› Forums › General Melanoma Community › Another newbie question: Mitotic rates
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Melanoma Mom.
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- November 20, 2010 at 8:40 pm
I have read the definition of mitotic rates and that a "high mitotic rate" indicates rapidly dividing cells and thus, higher chance of metastasis. But what is high and what is low?? I can't find any examples.
Our path report says: mitotic rare of 2-3/mm2
I have read the definition of mitotic rates and that a "high mitotic rate" indicates rapidly dividing cells and thus, higher chance of metastasis. But what is high and what is low?? I can't find any examples.
Our path report says: mitotic rare of 2-3/mm2
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- November 20, 2010 at 10:08 pm
Hi again,
As most things, it is a bit subjective. In staging for most melanomas I believe it is usually broken down as <1 and >1, with anything >1 per mm2 being considered "high" and on par with ulceration as increasing risk of recurrence, etc. However, one research paper I read had them broken down to <1, 1-4, 5-8, and >8, and they seemed to equate everything under 4. I wish I could be of more help, but perhaps it sheds some light on the idea that none of this is an exact science.
Take care,
ChristineL
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- November 20, 2010 at 10:08 pm
Hi again,
As most things, it is a bit subjective. In staging for most melanomas I believe it is usually broken down as <1 and >1, with anything >1 per mm2 being considered "high" and on par with ulceration as increasing risk of recurrence, etc. However, one research paper I read had them broken down to <1, 1-4, 5-8, and >8, and they seemed to equate everything under 4. I wish I could be of more help, but perhaps it sheds some light on the idea that none of this is an exact science.
Take care,
ChristineL
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- November 20, 2010 at 11:44 pm
Résumé / Abstract
Hi Mary,
Wow, Egypt. That is on my list of places to see. I love to travel.
Good luck with the PET/CT tomorrow. I hope and pray for you that it will be negative.
They haven’t told me yet what I will be facing if my SNB turns up positive. My doctor just said we would have that discussion if and when needed. I assume it would be as you have experienced…removal of the remaining nodes and periodic evaluations. Are the PET/CTs of the original tumor site or somewhere else?
I found a 2003 medical journal out of Australia that studied the use of the Mitotic Index as an “independent prognostic factor in patients with localized cutaneous melanoma on 3661 patients.” (ISSN 0008-543X)
I found a 2003 medical journal article on this subject.Their findings were:
1) Tumor thickness, ulceration, and TMR (tumor mitotic rate) were closely correlated
2) Patients were grouped into 4 groups according to TMR (0, 1-4, 5-10, and ≥ 11 mitoses/mm2)
3) TMR was a highly significant independent prognostic factor, second only to tumor thickness as the most powerful predictor of survival
I didn’t have access to the whole article, but I was able t
o get this from the abstract.
I hope this helps!Goodluck,
Mark from California -
- November 20, 2010 at 11:44 pm
Résumé / Abstract
Hi Mary,
Wow, Egypt. That is on my list of places to see. I love to travel.
Good luck with the PET/CT tomorrow. I hope and pray for you that it will be negative.
They haven’t told me yet what I will be facing if my SNB turns up positive. My doctor just said we would have that discussion if and when needed. I assume it would be as you have experienced…removal of the remaining nodes and periodic evaluations. Are the PET/CTs of the original tumor site or somewhere else?
I found a 2003 medical journal out of Australia that studied the use of the Mitotic Index as an “independent prognostic factor in patients with localized cutaneous melanoma on 3661 patients.” (ISSN 0008-543X)
I found a 2003 medical journal article on this subject.Their findings were:
1) Tumor thickness, ulceration, and TMR (tumor mitotic rate) were closely correlated
2) Patients were grouped into 4 groups according to TMR (0, 1-4, 5-10, and ≥ 11 mitoses/mm2)
3) TMR was a highly significant independent prognostic factor, second only to tumor thickness as the most powerful predictor of survival
I didn’t have access to the whole article, but I was able t
o get this from the abstract.
I hope this helps!Goodluck,
Mark from California -
- November 21, 2010 at 3:11 am
My husband's mitotic rate was 6/mm2 and his pathology report called it "significant." We were concerned about the mitotic rate and voiced that concern to his oncologist at the beginning. His response was, "Yes, it is somewhat concerning, but I would be more concerned if it were 30 or 40." Don't know if he was being glib or trying to make us feel better. Joe's mel was 2.22mm, nodular, and on his ear. Negative SNB and so Stage IIA. He is now 3 years and 10 months NED (no evidence of disease) with no further treatment other than WLE/SNB. There is just no way to predict who will have a recurrence and who will not. We are always aware that a recurrence is possible and are prepared if that should happen, but we are also now able to live life with the realization that it is very possible that we may never have to deal with melanoma again. I hope you will get to that place as well.
Best wishes,
Niki (Wife of Joe, Stage IIA)
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- November 21, 2010 at 1:34 pm
Because my son's growth was SO deep – 14mm – I assumed that his mitotic rate would be off the charts. I am just hoping that a 2/mm2 mitotic rate meant that the cells were dividing and growing slowly (even though it got so big …. but our son didn't tell us about it and it was located near his anus so we didn't figure it out until he got very uncomfortable sitting and we asked him). I'm still working on learning my Melanoma facts …. eventually, I will be an expert!
So glad to hear that Joe is doing so well. 😀
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- November 21, 2010 at 1:38 pm
Also, I know ulceration is a big factor with staging ….. that confuses me a bit as well. When this is noted, is it on the surface level or within the tumor? Our path notes ulceration, but makes it clear that it was on the surface where a punch biopsy was done about a month before and nowhere else.
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- November 21, 2010 at 2:07 pm
The Melanoma Research Foundation defines Ulceration as the “sloughing of dead tissue. This can sometimes occur in the center of a melanoma lesion. The presence of ulceration may alter the stage classification of a melanoma. Ulceration is thought to reflect rapid tumor growth, leading to the death of cells in the center of the melanoma.”I think this is often associated with breaking thru the epidermis, but either way, it is noted in the biopsy based on their observations.
Best regards,
Mark from California -
- November 21, 2010 at 2:07 pm
The Melanoma Research Foundation defines Ulceration as the “sloughing of dead tissue. This can sometimes occur in the center of a melanoma lesion. The presence of ulceration may alter the stage classification of a melanoma. Ulceration is thought to reflect rapid tumor growth, leading to the death of cells in the center of the melanoma.”I think this is often associated with breaking thru the epidermis, but either way, it is noted in the biopsy based on their observations.
Best regards,
Mark from California -
- November 21, 2010 at 5:56 pm
Melanoma Mom — It sounds like your mitotic rate is as low as could be expected, so you'd have to say that's good news. As for ulceration, it's either present or absent, so you do have ulceration, which is a negative factor. That would be expected with a thick melanoma. The staging system breaks all this down pretty well, so his stage should tell you where he stands and you can go from there. The fact the the snb was negative was very good news! Good luck!
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- November 21, 2010 at 10:58 pm
They didn't officially stage him, even though I asked twice, because they said some of his pathology seems to contradict itself. Of course the size of the growth and the lack of nodal involvement would make him a IIB or IIC in my humble opinion.
I guess I am just confused when they say the ulceration was directly caused by the punch biopsy that was done about three weeks before surgery. They weren't in any way expecting melanoma so that is why they did the punch biopsy in the Dermatologist's office. He thought it was some sort of virus since it presented pink and similar to a wart.
So I am thinking positively and thinking that they are saying the ulceration was caused by damage to the outer layer of the surface and would not have been there if they hadn't irritated it with the biopsy. Wishful thinking and maybe not even worth focusing on. But I'll take any positive news I can gleam from the report! 🙂
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- November 21, 2010 at 10:58 pm
They didn't officially stage him, even though I asked twice, because they said some of his pathology seems to contradict itself. Of course the size of the growth and the lack of nodal involvement would make him a IIB or IIC in my humble opinion.
I guess I am just confused when they say the ulceration was directly caused by the punch biopsy that was done about three weeks before surgery. They weren't in any way expecting melanoma so that is why they did the punch biopsy in the Dermatologist's office. He thought it was some sort of virus since it presented pink and similar to a wart.
So I am thinking positively and thinking that they are saying the ulceration was caused by damage to the outer layer of the surface and would not have been there if they hadn't irritated it with the biopsy. Wishful thinking and maybe not even worth focusing on. But I'll take any positive news I can gleam from the report! 🙂
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- November 21, 2010 at 5:56 pm
Melanoma Mom — It sounds like your mitotic rate is as low as could be expected, so you'd have to say that's good news. As for ulceration, it's either present or absent, so you do have ulceration, which is a negative factor. That would be expected with a thick melanoma. The staging system breaks all this down pretty well, so his stage should tell you where he stands and you can go from there. The fact the the snb was negative was very good news! Good luck!
-
- November 21, 2010 at 1:38 pm
Also, I know ulceration is a big factor with staging ….. that confuses me a bit as well. When this is noted, is it on the surface level or within the tumor? Our path notes ulceration, but makes it clear that it was on the surface where a punch biopsy was done about a month before and nowhere else.
-
- November 21, 2010 at 1:34 pm
Because my son's growth was SO deep – 14mm – I assumed that his mitotic rate would be off the charts. I am just hoping that a 2/mm2 mitotic rate meant that the cells were dividing and growing slowly (even though it got so big …. but our son didn't tell us about it and it was located near his anus so we didn't figure it out until he got very uncomfortable sitting and we asked him). I'm still working on learning my Melanoma facts …. eventually, I will be an expert!
So glad to hear that Joe is doing so well. 😀
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- November 21, 2010 at 3:11 am
My husband's mitotic rate was 6/mm2 and his pathology report called it "significant." We were concerned about the mitotic rate and voiced that concern to his oncologist at the beginning. His response was, "Yes, it is somewhat concerning, but I would be more concerned if it were 30 or 40." Don't know if he was being glib or trying to make us feel better. Joe's mel was 2.22mm, nodular, and on his ear. Negative SNB and so Stage IIA. He is now 3 years and 10 months NED (no evidence of disease) with no further treatment other than WLE/SNB. There is just no way to predict who will have a recurrence and who will not. We are always aware that a recurrence is possible and are prepared if that should happen, but we are also now able to live life with the realization that it is very possible that we may never have to deal with melanoma again. I hope you will get to that place as well.
Best wishes,
Niki (Wife of Joe, Stage IIA)
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