanoma and freaked out and my wife would tell you I am the hypochondriac in our family as well.  I went through all the testing and mine had spread to my lungs, "oh crap" I thought….then….I started reading posts here and elsewhere of the advances in Melanoma therapies and of all the survivors and their stories.  I joined a cancer support group at my local hospital and everyday I put one foot in front of the other and move on.  I am scheduled for another PET/CT scan next week to see if anything has changed and to use as a baseline for treatment.  We are reviewing the various treatments out there to find the one that will be best for me. 

      I will pray for you and your husband for strength, courage and hope as the waiting can bring needless worry. 

      "trust in the Lord with your heart and lean not on your own understanding, In all your ways acknowledge him and he shall direct thy path"  Proverbs 3, 5-6

      God Bless.

      Robert

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      thebunches
      Participant

      THANKS, Janner! So I assume that when the nurse at the derm office told me on the phone that it's "Stage 4", she meant Clark Level IV which is an entirely different scale?! This is only at Stage 1?!?!

      Are these always connected to a lymph node?

      Getting further surgery to get rid of it is FINE with me… we have just been going back and forth with him "not seeing our kids grow up", figuring out life insurance, etc etc etc. It sure would have been nice if the derm office hadn't completely FREAKED us out by saying "Stage Four"!!!!!!!!!

      I will definitely keep you all updated as I know we will have questions in the future and in starting to deal with this disease. I think we both thought we were handed a pink slip and this was the end of the line. I do anxiously anticipate what the surg onc will have to say, but at least at this point, we can try to tread water instead of drown. Right?

      THANK YOU all again for your helpful words and your replies. I know you've all been there before, but there's just nothing like it when you get a phone call that says, "You have cancer."

      It is my prayer now that this is the worst one in his body, and that we will catch any others in the very early stages. Hugs to each and every one of you…words cannot express my gratitude.

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        Janner
        Participant

        Skin biopsy reports will really only put you at stage I or II.  They analyze a skin lesion for abnormal cells, depth, and other factors.  They don't analyze the entire body.  So they can't tell if the lesion is in the lymph nodes (stage III) or in organs (stage IV).  This is why we know that your husband can't be stage IV from just the initial biopsy report.  (I would suggest you call your doctor to make sure the nurse does NOT mention stage as Clark's Level in the future – no sense in others going through what you did yesterday).  At this point, your husband is stage I.  

        "Are these things always connected to a lymph node?"  Basically everywhere in your body is connected to a lymph node.  They are the garbage collectors / filters for the body.  They are also the most likely place to find melanoma if it has traveled from the original lesion.  They do the SNB for melanoma as well as breast cancer.  This way, they can just check the most likely lymph node for cancer.   If it isn't in that node, it's highly unlikely to be in any others.  There is never a 100% guarantee with cancer however.  If his SNB is clear, then he will stay stage I and just be monitored.  Just to be clear, it is also quite unusual to have more than one melanoma.  I've had 3, but only about 8% of the melanoma population have more than one.  But you should continue to monitor his body for things that CHANGE or stick out from the rest of his moles.

        Hang in there!

        Janner

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        Janner
        Participant

        Skin biopsy reports will really only put you at stage I or II.  They analyze a skin lesion for abnormal cells, depth, and other factors.  They don't analyze the entire body.  So they can't tell if the lesion is in the lymph nodes (stage III) or in organs (stage IV).  This is why we know that your husband can't be stage IV from just the initial biopsy report.  (I would suggest you call your doctor to make sure the nurse does NOT mention stage as Clark's Level in the future – no sense in others going through what you did yesterday).  At this point, your husband is stage I.  

        "Are these things always connected to a lymph node?"  Basically everywhere in your body is connected to a lymph node.  They are the garbage collectors / filters for the body.  They are also the most likely place to find melanoma if it has traveled from the original lesion.  They do the SNB for melanoma as well as breast cancer.  This way, they can just check the most likely lymph node for cancer.   If it isn't in that node, it's highly unlikely to be in any others.  There is never a 100% guarantee with cancer however.  If his SNB is clear, then he will stay stage I and just be monitored.  Just to be clear, it is also quite unusual to have more than one melanoma.  I've had 3, but only about 8% of the melanoma population have more than one.  But you should continue to monitor his body for things that CHANGE or stick out from the rest of his moles.

        Hang in there!

        Janner

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      thebunches
      Participant

      THANKS, Janner! So I assume that when the nurse at the derm office told me on the phone that it's "Stage 4", she meant Clark Level IV which is an entirely different scale?! This is only at Stage 1?!?!

      Are these always connected to a lymph node?

      Getting further surgery to get rid of it is FINE with me… we have just been going back and forth with him "not seeing our kids grow up", figuring out life insurance, etc etc etc. It sure would have been nice if the derm office hadn't completely FREAKED us out by saying "Stage Four"!!!!!!!!!

      I will definitely keep you all updated as I know we will have questions in the future and in starting to deal with this disease. I think we both thought we were handed a pink slip and this was the end of the line. I do anxiously anticipate what the surg onc will have to say, but at least at this point, we can try to tread water instead of drown. Right?

      THANK YOU all again for your helpful words and your replies. I know you've all been there before, but there's just nothing like it when you get a phone call that says, "You have cancer."

      It is my prayer now that this is the worst one in his body, and that we will catch any others in the very early stages. Hugs to each and every one of you…words cannot express my gratitude.

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      scaredsilly
      Participant

      Thank you so much for posting this – and for all the wonderful responses.  (This entire thread calmed me down and helped me through the night).  We were also told that my husband, age 37, has stage 3 melanoma.  After reading your post and the replies, it made me wonder so I requested the path report. Can anyone please tell me what this means (in layman's terms):

      Skin Biopsy, Upper Back
      ·        Malignant melanoma
      ·        Thickness – 0.75mm
      ·        Level of invasion – Level III
      ·        Ulceration – not identified
      ·        Mitotic Rate – <1/mm2
      ·        Pathologic Stage – T1a
      ·        Note:  Immunoperoxidase stain for Pan melanoma was performed.  The lesion extends to the peripheral and deep margins.  This lesion should be completely removed.

      Thanks for the support (and the prayers helped too).  Sorry to be here, but glad that this site is availabe.

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        thebunches
        Participant

        Hi there! Based on the feedback we got from my husband's surgical oncologist, here's what your path report probably means:

        Thickness (also called the Breslow depth) of 0.75 mm = this is actually LESS than what my husband's thickness was; this is what the doctors typically use to discern the status of the cancer. 0.75 is somewhat thick, but in the grand scheme of things, still very manageable.

        Level of Invasion = this is actually NOT your husband's "stage" of cancer. This is the Clark's Level. (My husband's was Level IV, which I originally thought that was the Stage. These are two TOTALLY different things.)

        Ulceration = this just means if it is oozing or leaking any sort of liquid…blood, pus, drainage, etc.

        Mitotic Rate = My husband had the exact same rate: <1/mm2. This means that the melanoma is NOT spreading at a brisk pace; it is very slow-growing (a GOOD thing!!).

        Path Stage = T1a; this is just another way of the doc figuring out the status of the cancer. This is on the LOW side of the path stages. (Another GOOD thing)

        My husband had the WLE (wide lateral excision) and the SNB (sentinel node biopsy). When all was said and done, the total size of the melanoma was 1.2mm (not much deeper than your husband's 0.75mm), and they took two lymph nodes that showed that that's where the cancer COULD have spread if it was going to spread. (It didn't, and both lymph nodes showed NO SIGNS of cancer.)

        After all is said and done, now my husband has a great big scar (about 10 inches) along with a smaller one where they removed the two lymph nodes. HE IS AT STAGE ONE and we now go back for 3-month follow ups wtih his dermatologist for awhile. If there were a "good" diagnosis under melanoma, this would be it. If you have to have cancer, it doesn't get much "better" than this stage.

        In all reality, your husband is probably NOT a Stage III…that is more than likely the Clark's Level III. (The dermatologists can sometimes be very confusing.)

        Make sure your husband sees an oncologist who SPECIALIZES in melanoma and not just a general oncologist to treat this disease. If you can find a melanoma specialist in a dermatologist, get them as well.

        Keep your chin up…I know it seems like the world may be ending, but I assure you, things can get better. Hugs to you; we're all here if you need us.

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        scaredsilly
        Participant

        Thank you again – I truly appreciate the time you took to post a response.  We had his follow up appointment yesterday, and the md practically gasped when I told him we were informed that it was stage 3.  Whew! 

        He will need to have an excision with 1cm margin in the next month, although just to be on the safe side, we're going to follow up at the Melanoma Center in DC for 2nd opinion.

        Thanks again!!

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        scaredsilly
        Participant

        Thank you again – I truly appreciate the time you took to post a response.  We had his follow up appointment yesterday, and the md practically gasped when I told him we were informed that it was stage 3.  Whew! 

        He will need to have an excision with 1cm margin in the next month, although just to be on the safe side, we're going to follow up at the Melanoma Center in DC for 2nd opinion.

        Thanks again!!

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        Ranisa
        Participant

        I am sure that others will reply to this….NO HE DOES NOT have stage III.  You can't tell that with a lymph node biopsy.  Has he had that? 

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        Ranisa
        Participant

        I am sure that others will reply to this….NO HE DOES NOT have stage III.  You can't tell that with a lymph node biopsy.  Has he had that? 

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        thebunches
        Participant

        Hi there! Based on the feedback we got from my husband's surgical oncologist, here's what your path report probably means:

        Thickness (also called the Breslow depth) of 0.75 mm = this is actually LESS than what my husband's thickness was; this is what the doctors typically use to discern the status of the cancer. 0.75 is somewhat thick, but in the grand scheme of things, still very manageable.

        Level of Invasion = this is actually NOT your husband's "stage" of cancer. This is the Clark's Level. (My husband's was Level IV, which I originally thought that was the Stage. These are two TOTALLY different things.)

        Ulceration = this just means if it is oozing or leaking any sort of liquid…blood, pus, drainage, etc.

        Mitotic Rate = My husband had the exact same rate: <1/mm2. This means that the melanoma is NOT spreading at a brisk pace; it is very slow-growing (a GOOD thing!!).

        Path Stage = T1a; this is just another way of the doc figuring out the status of the cancer. This is on the LOW side of the path stages. (Another GOOD thing)

        My husband had the WLE (wide lateral excision) and the SNB (sentinel node biopsy). When all was said and done, the total size of the melanoma was 1.2mm (not much deeper than your husband's 0.75mm), and they took two lymph nodes that showed that that's where the cancer COULD have spread if it was going to spread. (It didn't, and both lymph nodes showed NO SIGNS of cancer.)

        After all is said and done, now my husband has a great big scar (about 10 inches) along with a smaller one where they removed the two lymph nodes. HE IS AT STAGE ONE and we now go back for 3-month follow ups wtih his dermatologist for awhile. If there were a "good" diagnosis under melanoma, this would be it. If you have to have cancer, it doesn't get much "better" than this stage.

        In all reality, your husband is probably NOT a Stage III…that is more than likely the Clark's Level III. (The dermatologists can sometimes be very confusing.)

        Make sure your husband sees an oncologist who SPECIALIZES in melanoma and not just a general oncologist to treat this disease. If you can find a melanoma specialist in a dermatologist, get them as well.

        Keep your chin up…I know it seems like the world may be ending, but I assure you, things can get better. Hugs to you; we're all here if you need us.

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      scaredsilly
      Participant

      Thank you so much for posting this – and for all the wonderful responses.  (This entire thread calmed me down and helped me through the night).  We were also told that my husband, age 37, has stage 3 melanoma.  After reading your post and the replies, it made me wonder so I requested the path report. Can anyone please tell me what this means (in layman's terms):

      Skin Biopsy, Upper Back
      ·        Malignant melanoma
      ·        Thickness – 0.75mm
      ·        Level of invasion – Level III
      ·        Ulceration – not identified
      ·        Mitotic Rate – <1/mm2
      ·        Pathologic Stage – T1a
      ·        Note:  Immunoperoxidase stain for Pan melanoma was performed.  The lesion extends to the peripheral and deep margins.  This lesion should be completely removed.

      Thanks for the support (and the prayers helped too).  Sorry to be here, but glad that this site is availabe.

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