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Any guidance, info, feedback appreciated!!
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Any guidance, info, feedback appreciated!!

› Forums › Cutaneous Melanoma Community › Any guidance, info, feedback appreciated!!

  • Post
    • March 8, 2013 at 3:41 pm
    kkhalsten
    Participant

      Hi, in 2009 I was diagnosed with a thin melanoma on the back of my left leg upper thigh- I had a wide local excision and sential node removal with pathology stating sn was benign…great! Then on 1/1/13- I found a lump on my left groin which grew within 1 week from a marble to small apple….went to the cancer center- had a PET scan – no other "areas" lit up except for the groin- then had surgery lymphadenectomy 3 weeks later and the pathology reads as this:

      Hi, in 2009 I was diagnosed with a thin melanoma on the back of my left leg upper thigh- I had a wide local excision and sential node removal with pathology stating sn was benign…great! Then on 1/1/13- I found a lump on my left groin which grew within 1 week from a marble to small apple….went to the cancer center- had a PET scan – no other "areas" lit up except for the groin- then had surgery lymphadenectomy 3 weeks later and the pathology reads as this:

       B *skin and subcutaneous tissue, left superficial inguinal; dissection: postivie for metastatic melanoma in subcutaneous tissue- see comment:

      there is a 4.5 cm composed of metastatic melanoma surrounded by lymphocytes and fibrotic tissue within this lymph node dissection. It is unclear if this nodule represents a lymph node completely replaced by melanoma or a subcutaneous metastasis…..

       

      B. seventeen lymph nodes negative for melanoma (0/17)  and benign skin with scar of operation…GOOD NEWS!

       

      So, my question is: I understand the actual melanoma node was unclear and the 17 extra nodes they dissected were benign- so  now I'm stage 3 NED- but the oncologist stated to me that there is possible metastasis due to the unclear pathology of the 3.4cm node….

       

      does this make any sense? I'm so confused!

      indecision

    Viewing 8 reply threads
    • Replies
        • March 8, 2013 at 5:18 pm
        Janner
        Participant

          I'm not sure I understand.  1. If this were a lymph node totally replaced by melanoma, you'd be stage III.  2. If this were a subcutaneous metastases, it is still located in the nearest lymph basin which makes it local, not "distant".  That would also be stage III.   So either way you read it, I still see it as stage III.   Whether it was "in transit" or "extracapsular extension" really doesn't matter that I see.  I'd have to review the staging but it is possible one would be Stage IIIC versus Stage IIIB.  Either way, they are basically treated the same.  The only other thing I could recommend would be sending out the pathology for a second opinion to see if someone else can make a determination.  That wouldn't change anything as far as treatment, though, as both are treated the same.

          I'd suggest you just ask your doctor what he meant.  That is what they are there for! 

          Best wishes,

          Janner

          • March 8, 2013 at 5:18 pm
          Janner
          Participant

            I'm not sure I understand.  1. If this were a lymph node totally replaced by melanoma, you'd be stage III.  2. If this were a subcutaneous metastases, it is still located in the nearest lymph basin which makes it local, not "distant".  That would also be stage III.   So either way you read it, I still see it as stage III.   Whether it was "in transit" or "extracapsular extension" really doesn't matter that I see.  I'd have to review the staging but it is possible one would be Stage IIIC versus Stage IIIB.  Either way, they are basically treated the same.  The only other thing I could recommend would be sending out the pathology for a second opinion to see if someone else can make a determination.  That wouldn't change anything as far as treatment, though, as both are treated the same.

            I'd suggest you just ask your doctor what he meant.  That is what they are there for! 

            Best wishes,

            Janner

              • March 8, 2013 at 5:23 pm
              kkhalsten
              Participant

                Hi Janner,

                I agree- it is stage III, but my question is what does it mean if the tumor is a subcutaneous metastasis? Not sure if I understand if the melanoma is swimming around other places….

                • March 8, 2013 at 7:16 pm
                Janner
                Participant

                  Either way,your  melanoma is considered metastatic.   It most likely traveled via the lymph system in both scenarios – either to the lymph node which was engulfed, or to a lymph vessel nearby where a tumor started (or some other method of which I have no clue).  If it traveled via the blood supply, it's unlikely you'd have a tumor in that area.  That scenario would mean you'd most likely have found melanoma in an organ.  At stage III, it is metastatic and really doesn't matter where the tumor began.  For the moment, it is localized to the nearest lymph basin and that is what makes you stage III instead of stage IV.  No matter the means of spread, It is possible for cells to go elsewhere if they weren't all removed via surgery.  Again, you would need to clarify with your doctor to see why he made the distinction as from a staging point of view, I don't see much difference.  People have "in transit' mets all the time where a subcutaneous tumor develops between the primary and the nearest lymph basin.  The lymph nodes in that basin might be negative but there is melanoma traveling in the lymph vessels that creates the subcutaneous tumor.

                  Please clarify your questions with your doctor!

                  Best wishes,

                  Janner

                  • March 8, 2013 at 7:16 pm
                  Janner
                  Participant

                    Either way,your  melanoma is considered metastatic.   It most likely traveled via the lymph system in both scenarios – either to the lymph node which was engulfed, or to a lymph vessel nearby where a tumor started (or some other method of which I have no clue).  If it traveled via the blood supply, it's unlikely you'd have a tumor in that area.  That scenario would mean you'd most likely have found melanoma in an organ.  At stage III, it is metastatic and really doesn't matter where the tumor began.  For the moment, it is localized to the nearest lymph basin and that is what makes you stage III instead of stage IV.  No matter the means of spread, It is possible for cells to go elsewhere if they weren't all removed via surgery.  Again, you would need to clarify with your doctor to see why he made the distinction as from a staging point of view, I don't see much difference.  People have "in transit' mets all the time where a subcutaneous tumor develops between the primary and the nearest lymph basin.  The lymph nodes in that basin might be negative but there is melanoma traveling in the lymph vessels that creates the subcutaneous tumor.

                    Please clarify your questions with your doctor!

                    Best wishes,

                    Janner

                    • March 8, 2013 at 7:16 pm
                    Janner
                    Participant

                      Either way,your  melanoma is considered metastatic.   It most likely traveled via the lymph system in both scenarios – either to the lymph node which was engulfed, or to a lymph vessel nearby where a tumor started (or some other method of which I have no clue).  If it traveled via the blood supply, it's unlikely you'd have a tumor in that area.  That scenario would mean you'd most likely have found melanoma in an organ.  At stage III, it is metastatic and really doesn't matter where the tumor began.  For the moment, it is localized to the nearest lymph basin and that is what makes you stage III instead of stage IV.  No matter the means of spread, It is possible for cells to go elsewhere if they weren't all removed via surgery.  Again, you would need to clarify with your doctor to see why he made the distinction as from a staging point of view, I don't see much difference.  People have "in transit' mets all the time where a subcutaneous tumor develops between the primary and the nearest lymph basin.  The lymph nodes in that basin might be negative but there is melanoma traveling in the lymph vessels that creates the subcutaneous tumor.

                      Please clarify your questions with your doctor!

                      Best wishes,

                      Janner

                      • March 8, 2013 at 7:23 pm
                      kkhalsten
                      Participant

                        Thank you Janner- this is good info. RIght now, the cancer center I'm at does not have any stage III protocols- and told me just to wait and see what happens….I understand that stage III is a rollercoaster ride and I have to take it one day at a time. thank you.

                        • March 8, 2013 at 7:23 pm
                        kkhalsten
                        Participant

                          Thank you Janner- this is good info. RIght now, the cancer center I'm at does not have any stage III protocols- and told me just to wait and see what happens….I understand that stage III is a rollercoaster ride and I have to take it one day at a time. thank you.

                          • March 9, 2013 at 12:37 am
                          dian in spokane
                          Participant

                            well.. there ARE things for stage III out there. Interferon, while lots of places pooh pooh it these days, is still the standard therapy for stage III, and there are trials out there too, although with no measureable disease, those trials are limited.

                            But there are some out there. If you are not confident searching for clinical trials (clinicaltrials.gov) you can call the American Cancer Society, they will call you back and interview you about your details and do a search FOR you.

                            Also.. check to see if your cancer  clinic has a research assistant who could help you, or a patient advocate.

                            And.. there are alternative things you can look into, Vitamins and supplements that work to boost the immune system and an assortment of other non traditional things.

                            I agree with Janner btw. I"m not sure how any of your docs could think you are stage IV.

                            dian

                            • March 9, 2013 at 12:37 am
                            dian in spokane
                            Participant

                              well.. there ARE things for stage III out there. Interferon, while lots of places pooh pooh it these days, is still the standard therapy for stage III, and there are trials out there too, although with no measureable disease, those trials are limited.

                              But there are some out there. If you are not confident searching for clinical trials (clinicaltrials.gov) you can call the American Cancer Society, they will call you back and interview you about your details and do a search FOR you.

                              Also.. check to see if your cancer  clinic has a research assistant who could help you, or a patient advocate.

                              And.. there are alternative things you can look into, Vitamins and supplements that work to boost the immune system and an assortment of other non traditional things.

                              I agree with Janner btw. I"m not sure how any of your docs could think you are stage IV.

                              dian

                              • March 11, 2013 at 3:51 pm
                              kkhalsten
                              Participant

                                Thank you dian in spokane for your reply- i agree that i'm not in stage IV…my original question was regarding the pathology report and wanted to know if anyone else out there had a similar situation- where the 4.5cm lump was taken out and the pathology couldn't confirm if it was a complete replacement of the node with melanoma or a tissue metatcized (excuse the spelling)…either way I'm stage III and sitting on the fence with what will happen next….

                                • March 11, 2013 at 3:51 pm
                                kkhalsten
                                Participant

                                  Thank you dian in spokane for your reply- i agree that i'm not in stage IV…my original question was regarding the pathology report and wanted to know if anyone else out there had a similar situation- where the 4.5cm lump was taken out and the pathology couldn't confirm if it was a complete replacement of the node with melanoma or a tissue metatcized (excuse the spelling)…either way I'm stage III and sitting on the fence with what will happen next….

                                  • March 11, 2013 at 3:51 pm
                                  kkhalsten
                                  Participant

                                    Thank you dian in spokane for your reply- i agree that i'm not in stage IV…my original question was regarding the pathology report and wanted to know if anyone else out there had a similar situation- where the 4.5cm lump was taken out and the pathology couldn't confirm if it was a complete replacement of the node with melanoma or a tissue metatcized (excuse the spelling)…either way I'm stage III and sitting on the fence with what will happen next….

                                    • March 9, 2013 at 12:37 am
                                    dian in spokane
                                    Participant

                                      well.. there ARE things for stage III out there. Interferon, while lots of places pooh pooh it these days, is still the standard therapy for stage III, and there are trials out there too, although with no measureable disease, those trials are limited.

                                      But there are some out there. If you are not confident searching for clinical trials (clinicaltrials.gov) you can call the American Cancer Society, they will call you back and interview you about your details and do a search FOR you.

                                      Also.. check to see if your cancer  clinic has a research assistant who could help you, or a patient advocate.

                                      And.. there are alternative things you can look into, Vitamins and supplements that work to boost the immune system and an assortment of other non traditional things.

                                      I agree with Janner btw. I"m not sure how any of your docs could think you are stage IV.

                                      dian

                                      • March 8, 2013 at 7:23 pm
                                      kkhalsten
                                      Participant

                                        Thank you Janner- this is good info. RIght now, the cancer center I'm at does not have any stage III protocols- and told me just to wait and see what happens….I understand that stage III is a rollercoaster ride and I have to take it one day at a time. thank you.

                                        • March 8, 2013 at 11:57 pm
                                        JC
                                        Participant

                                          does regression make it more likely to have traveled?

                                          • March 8, 2013 at 11:57 pm
                                          JC
                                          Participant

                                            does regression make it more likely to have traveled?

                                            • March 9, 2013 at 12:47 am
                                            Janner
                                            Participant

                                              That's too open ended a question to answer.  If you want to post a pathology report and more detail, maybe we could speculate.  But without details, I don't feel comfortable answering.

                                              • March 9, 2013 at 12:47 am
                                              Janner
                                              Participant

                                                That's too open ended a question to answer.  If you want to post a pathology report and more detail, maybe we could speculate.  But without details, I don't feel comfortable answering.

                                                • March 9, 2013 at 12:47 am
                                                Janner
                                                Participant

                                                  That's too open ended a question to answer.  If you want to post a pathology report and more detail, maybe we could speculate.  But without details, I don't feel comfortable answering.

                                                  • March 8, 2013 at 11:57 pm
                                                  JC
                                                  Participant

                                                    does regression make it more likely to have traveled?

                                                    • March 8, 2013 at 5:23 pm
                                                    kkhalsten
                                                    Participant

                                                      Hi Janner,

                                                      I agree- it is stage III, but my question is what does it mean if the tumor is a subcutaneous metastasis? Not sure if I understand if the melanoma is swimming around other places….

                                                      • March 8, 2013 at 5:23 pm
                                                      kkhalsten
                                                      Participant

                                                        Hi Janner,

                                                        I agree- it is stage III, but my question is what does it mean if the tumor is a subcutaneous metastasis? Not sure if I understand if the melanoma is swimming around other places….

                                                      • March 8, 2013 at 5:18 pm
                                                      Janner
                                                      Participant

                                                        I'm not sure I understand.  1. If this were a lymph node totally replaced by melanoma, you'd be stage III.  2. If this were a subcutaneous metastases, it is still located in the nearest lymph basin which makes it local, not "distant".  That would also be stage III.   So either way you read it, I still see it as stage III.   Whether it was "in transit" or "extracapsular extension" really doesn't matter that I see.  I'd have to review the staging but it is possible one would be Stage IIIC versus Stage IIIB.  Either way, they are basically treated the same.  The only other thing I could recommend would be sending out the pathology for a second opinion to see if someone else can make a determination.  That wouldn't change anything as far as treatment, though, as both are treated the same.

                                                        I'd suggest you just ask your doctor what he meant.  That is what they are there for! 

                                                        Best wishes,

                                                        Janner

                                                        • March 8, 2013 at 5:34 pm
                                                        JC
                                                        Participant

                                                          You say "thin melanoma in 2009" but your profile says Depth of Primary: Over 4.00 mm.  Female, extremity, negative nodes. . would see low risk, but Breslow of over 4 mm is not categorized as "thin" I don't believe.  Sorry you're dealing with this now again from 2009. Best to you.

                                                           
                                                          • March 8, 2013 at 5:34 pm
                                                          JC
                                                          Participant

                                                            You say "thin melanoma in 2009" but your profile says Depth of Primary: Over 4.00 mm.  Female, extremity, negative nodes. . would see low risk, but Breslow of over 4 mm is not categorized as "thin" I don't believe.  Sorry you're dealing with this now again from 2009. Best to you.

                                                             
                                                            • March 8, 2013 at 5:34 pm
                                                            JC
                                                            Participant

                                                              You say "thin melanoma in 2009" but your profile says Depth of Primary: Over 4.00 mm.  Female, extremity, negative nodes. . would see low risk, but Breslow of over 4 mm is not categorized as "thin" I don't believe.  Sorry you're dealing with this now again from 2009. Best to you.

                                                               
                                                                • March 8, 2013 at 5:41 pm
                                                                kkhalsten
                                                                Participant

                                                                  Yikes! my mistake that the profile was over 4.0- meant to say under 4.0…..and there was no negative nodes in 2009- I will edit the profile. thanks!

                                                                  • March 8, 2013 at 5:41 pm
                                                                  kkhalsten
                                                                  Participant

                                                                    Yikes! my mistake that the profile was over 4.0- meant to say under 4.0…..and there was no negative nodes in 2009- I will edit the profile. thanks!

                                                                    • March 8, 2013 at 5:41 pm
                                                                    kkhalsten
                                                                    Participant

                                                                      Yikes! my mistake that the profile was over 4.0- meant to say under 4.0…..and there was no negative nodes in 2009- I will edit the profile. thanks!

                                                                    • March 8, 2013 at 6:14 pm
                                                                    JC
                                                                    Participant

                                                                      negative nodes came from your post, " had a wide local excision and sential node removal with pathology stating sn was benign"

                                                                      • March 8, 2013 at 6:14 pm
                                                                      JC
                                                                      Participant

                                                                        negative nodes came from your post, " had a wide local excision and sential node removal with pathology stating sn was benign"

                                                                          • March 8, 2013 at 6:21 pm
                                                                          kkhalsten
                                                                          Participant

                                                                            You are correct- I meant to state, "there were no POSITIVE nodes in 2009. thanks so much!

                                                                            • March 8, 2013 at 6:21 pm
                                                                            kkhalsten
                                                                            Participant

                                                                              You are correct- I meant to state, "there were no POSITIVE nodes in 2009. thanks so much!

                                                                              • March 8, 2013 at 6:21 pm
                                                                              kkhalsten
                                                                              Participant

                                                                                You are correct- I meant to state, "there were no POSITIVE nodes in 2009. thanks so much!

                                                                              • March 8, 2013 at 6:14 pm
                                                                              JC
                                                                              Participant

                                                                                negative nodes came from your post, " had a wide local excision and sential node removal with pathology stating sn was benign"

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