confused daughter

You don't typically biopsy stage IV.  Staging is systemic analysis of the disease and usually indicated by the doctor.  Pathologists read tissue and therefore don't typically stage because they do not know the status of disease elsewhere.  That's why pathologists say Clark's Level IV (deep layer of skin) but not stage IV.  Stage IV is either organ involvement OR distant metastasis.  You biopsy Clark's Level IV.   If this is his primary site, it isn't distant mets and it isn't organ involvement.  That implies stage I or more likely stage II.  Radiation might be done because the lesion is deep and the margins not clear.  Has he ever had a sentinel lymph node biopsy?  Basically, have the lymph nodes been surgically tested?  PET scans don't show microscopic disease.  And finally, is he seeing a melanoma specialist?  Because that is the most important thing.  If you are not getting the answers you need, a second opinion is in order. 

So to hopefully make this maybe a bit more clear:

A biopsy of the skin can say two things:  This is the melanoma primary or this is a metastatic lesion. 

Since you indicate this is the melanoma primary – the biopsy does NOT say stage IV.  A skin biopsy can only report about the skin being looked at and can't report anything else.  So it looks at what is being removed and describes that lesion – not what is happening anywhere else in the body.  Like I stated above, stage IV is organ involvement or distant mets and a skin pathology report that is describing a primary site cannot report on either of the 2 stage IV criteria.  So it can't say stage IV when describing a primary.   Given the fact they are still trying to manage this surgically – maybe to get better margins – that again that implies that this is a stage I or stage II lesion, not stage IV.  Nothing you describe fits the stage IV scenario so far unless there is missing information.  The missing piece is whether or not his lymph nodes have been tested – that is where you get the stage III diagnosis.

A biopsy can differentiate between a primary and secondary tumor.  Initial diagnosis based on a metastatic tumor with no known primary is an uncommon but not unheard of occurrence, and there are several people on this site who got here by that route.  I'm not sure what they are irradiating if a single cutaneous tumor is all they've identified, unless it's some sort of preventative measure.  Perhaps excision plus irradiation is a normal approach when the initial diagnosis confirms active metastasis.

A biopsy can differentiate between a primary and secondary tumor.  Initial diagnosis based on a metastatic tumor with no known primary is an uncommon but not unheard of occurrence, and there are several people on this site who got here by that route.  I'm not sure what they are irradiating if a single cutaneous tumor is all they've identified, unless it's some sort of preventative measure.  Perhaps excision plus irradiation is a normal approach when the initial diagnosis confirms active metastasis.

A biopsy can differentiate between a primary and secondary tumor.  Initial diagnosis based on a metastatic tumor with no known primary is an uncommon but not unheard of occurrence, and there are several people on this site who got here by that route.  I'm not sure what they are irradiating if a single cutaneous tumor is all they've identified, unless it's some sort of preventative measure.  Perhaps excision plus irradiation is a normal approach when the initial diagnosis confirms active metastasis.

People with an "unknown primary" are typically considered stage III upon initial diagnosis.  It is thought that the original primary may have "regressed", or the body might have fought that cancer and destroyed it, but not before some extra cells traveled away from the original site.  In general, the thought is that the metastases are probably "regional" or in the same lymph basin which means stage III.  But that is typically when the melanoma is first found in the lymph nodes.  Since your father's melanoma was on his head, stage III or IV are both possibilities.  Since you don't know where it started, you can only make an educated guess on stage III/IV staging.

So if the brain MRI is clear and the PET scan shows nothing else, the head would be the only location known.  Radiation isn't normally used to fight melanoma, but it is sometimes used to clean up an area.  It is used for local control of an area.

Moffit is a good place to be if you have melanoma – they have melanoma specialists and clinical trials.  While not common, your father isn't unique in not finding other evidence of disease.  Just keep asking questions.  If the brain MRI is clear, are they planning on doing some type of clinical trial?  Adjuvant therapy? 

People with an "unknown primary" are typically considered stage III upon initial diagnosis.  It is thought that the original primary may have "regressed", or the body might have fought that cancer and destroyed it, but not before some extra cells traveled away from the original site.  In general, the thought is that the metastases are probably "regional" or in the same lymph basin which means stage III.  But that is typically when the melanoma is first found in the lymph nodes.  Since your father's melanoma was on his head, stage III or IV are both possibilities.  Since you don't know where it started, you can only make an educated guess on stage III/IV staging.

So if the brain MRI is clear and the PET scan shows nothing else, the head would be the only location known.  Radiation isn't normally used to fight melanoma, but it is sometimes used to clean up an area.  It is used for local control of an area.

Moffit is a good place to be if you have melanoma – they have melanoma specialists and clinical trials.  While not common, your father isn't unique in not finding other evidence of disease.  Just keep asking questions.  If the brain MRI is clear, are they planning on doing some type of clinical trial?  Adjuvant therapy? 

People with an "unknown primary" are typically considered stage III upon initial diagnosis.  It is thought that the original primary may have "regressed", or the body might have fought that cancer and destroyed it, but not before some extra cells traveled away from the original site.  In general, the thought is that the metastases are probably "regional" or in the same lymph basin which means stage III.  But that is typically when the melanoma is first found in the lymph nodes.  Since your father's melanoma was on his head, stage III or IV are both possibilities.  Since you don't know where it started, you can only make an educated guess on stage III/IV staging.

So if the brain MRI is clear and the PET scan shows nothing else, the head would be the only location known.  Radiation isn't normally used to fight melanoma, but it is sometimes used to clean up an area.  It is used for local control of an area.

Moffit is a good place to be if you have melanoma – they have melanoma specialists and clinical trials.  While not common, your father isn't unique in not finding other evidence of disease.  Just keep asking questions.  If the brain MRI is clear, are they planning on doing some type of clinical trial?  Adjuvant therapy? 

So to hopefully make this maybe a bit more clear:

A biopsy of the skin can say two things:  This is the melanoma primary or this is a metastatic lesion. 

Since you indicate this is the melanoma primary – the biopsy does NOT say stage IV.  A skin biopsy can only report about the skin being looked at and can't report anything else.  So it looks at what is being removed and describes that lesion – not what is happening anywhere else in the body.  Like I stated above, stage IV is organ involvement or distant mets and a skin pathology report that is describing a primary site cannot report on either of the 2 stage IV criteria.  So it can't say stage IV when describing a primary.   Given the fact they are still trying to manage this surgically – maybe to get better margins – that again that implies that this is a stage I or stage II lesion, not stage IV.  Nothing you describe fits the stage IV scenario so far unless there is missing information.  The missing piece is whether or not his lymph nodes have been tested – that is where you get the stage III diagnosis.

So to hopefully make this maybe a bit more clear:

A biopsy of the skin can say two things:  This is the melanoma primary or this is a metastatic lesion. 

Since you indicate this is the melanoma primary – the biopsy does NOT say stage IV.  A skin biopsy can only report about the skin being looked at and can't report anything else.  So it looks at what is being removed and describes that lesion – not what is happening anywhere else in the body.  Like I stated above, stage IV is organ involvement or distant mets and a skin pathology report that is describing a primary site cannot report on either of the 2 stage IV criteria.  So it can't say stage IV when describing a primary.   Given the fact they are still trying to manage this surgically – maybe to get better margins – that again that implies that this is a stage I or stage II lesion, not stage IV.  Nothing you describe fits the stage IV scenario so far unless there is missing information.  The missing piece is whether or not his lymph nodes have been tested – that is where you get the stage III diagnosis.

You don't typically biopsy stage IV.  Staging is systemic analysis of the disease and usually indicated by the doctor.  Pathologists read tissue and therefore don't typically stage because they do not know the status of disease elsewhere.  That's why pathologists say Clark's Level IV (deep layer of skin) but not stage IV.  Stage IV is either organ involvement OR distant metastasis.  You biopsy Clark's Level IV.   If this is his primary site, it isn't distant mets and it isn't organ involvement.  That implies stage I or more likely stage II.  Radiation might be done because the lesion is deep and the margins not clear.  Has he ever had a sentinel lymph node biopsy?  Basically, have the lymph nodes been surgically tested?  PET scans don't show microscopic disease.  And finally, is he seeing a melanoma specialist?  Because that is the most important thing.  If you are not getting the answers you need, a second opinion is in order. 

You don't typically biopsy stage IV.  Staging is systemic analysis of the disease and usually indicated by the doctor.  Pathologists read tissue and therefore don't typically stage because they do not know the status of disease elsewhere.  That's why pathologists say Clark's Level IV (deep layer of skin) but not stage IV.  Stage IV is either organ involvement OR distant metastasis.  You biopsy Clark's Level IV.   If this is his primary site, it isn't distant mets and it isn't organ involvement.  That implies stage I or more likely stage II.  Radiation might be done because the lesion is deep and the margins not clear.  Has he ever had a sentinel lymph node biopsy?  Basically, have the lymph nodes been surgically tested?  PET scans don't show microscopic disease.  And finally, is he seeing a melanoma specialist?  Because that is the most important thing.  If you are not getting the answers you need, a second opinion is in order.