› Forums › General Melanoma Community › Clark rating and thin melanomas
- This topic has 27 replies, 5 voices, and was last updated 12 years, 9 months ago by
HoolieB.
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- March 21, 2012 at 5:37 pm
I stumbled across the site in a search and have been reading the wealth of wonderful information on this board. One thing that caught my eye was a couple of responses that included (paraphrased) "…Clark rating is no longer considered important unless it's with a thin melanoma…" All my searching here couldn't find an explanation for that statement. I was hopeful somebody might be able to shed some light on the relationship between Clark numbers and thin melanomas. My melanoma was Breslow "at least" .42, Clark III.
I stumbled across the site in a search and have been reading the wealth of wonderful information on this board. One thing that caught my eye was a couple of responses that included (paraphrased) "…Clark rating is no longer considered important unless it's with a thin melanoma…" All my searching here couldn't find an explanation for that statement. I was hopeful somebody might be able to shed some light on the relationship between Clark numbers and thin melanomas. My melanoma was Breslow "at least" .42, Clark III.
Thank you!
Julie
- Replies
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- March 21, 2012 at 5:52 pm
In years past, Clark Level IV distinguished a 1A lesion from a 1B lesion. That is no longer the case. The only Clark's Level currently in use is Clark's Level 0. This is in situ by definition. The melanoma is confined to the epidermis only. The ability to distinguish between Clark's Level II, III and IV was quite inconsistent among pathologists so it is no longer included in the current staging guidelines. Other factors showed more "significance" in studies. Some doctors still use Clark's Level when describing a lesion to patients out of habit. I, personally, wish doctor's wouldn't even mention Clark's Level to the newly diagnosed. It is very often confused with stage and can cause unnecessary anxiety. I can't tell you the number of times a person with a Clark's Level II, III or IV lesion came on this site thinking they were stage II, III or IV. They hear/see the number and assume they mean the same thing.
Best wishes,
Janner
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- March 21, 2012 at 5:52 pm
In years past, Clark Level IV distinguished a 1A lesion from a 1B lesion. That is no longer the case. The only Clark's Level currently in use is Clark's Level 0. This is in situ by definition. The melanoma is confined to the epidermis only. The ability to distinguish between Clark's Level II, III and IV was quite inconsistent among pathologists so it is no longer included in the current staging guidelines. Other factors showed more "significance" in studies. Some doctors still use Clark's Level when describing a lesion to patients out of habit. I, personally, wish doctor's wouldn't even mention Clark's Level to the newly diagnosed. It is very often confused with stage and can cause unnecessary anxiety. I can't tell you the number of times a person with a Clark's Level II, III or IV lesion came on this site thinking they were stage II, III or IV. They hear/see the number and assume they mean the same thing.
Best wishes,
Janner
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- March 21, 2012 at 5:52 pm
In years past, Clark Level IV distinguished a 1A lesion from a 1B lesion. That is no longer the case. The only Clark's Level currently in use is Clark's Level 0. This is in situ by definition. The melanoma is confined to the epidermis only. The ability to distinguish between Clark's Level II, III and IV was quite inconsistent among pathologists so it is no longer included in the current staging guidelines. Other factors showed more "significance" in studies. Some doctors still use Clark's Level when describing a lesion to patients out of habit. I, personally, wish doctor's wouldn't even mention Clark's Level to the newly diagnosed. It is very often confused with stage and can cause unnecessary anxiety. I can't tell you the number of times a person with a Clark's Level II, III or IV lesion came on this site thinking they were stage II, III or IV. They hear/see the number and assume they mean the same thing.
Best wishes,
Janner
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- March 21, 2012 at 6:08 pm
Thanks for your response! Fortunately I knew I was only Stage I; my doctor was good about explaining that to me.
My question stems only from the statement found here (and in other research) that "Clark numbers don't matter unless one has a thin melanoma." I was hoping for an expansion of that statement, e.g., higher percentage of local recurrence for those patients, etc. Unless even that statement is incorrect/unimportant.
Thanks again!
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- March 21, 2012 at 6:16 pm
Clark's Level has never applied to anyone other than stage 0/I individuals. It doesn't matter if you have a lesion > 2mm what the Clark's Level is. It doesn't matter if you are stage III or IV. It has always only applied to stage 0/1 (and possibly early stage II) individuals. Nothing more than that. There isn't anything inherently negative in that statement, it's just a reality of how things are staged. When you get over 2mm (stage II), Clark's Level wasn't even considered.
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- March 21, 2012 at 6:41 pm
Or to put it another way, Clark's Level WAS used to further categorize/distinguish the different aspects of stage I. If you were to look at the TNM staging for melanoma, T represents Primary Tumor. There are subcategories of T, i.e. T1, T2, T3 and T4. (I don't have a link that uses the old staging methods anymore – the new staging doesn't use Clark's Level). You can see the current breakout here: http://www.melanomacenter.org/staging/tnmstagingsystem.html
Breslow Depth and Clark's Level and ulceration were further used to stratify the "T" staging like mitosis and ulceration are shown in the link. The "T" staging is really only important if the N (# metastatic nodes) and M (metastasis site) portions are 0 meaning there is no metastases of any type. So Clark's Level really only applies to early stage lesions. No one cares if you had a Clark's Level IV lesion when you are stage III or IV, it means little when there is already metastasis. So the statement you are questioning is basically a statement that Clark's Level ONLY APPLIES to early staged lesions, not that it negatively impacts them.
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- March 21, 2012 at 6:46 pm
Thanks! That is a perfect clarification for me. My apologies for my ignorant questions/statements; this is all quite new to me and I'm just looking for information. It's a bit embarrassing to be concerned about a Stage I diagnosis when so many here are dealing with far more serious stages. But it is concerning to me nonetheless.
Thanks again.
Julie
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- March 21, 2012 at 6:46 pm
Thanks! That is a perfect clarification for me. My apologies for my ignorant questions/statements; this is all quite new to me and I'm just looking for information. It's a bit embarrassing to be concerned about a Stage I diagnosis when so many here are dealing with far more serious stages. But it is concerning to me nonetheless.
Thanks again.
Julie
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- March 21, 2012 at 6:46 pm
Thanks! That is a perfect clarification for me. My apologies for my ignorant questions/statements; this is all quite new to me and I'm just looking for information. It's a bit embarrassing to be concerned about a Stage I diagnosis when so many here are dealing with far more serious stages. But it is concerning to me nonetheless.
Thanks again.
Julie
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- March 22, 2012 at 5:04 am
Asking is the only way to learn! AND don’t be “embarrassed” about being only a “Stage I”.
I was never knowingly a Stage 1 or Stage II ‘er! OF course having any cancer diagnosis is concerning. The thing to do is to be like you are and LEARN.
While I think I am a fairly knowledgeable stage IV patient, I still learn so much from Janner’s posts to the lower stage people. I didn’t even know what an Oncologist was when I was stage I or II.
While statistically your odds are great, with Melanoma it pays to learn because one can never be 100% sure what the future will bring for an individual case. Learn and be vigilant, do not be paranoid.
Enjoy life while the bad word plays around in the back of your mind. (It is very likely that One day it will not be the first thing hitting you when you wake up and the last thing when you go to bed.) It seems to take about a year for the immediacy to back off!
Keep asking questions for now and in the future, pop in and let us hear the results of future check ups. (New stage 1 people love to hear that others have gone years and never had a recurrence.) Wouldn’t it be great if most of the people here were Stage 1’s that could tell you that theirs never came back? Most stage 1’s are long gone forward with life and leave us late stagers here where new stage 1 people only find us and feel that they have little chance because most people here are more advanced.
Enjoy life and keep an open eye for the rare additional primaries as well as the slight possibility of a loose cell getting into a lymph node. Get swollen lymph nodes checked in the future. Just remember that most swollen lymph nodes do NOT relate to cancer. Learning for sure is better than worrying though! -
- March 22, 2012 at 5:04 am
Asking is the only way to learn! AND don’t be “embarrassed” about being only a “Stage I”.
I was never knowingly a Stage 1 or Stage II ‘er! OF course having any cancer diagnosis is concerning. The thing to do is to be like you are and LEARN.
While I think I am a fairly knowledgeable stage IV patient, I still learn so much from Janner’s posts to the lower stage people. I didn’t even know what an Oncologist was when I was stage I or II.
While statistically your odds are great, with Melanoma it pays to learn because one can never be 100% sure what the future will bring for an individual case. Learn and be vigilant, do not be paranoid.
Enjoy life while the bad word plays around in the back of your mind. (It is very likely that One day it will not be the first thing hitting you when you wake up and the last thing when you go to bed.) It seems to take about a year for the immediacy to back off!
Keep asking questions for now and in the future, pop in and let us hear the results of future check ups. (New stage 1 people love to hear that others have gone years and never had a recurrence.) Wouldn’t it be great if most of the people here were Stage 1’s that could tell you that theirs never came back? Most stage 1’s are long gone forward with life and leave us late stagers here where new stage 1 people only find us and feel that they have little chance because most people here are more advanced.
Enjoy life and keep an open eye for the rare additional primaries as well as the slight possibility of a loose cell getting into a lymph node. Get swollen lymph nodes checked in the future. Just remember that most swollen lymph nodes do NOT relate to cancer. Learning for sure is better than worrying though! -
- March 22, 2012 at 5:04 am
Asking is the only way to learn! AND don’t be “embarrassed” about being only a “Stage I”.
I was never knowingly a Stage 1 or Stage II ‘er! OF course having any cancer diagnosis is concerning. The thing to do is to be like you are and LEARN.
While I think I am a fairly knowledgeable stage IV patient, I still learn so much from Janner’s posts to the lower stage people. I didn’t even know what an Oncologist was when I was stage I or II.
While statistically your odds are great, with Melanoma it pays to learn because one can never be 100% sure what the future will bring for an individual case. Learn and be vigilant, do not be paranoid.
Enjoy life while the bad word plays around in the back of your mind. (It is very likely that One day it will not be the first thing hitting you when you wake up and the last thing when you go to bed.) It seems to take about a year for the immediacy to back off!
Keep asking questions for now and in the future, pop in and let us hear the results of future check ups. (New stage 1 people love to hear that others have gone years and never had a recurrence.) Wouldn’t it be great if most of the people here were Stage 1’s that could tell you that theirs never came back? Most stage 1’s are long gone forward with life and leave us late stagers here where new stage 1 people only find us and feel that they have little chance because most people here are more advanced.
Enjoy life and keep an open eye for the rare additional primaries as well as the slight possibility of a loose cell getting into a lymph node. Get swollen lymph nodes checked in the future. Just remember that most swollen lymph nodes do NOT relate to cancer. Learning for sure is better than worrying though! -
- March 21, 2012 at 6:41 pm
Or to put it another way, Clark's Level WAS used to further categorize/distinguish the different aspects of stage I. If you were to look at the TNM staging for melanoma, T represents Primary Tumor. There are subcategories of T, i.e. T1, T2, T3 and T4. (I don't have a link that uses the old staging methods anymore – the new staging doesn't use Clark's Level). You can see the current breakout here: http://www.melanomacenter.org/staging/tnmstagingsystem.html
Breslow Depth and Clark's Level and ulceration were further used to stratify the "T" staging like mitosis and ulceration are shown in the link. The "T" staging is really only important if the N (# metastatic nodes) and M (metastasis site) portions are 0 meaning there is no metastases of any type. So Clark's Level really only applies to early stage lesions. No one cares if you had a Clark's Level IV lesion when you are stage III or IV, it means little when there is already metastasis. So the statement you are questioning is basically a statement that Clark's Level ONLY APPLIES to early staged lesions, not that it negatively impacts them.
-
- March 21, 2012 at 6:41 pm
Or to put it another way, Clark's Level WAS used to further categorize/distinguish the different aspects of stage I. If you were to look at the TNM staging for melanoma, T represents Primary Tumor. There are subcategories of T, i.e. T1, T2, T3 and T4. (I don't have a link that uses the old staging methods anymore – the new staging doesn't use Clark's Level). You can see the current breakout here: http://www.melanomacenter.org/staging/tnmstagingsystem.html
Breslow Depth and Clark's Level and ulceration were further used to stratify the "T" staging like mitosis and ulceration are shown in the link. The "T" staging is really only important if the N (# metastatic nodes) and M (metastasis site) portions are 0 meaning there is no metastases of any type. So Clark's Level really only applies to early stage lesions. No one cares if you had a Clark's Level IV lesion when you are stage III or IV, it means little when there is already metastasis. So the statement you are questioning is basically a statement that Clark's Level ONLY APPLIES to early staged lesions, not that it negatively impacts them.
-
- March 21, 2012 at 6:16 pm
Clark's Level has never applied to anyone other than stage 0/I individuals. It doesn't matter if you have a lesion > 2mm what the Clark's Level is. It doesn't matter if you are stage III or IV. It has always only applied to stage 0/1 (and possibly early stage II) individuals. Nothing more than that. There isn't anything inherently negative in that statement, it's just a reality of how things are staged. When you get over 2mm (stage II), Clark's Level wasn't even considered.
-
- March 21, 2012 at 6:16 pm
Clark's Level has never applied to anyone other than stage 0/I individuals. It doesn't matter if you have a lesion > 2mm what the Clark's Level is. It doesn't matter if you are stage III or IV. It has always only applied to stage 0/1 (and possibly early stage II) individuals. Nothing more than that. There isn't anything inherently negative in that statement, it's just a reality of how things are staged. When you get over 2mm (stage II), Clark's Level wasn't even considered.
-
- March 21, 2012 at 6:08 pm
Thanks for your response! Fortunately I knew I was only Stage I; my doctor was good about explaining that to me.
My question stems only from the statement found here (and in other research) that "Clark numbers don't matter unless one has a thin melanoma." I was hoping for an expansion of that statement, e.g., higher percentage of local recurrence for those patients, etc. Unless even that statement is incorrect/unimportant.
Thanks again!
-
- March 21, 2012 at 6:08 pm
Thanks for your response! Fortunately I knew I was only Stage I; my doctor was good about explaining that to me.
My question stems only from the statement found here (and in other research) that "Clark numbers don't matter unless one has a thin melanoma." I was hoping for an expansion of that statement, e.g., higher percentage of local recurrence for those patients, etc. Unless even that statement is incorrect/unimportant.
Thanks again!
-
- March 28, 2012 at 2:46 pm
Hello Julie,
I am also a stage I patiënt, and I understand your feelings. I also felt quilty being worried and scared- being a stage I- after reading stories here of people in much worse conditions. But when you are early diagnosed, YOU ARE scared and worried and you go looking for answers. This is a great website, which contains a lot of information and people who understand the disease. I was diagnosed in august 2010, and I am still OK after treatment. I know it is only 1.5 year, but my main message to you is that the scared feelings slowly fade away. Just give it a little time. You keep alert to your body, but I don't think about it every day anymore. This was very different in the beginning, when melanoma really controlled my life. And it is true what here was written before: when we still have the possibility to live our lives without having to coop with it every day, it should be a blessing and we should enjoy life. I wish you, and especially everyone here who is fighting a couragious fight, all my best wishes and many years to come!
Marleen
Belgium
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- March 29, 2012 at 7:48 pm
Thanks a million for letting me know I'm not alone in a.) feeling guilty for worrying about Stage I, and b.) thinking about melanoma every day. For as prevalent as this cancer seems to be now, none of my friends or coworkers have experienced it. So, my pool of resources was quite shallow until I found this place.
I had a severely dysplastic nevus removed off my back in early January, and just last week found out I have a moderately dysplastic nevus on my chest that should be removed. The hits keep coming! 😉 But I am grateful they were not called by melanoma by the pathologist's report.
Thanks again for the support. It's nice not to feel alone.
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- March 29, 2012 at 7:48 pm
Thanks a million for letting me know I'm not alone in a.) feeling guilty for worrying about Stage I, and b.) thinking about melanoma every day. For as prevalent as this cancer seems to be now, none of my friends or coworkers have experienced it. So, my pool of resources was quite shallow until I found this place.
I had a severely dysplastic nevus removed off my back in early January, and just last week found out I have a moderately dysplastic nevus on my chest that should be removed. The hits keep coming! 😉 But I am grateful they were not called by melanoma by the pathologist's report.
Thanks again for the support. It's nice not to feel alone.
-
- March 29, 2012 at 7:48 pm
Thanks a million for letting me know I'm not alone in a.) feeling guilty for worrying about Stage I, and b.) thinking about melanoma every day. For as prevalent as this cancer seems to be now, none of my friends or coworkers have experienced it. So, my pool of resources was quite shallow until I found this place.
I had a severely dysplastic nevus removed off my back in early January, and just last week found out I have a moderately dysplastic nevus on my chest that should be removed. The hits keep coming! 😉 But I am grateful they were not called by melanoma by the pathologist's report.
Thanks again for the support. It's nice not to feel alone.
-
- March 28, 2012 at 2:46 pm
Hello Julie,
I am also a stage I patiënt, and I understand your feelings. I also felt quilty being worried and scared- being a stage I- after reading stories here of people in much worse conditions. But when you are early diagnosed, YOU ARE scared and worried and you go looking for answers. This is a great website, which contains a lot of information and people who understand the disease. I was diagnosed in august 2010, and I am still OK after treatment. I know it is only 1.5 year, but my main message to you is that the scared feelings slowly fade away. Just give it a little time. You keep alert to your body, but I don't think about it every day anymore. This was very different in the beginning, when melanoma really controlled my life. And it is true what here was written before: when we still have the possibility to live our lives without having to coop with it every day, it should be a blessing and we should enjoy life. I wish you, and especially everyone here who is fighting a couragious fight, all my best wishes and many years to come!
Marleen
Belgium
-
- March 28, 2012 at 2:46 pm
Hello Julie,
I am also a stage I patiënt, and I understand your feelings. I also felt quilty being worried and scared- being a stage I- after reading stories here of people in much worse conditions. But when you are early diagnosed, YOU ARE scared and worried and you go looking for answers. This is a great website, which contains a lot of information and people who understand the disease. I was diagnosed in august 2010, and I am still OK after treatment. I know it is only 1.5 year, but my main message to you is that the scared feelings slowly fade away. Just give it a little time. You keep alert to your body, but I don't think about it every day anymore. This was very different in the beginning, when melanoma really controlled my life. And it is true what here was written before: when we still have the possibility to live our lives without having to coop with it every day, it should be a blessing and we should enjoy life. I wish you, and especially everyone here who is fighting a couragious fight, all my best wishes and many years to come!
Marleen
Belgium
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