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Can Staging be done from initial biopsy???

Forums General Melanoma Community Can Staging be done from initial biopsy???

  • Post
    davekarrie
    Participant

      My name is Dave, I am very healthy at 36, and I was diagnosed with melanoma yesterday after having what I thought was an innocent large mole removed.  The dr. said it was stage 4, but after reading I am hoping he meant thickness 4.  He said there were 5 stages, but he wasn't too confident.  I am going to meet with a surgeon Thursday and sounds like they want to take a larger area around the mole and test lymph nodes.

      My name is Dave, I am very healthy at 36, and I was diagnosed with melanoma yesterday after having what I thought was an innocent large mole removed.  The dr. said it was stage 4, but after reading I am hoping he meant thickness 4.  He said there were 5 stages, but he wasn't too confident.  I am going to meet with a surgeon Thursday and sounds like they want to take a larger area around the mole and test lymph nodes. Very scary for sure, and my world is now upside down.  any info would help.  I will call and get my biopsy report so I can look at thickness etc.

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    • Replies
        W.
        Participant

          He probably meant Clark's Level. There are 5 different Clark's Levels.

           

          Staging cannot be done from initial biopsy (except for very thin stage 0 or stage 1 melanomas).

          To diagnose stage 4, a doctor must find remote metastases which is usually done with PET/CT scans plus biopsy.

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            davekarrie
            Participant

              Thank you very much for response, it puts me a bit more at ease. thanks again

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              ChristineL
              Participant

                And as is commonly mentioned, find someone (Dr.) who is familiar with melanoma.  I hate that doctors confuse Stages with Clark's.  In my mind, it causes MUCH undue stress to the patient.  I'm glad you were able to get an answer from this board to ease your mind.  Now go kick some melanoma butt!

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                ChristineL
                Participant

                  And as is commonly mentioned, find someone (Dr.) who is familiar with melanoma.  I hate that doctors confuse Stages with Clark's.  In my mind, it causes MUCH undue stress to the patient.  I'm glad you were able to get an answer from this board to ease your mind.  Now go kick some melanoma butt!

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                  davekarrie
                  Participant

                    Thank you very much for response, it puts me a bit more at ease. thanks again

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                  W.
                  Participant

                    He probably meant Clark's Level. There are 5 different Clark's Levels.

                     

                    Staging cannot be done from initial biopsy (except for very thin stage 0 or stage 1 melanomas).

                    To diagnose stage 4, a doctor must find remote metastases which is usually done with PET/CT scans plus biopsy.

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                    Dynasysman
                    Participant

                      Dave —

                      I couldn't agree with Christine more…it's critical to get yourself to a melanoma specialist.  Misinformation saps the will, and in this kind of battle, will is everything.

                      Now to agree with Christine again, get the right expert to help drive your treatment, and go kick some melanoma butt.

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                      Dynasysman
                      Participant

                        Dave —

                        I couldn't agree with Christine more…it's critical to get yourself to a melanoma specialist.  Misinformation saps the will, and in this kind of battle, will is everything.

                        Now to agree with Christine again, get the right expert to help drive your treatment, and go kick some melanoma butt.

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                        Fen
                        Participant

                           

                          Dave – if you will post your general location people might be able to make suggestions about who to see in that area. You want to find a melanoma onc who will spend time with you and be able to discuss current treatments.  Reading about others' experiences can make that process more efficient.

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                            davekarrie
                            Participant

                              Thanks to everyone for the great support!  I live in Grand Forks, ND, so anyone knows of a good specialist let me know.  I am going to see a general surgeon on Thursday for a consulation, and will ask him of any specialists as well.  We have a cancer center here in Grand Forks, so will also look into that.  Thanks again!

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                              davekarrie
                              Participant

                                Thanks to everyone for the great support!  I live in Grand Forks, ND, so anyone knows of a good specialist let me know.  I am going to see a general surgeon on Thursday for a consulation, and will ask him of any specialists as well.  We have a cancer center here in Grand Forks, so will also look into that.  Thanks again!

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                              Fen
                              Participant

                                 

                                Dave – if you will post your general location people might be able to make suggestions about who to see in that area. You want to find a melanoma onc who will spend time with you and be able to discuss current treatments.  Reading about others' experiences can make that process more efficient.

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                                Janner
                                Participant

                                  Dave,

                                  Ask for a copy of your pathology report.  That will give you the information you need to know.  Clark's Level, not stage is the information you will find with the initial biopsy.  However, Clark's Level is not the most important piece of information.  Breslow depth – or the depth of the lesion – is the most significant prognostic indicator.  This is typically given in millimeters.  If you get a copy of your report and post it here, we can also help you understand the important parts. 

                                  I'll give you a brief warning.  If the lesion is over 1mm, you want the surgeon to schedule a Sentinal Lymph Node Biopsy (usually abbreviated SNB on this site).  This must be done prior to the WLE (wide local excision).  You are seeing the surgeon for AT LEAST the WLE to get good margins on the mole.  You don't want to have any stray cells left behind.  But depending on depth (and other possible factors), you need to have the SNB done PRIOR to the WLE.  Usually, they are done at the same surgical setting with the SNB first immediately followed by the WLE.  The order is important.

                                  If you can post a copy of your pathology report, we can be of better help to you.

                                  Best wishes,

                                  Janner

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                                    ChristineL
                                    Participant

                                      And now, some are suggesting SNB for lesions 0.75 mm and greater.  Mine was about 0.8 mm and I had positive node in my SNB.  Microscopic, yes, but I'm glad that sucker is gone!!!

                                      ChristineL

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                                      ChristineL
                                      Participant

                                        And now, some are suggesting SNB for lesions 0.75 mm and greater.  Mine was about 0.8 mm and I had positive node in my SNB.  Microscopic, yes, but I'm glad that sucker is gone!!!

                                        ChristineL

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                                        Springbok
                                        Participant

                                          Janner… Could you please explain why the SNB needs to be done before the WLE?

                                          Many thanks

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                                          Springbok
                                          Participant

                                            Janner… Could you please explain why the SNB needs to be done before the WLE?

                                            Many thanks

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                                            ChristineL
                                            Participant

                                              I can answer this one if you don't mind…they need the skin nearest to the tumor intact so they can find out exactly which node that area is draining to.  Before they do the WLE, they inject radioactive material into the skin near the tumor and follow the radioactivity to a node (or nodes).  If they do the WLE first, the local skin will be gone, and there is really no way of knowing where the lymph from that area is going.  Even a few inches from the tumor may actually drain to a different node.  The WLE and SNB are usually done during the same surgery.

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                                              ChristineL
                                              Participant

                                                I can answer this one if you don't mind…they need the skin nearest to the tumor intact so they can find out exactly which node that area is draining to.  Before they do the WLE, they inject radioactive material into the skin near the tumor and follow the radioactivity to a node (or nodes).  If they do the WLE first, the local skin will be gone, and there is really no way of knowing where the lymph from that area is going.  Even a few inches from the tumor may actually drain to a different node.  The WLE and SNB are usually done during the same surgery.

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                                                davekarrie
                                                Participant

                                                  My pathology report says I have Clarks level 4 and Breslow depth 1.5mm.  I will be calling the Mayo clinic in Rochester MN to talk to specialist and deal with them. They are one of the best melanoma hospitals in the US.  thanks for all the help and support, this is a great site.

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                                                  davekarrie
                                                  Participant

                                                    My pathology report says I have Clarks level 4 and Breslow depth 1.5mm.  I will be calling the Mayo clinic in Rochester MN to talk to specialist and deal with them. They are one of the best melanoma hospitals in the US.  thanks for all the help and support, this is a great site.

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                                                    Springbok
                                                    Participant

                                                      Davekarrie,

                                                      Please post the advice you get from the Mayo. I am in a very similar situation – 2.6mm Breslow, and Clarkes level 4

                                                       

                                                      Thanks

                                                      Springbok

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                                                      Springbok
                                                      Participant

                                                        Davekarrie,

                                                        Please post the advice you get from the Mayo. I am in a very similar situation – 2.6mm Breslow, and Clarkes level 4

                                                         

                                                        Thanks

                                                        Springbok

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                                                        davekarrie
                                                        Participant

                                                          I will post what we find out at the Mayo, hopefully they can see me soon. will call first thing monday morning.

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                                                          davekarrie
                                                          Participant

                                                            I will post what we find out at the Mayo, hopefully they can see me soon. will call first thing monday morning.

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                                                            fliberdy
                                                            Participant

                                                              Janner,

                                                              Thanks for the info you posted about having the SNB done before the WLE.  After reading these comments I am a little freaked out!  My Dr. opted not to do the SNB and my labs came back with rogue cancer cells even though I had clear margins. So 2 weeks ago he went back in and did a wider incision and the SNB. He took two nodes which turned out to be negative but after reading your post I am worried.  I wonder why he decided not to do the SNB during the first surgery.  He is regarded as the best surgical oncologist in my local so what gives? I go for my final post op on Tuesday and will have some ??? for him.

                                                              I am so grateful for the people on this site.

                                                              fliberdy

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                                                              fliberdy
                                                              Participant

                                                                Janner,

                                                                Thanks for the info you posted about having the SNB done before the WLE.  After reading these comments I am a little freaked out!  My Dr. opted not to do the SNB and my labs came back with rogue cancer cells even though I had clear margins. So 2 weeks ago he went back in and did a wider incision and the SNB. He took two nodes which turned out to be negative but after reading your post I am worried.  I wonder why he decided not to do the SNB during the first surgery.  He is regarded as the best surgical oncologist in my local so what gives? I go for my final post op on Tuesday and will have some ??? for him.

                                                                I am so grateful for the people on this site.

                                                                fliberdy

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                                                              Janner
                                                              Participant

                                                                Dave,

                                                                Ask for a copy of your pathology report.  That will give you the information you need to know.  Clark's Level, not stage is the information you will find with the initial biopsy.  However, Clark's Level is not the most important piece of information.  Breslow depth – or the depth of the lesion – is the most significant prognostic indicator.  This is typically given in millimeters.  If you get a copy of your report and post it here, we can also help you understand the important parts. 

                                                                I'll give you a brief warning.  If the lesion is over 1mm, you want the surgeon to schedule a Sentinal Lymph Node Biopsy (usually abbreviated SNB on this site).  This must be done prior to the WLE (wide local excision).  You are seeing the surgeon for AT LEAST the WLE to get good margins on the mole.  You don't want to have any stray cells left behind.  But depending on depth (and other possible factors), you need to have the SNB done PRIOR to the WLE.  Usually, they are done at the same surgical setting with the SNB first immediately followed by the WLE.  The order is important.

                                                                If you can post a copy of your pathology report, we can be of better help to you.

                                                                Best wishes,

                                                                Janner

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                                                                mimi0201
                                                                Participant

                                                                  Please do not use Mayo as your only source of info, get a second opnion.  We had Mayo consultion and were not at all satisified.  They do not specialize in Melanoma.

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                                                                  mimi0201
                                                                  Participant

                                                                    Please do not use Mayo as your only source of info, get a second opnion.  We had Mayo consultion and were not at all satisified.  They do not specialize in Melanoma.

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