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So I had an itchy mole removed. Shave biopsy showed to be .7 deep, non ulcerated. Surgeon didn’t think we needed to do SLB since it was only .7. He was confident it was a one and done situation. Have WLE last Monday. Wednesday get path report back that shows that it is nodular, 2.2 m deep, and mitotic rate of 8. Pathology labeled it a 3a (which I also don’t understand because we don’t know if it is in lymph nodes yet)
Now surgeon wants to go back in to get more margin and do SLB. I’m reading that we should have done that first.
Considering going to MDA.
I’m just feeling overwhelmed and totally freaked. I don’t even know what questions I have or what to say.
I am sorry you are finding yourself in this situation.
3a refers to just the pathology of the excised tumor. 3 says what layer of skin the tumor reached (in your case it was quite deep) and a is that it was non-ulcerated. Your melanoma stage will be determined after SLNB and CT/MRI scan. It will be 2 or higher because of your tumor depth.
Mitotic rate of 8 is high. It is more common in nodular melanomas like yours.
It still doesn’t mean that your melanoma had spread but it is concerning. Please take it seriously. In this situation, yes, I would go to the best center available to you, and you need a second opinion ASAP. I would guess you still need to do SLNB (or maybe even a full dissection given that it wasn’t done at the same time as WLE? I think SLNB is more likely but it is a question for an experienced surgeon.).
Because of your mitotic rate I personally would take as aggressive treatment path as they offer. There is immunotherapy treatment available for stage three melanoma that is being trialed for stage 2 patients (pembrolizumab or nivolumab are the names of the drugs – they are essentially the same drug). If you are stage 2 ask your treating physician in depth about possibility of getting this through trial, or otherwise, especially given the fact that your SLNB was not done at the same time as your WLE so the result is less reliable if negative.
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