› Forums › General Melanoma Community › Another recently diagnosed
- This topic has 18 replies, 3 voices, and was last updated 12 years ago by
Joanie60.
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- March 14, 2014 at 9:17 pm
I have just found this site and I think i should probably be on the International Site because right now my diagnosis is T1b but I do have a concern someone may be able to help with.
I was first diagnosed with Melanoma in 2000. It was a simple Clarks Level II, Breslow 0.23mm. On Jan 31 of this year (2014) I had a shave biopsy done of a scar which was Breslow 0.62 but reached the margins so we dont know how deep it was. Mitotis was 3/sq mm. My surgical oncologist did a wide margin excision and checked 4 sentinel lymph nodes. Thankfully, the lymph nodes were negative.
The margins on the wide excision, however, were positive for in situ melanoma (Breslow 0.32, Clark level III, no mitotic figures identified).
He is going to do another wide margin excision. This seems very strange to me, that he removed a section (8.1cm x 4.2cm x 2.2cm) of my upper chest and still found melanoma at the 12:00 and 3:00 positions?
Has anyone been through this? Should I expect that one more wide excision will take care of this? The doctor led me to believe that sometimes they have to keep going in and re-excising, that twice might not be enough. But honesty, I was so relieved the lymph nodes were not involved and had not anticipated the margins would not be clear!!
Thanks for any thoughts you might have! And thanks from the bottom of my heart for being here.
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- March 14, 2014 at 9:33 pm
It's not unheard of but it doesn't happen often in the WLE. Was your melanoma Lentigo Maligna? It has a higher local recurrence rate and is harder to get clear margins on the WLE. For that type, it probably isn't uncommon to have to go back and take more. For the other types of melanoma, I'd say it isn't all that common. The doc takes their best educated guess on how much is needed to be removed but that's the reason they do pathology – to make sure!
(BTW, melanoma in situ has 0 depth so your Breslow 0.32/Clark III is not in situ).
Best wishes,
Janner
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- March 14, 2014 at 9:33 pm
It's not unheard of but it doesn't happen often in the WLE. Was your melanoma Lentigo Maligna? It has a higher local recurrence rate and is harder to get clear margins on the WLE. For that type, it probably isn't uncommon to have to go back and take more. For the other types of melanoma, I'd say it isn't all that common. The doc takes their best educated guess on how much is needed to be removed but that's the reason they do pathology – to make sure!
(BTW, melanoma in situ has 0 depth so your Breslow 0.32/Clark III is not in situ).
Best wishes,
Janner
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- March 14, 2014 at 9:33 pm
It's not unheard of but it doesn't happen often in the WLE. Was your melanoma Lentigo Maligna? It has a higher local recurrence rate and is harder to get clear margins on the WLE. For that type, it probably isn't uncommon to have to go back and take more. For the other types of melanoma, I'd say it isn't all that common. The doc takes their best educated guess on how much is needed to be removed but that's the reason they do pathology – to make sure!
(BTW, melanoma in situ has 0 depth so your Breslow 0.32/Clark III is not in situ).
Best wishes,
Janner
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- March 14, 2014 at 9:58 pm
Thanks Janner. I guess I need more help reading path reports! The initial shave biopsy was actually of a scar from a previously removed "atypical lentiginous and nested melanoctic hyperplasia". in 2012. The shave biopsy from 2014 was listed as invasive non-ulcerated, with an area of spindle cells, possibly representing desmoplastic area. As I mentioned, it was 0.62mm but tumor was present at margins.
The Wide Area Excision says "residual malignant melanoma", 0.32mm, clarks level III, so I have no idea where that measurment of 0.32 fits in. I thought it would be added to the original 0.62 but doc said no, we won't ever know what original depth was. Again, from the wide exicision path report: Predominant cystology: epithelioid, no spindled component identified, surgical margins: peripheral margin is positive for melanoma in situ (C5). Whatever C5 means. Another description is superficial spreading. I don't see the words: Lentigo Maligma anywhere…unless that is what the ORIGINAL 2012 "thing" was.
Thanks for wading thru this with me!
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- March 14, 2014 at 9:58 pm
Thanks Janner. I guess I need more help reading path reports! The initial shave biopsy was actually of a scar from a previously removed "atypical lentiginous and nested melanoctic hyperplasia". in 2012. The shave biopsy from 2014 was listed as invasive non-ulcerated, with an area of spindle cells, possibly representing desmoplastic area. As I mentioned, it was 0.62mm but tumor was present at margins.
The Wide Area Excision says "residual malignant melanoma", 0.32mm, clarks level III, so I have no idea where that measurment of 0.32 fits in. I thought it would be added to the original 0.62 but doc said no, we won't ever know what original depth was. Again, from the wide exicision path report: Predominant cystology: epithelioid, no spindled component identified, surgical margins: peripheral margin is positive for melanoma in situ (C5). Whatever C5 means. Another description is superficial spreading. I don't see the words: Lentigo Maligma anywhere…unless that is what the ORIGINAL 2012 "thing" was.
Thanks for wading thru this with me!
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- March 14, 2014 at 9:58 pm
Thanks Janner. I guess I need more help reading path reports! The initial shave biopsy was actually of a scar from a previously removed "atypical lentiginous and nested melanoctic hyperplasia". in 2012. The shave biopsy from 2014 was listed as invasive non-ulcerated, with an area of spindle cells, possibly representing desmoplastic area. As I mentioned, it was 0.62mm but tumor was present at margins.
The Wide Area Excision says "residual malignant melanoma", 0.32mm, clarks level III, so I have no idea where that measurment of 0.32 fits in. I thought it would be added to the original 0.62 but doc said no, we won't ever know what original depth was. Again, from the wide exicision path report: Predominant cystology: epithelioid, no spindled component identified, surgical margins: peripheral margin is positive for melanoma in situ (C5). Whatever C5 means. Another description is superficial spreading. I don't see the words: Lentigo Maligma anywhere…unless that is what the ORIGINAL 2012 "thing" was.
Thanks for wading thru this with me!
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- March 14, 2014 at 10:41 pm
One lesson of this is to still pay attention to the scars of previously removed atypical lesions. I think a lot of people have had a lot of biopsies after their melanoma diagnosis, many of which are atypical, and it's easy to forget about those scars, not pay attention to them anymore since they weren't melanoma.
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- March 14, 2014 at 10:41 pm
One lesson of this is to still pay attention to the scars of previously removed atypical lesions. I think a lot of people have had a lot of biopsies after their melanoma diagnosis, many of which are atypical, and it's easy to forget about those scars, not pay attention to them anymore since they weren't melanoma.
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- March 14, 2014 at 10:41 pm
One lesson of this is to still pay attention to the scars of previously removed atypical lesions. I think a lot of people have had a lot of biopsies after their melanoma diagnosis, many of which are atypical, and it's easy to forget about those scars, not pay attention to them anymore since they weren't melanoma.
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- March 15, 2014 at 12:31 am
I had no idea that a "scar" could be melanoma! It was raised and a little bit red, but that can happen from any number of things (scratch, jewelry irritation, etc). In fact, I think that is how "desmoplastic melanoma" presents! So yes, I will be keeping a closer eye on my dozens of scars.
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- March 15, 2014 at 12:31 am
I had no idea that a "scar" could be melanoma! It was raised and a little bit red, but that can happen from any number of things (scratch, jewelry irritation, etc). In fact, I think that is how "desmoplastic melanoma" presents! So yes, I will be keeping a closer eye on my dozens of scars.
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- March 15, 2014 at 12:31 am
I had no idea that a "scar" could be melanoma! It was raised and a little bit red, but that can happen from any number of things (scratch, jewelry irritation, etc). In fact, I think that is how "desmoplastic melanoma" presents! So yes, I will be keeping a closer eye on my dozens of scars.
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- March 14, 2014 at 11:00 pm
Ok. This about this. If you take off the top 2/3rds of the lesion, more tumor remains. You can measure what you removed, and you can measure what's left at the bottom. But when you do a pathology, you slice up the original tumor into a bunch of thin slices. Then you get the new section of skin that you cut up into little slices. How do you know which slice from the top section goes with which slice from the bottom section? You can't. So you get to say your lesion was "at least 0.62mm" deep. The 0.32mm is telling in that it isn't a huge amount left, but it could easily have been on a section NOT at the deepest point. Think about taking a scoop of ice cream from a carton – the deepest point of the scoop may be at the center but it is shallower on the sides. The side area may actually be where the residual melanoma is located. As for the melanoma in situ on the margins, lesions typically start at melanoma in situ (epidermis only) and then become invasive and grow downward. So the edges of the lesion are the earliest form of melanoma and it is common to have melanoma in situ on the edges of a lesion. However, since that wasn't removed, this means that you do need more tissue removed.
In the future, I suggest you tell your doc that you don't want any shave biopsies. Shave biopsies are notorious for not getting enough depth. A punch or excisional biopsy get a full skin thickness biopsy and you know exactly what you are dealing with.
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- March 14, 2014 at 11:00 pm
Ok. This about this. If you take off the top 2/3rds of the lesion, more tumor remains. You can measure what you removed, and you can measure what's left at the bottom. But when you do a pathology, you slice up the original tumor into a bunch of thin slices. Then you get the new section of skin that you cut up into little slices. How do you know which slice from the top section goes with which slice from the bottom section? You can't. So you get to say your lesion was "at least 0.62mm" deep. The 0.32mm is telling in that it isn't a huge amount left, but it could easily have been on a section NOT at the deepest point. Think about taking a scoop of ice cream from a carton – the deepest point of the scoop may be at the center but it is shallower on the sides. The side area may actually be where the residual melanoma is located. As for the melanoma in situ on the margins, lesions typically start at melanoma in situ (epidermis only) and then become invasive and grow downward. So the edges of the lesion are the earliest form of melanoma and it is common to have melanoma in situ on the edges of a lesion. However, since that wasn't removed, this means that you do need more tissue removed.
In the future, I suggest you tell your doc that you don't want any shave biopsies. Shave biopsies are notorious for not getting enough depth. A punch or excisional biopsy get a full skin thickness biopsy and you know exactly what you are dealing with.
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- March 14, 2014 at 11:00 pm
Ok. This about this. If you take off the top 2/3rds of the lesion, more tumor remains. You can measure what you removed, and you can measure what's left at the bottom. But when you do a pathology, you slice up the original tumor into a bunch of thin slices. Then you get the new section of skin that you cut up into little slices. How do you know which slice from the top section goes with which slice from the bottom section? You can't. So you get to say your lesion was "at least 0.62mm" deep. The 0.32mm is telling in that it isn't a huge amount left, but it could easily have been on a section NOT at the deepest point. Think about taking a scoop of ice cream from a carton – the deepest point of the scoop may be at the center but it is shallower on the sides. The side area may actually be where the residual melanoma is located. As for the melanoma in situ on the margins, lesions typically start at melanoma in situ (epidermis only) and then become invasive and grow downward. So the edges of the lesion are the earliest form of melanoma and it is common to have melanoma in situ on the edges of a lesion. However, since that wasn't removed, this means that you do need more tissue removed.
In the future, I suggest you tell your doc that you don't want any shave biopsies. Shave biopsies are notorious for not getting enough depth. A punch or excisional biopsy get a full skin thickness biopsy and you know exactly what you are dealing with.
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- March 15, 2014 at 12:30 am
Now that makes sense! Thank you for taking all my ramblings, translating them into English, and serving them up so I can understand.
My new oncologist said no more shave biopsies, they must be at least punch biopsies inthe future. My dermo has cut and shaved so many moles from me 🙂 I am sure I have avoided plenty of other potential sites.
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- March 15, 2014 at 12:30 am
Now that makes sense! Thank you for taking all my ramblings, translating them into English, and serving them up so I can understand.
My new oncologist said no more shave biopsies, they must be at least punch biopsies inthe future. My dermo has cut and shaved so many moles from me 🙂 I am sure I have avoided plenty of other potential sites.
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- March 15, 2014 at 12:30 am
Now that makes sense! Thank you for taking all my ramblings, translating them into English, and serving them up so I can understand.
My new oncologist said no more shave biopsies, they must be at least punch biopsies inthe future. My dermo has cut and shaved so many moles from me 🙂 I am sure I have avoided plenty of other potential sites.
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