› Forums › Cutaneous Melanoma Community › Diagnosed earlier today: Some newbie Q’s on T4b and Biopsies/Pathology Reports
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GeoTony.
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- August 28, 2017 at 5:23 pm
My Derm told me my nickel-sized mole was "probably melanoma" and based on the sample he took as a shave biopsy it was "probably more than 4mm thick."
Pathology came back today, and he was right on both counts–T4b officially. As I understand it the next step is to get the entire tumor removed and then check on sentinel lobe and some other lobes.
Some hopefully easy Q's:
(1) Because the Derm did just a "shave biopsy" (and it's clear he didn't attempt to take all of it because it's just a shave), I'm assuming that what this pathology report (i.e. from the shave biopsy) says about "margins" is basically meaningless? In other words, when you're interpreting margins, I assume that's germane only after they cut out the entire tumor so the pathology gives you some sense as to whether they "got it all"?
(2) Lingo Q: When I go do the surgical oncologist and he/she cuts out the whole thing, am I right that what folks here refer to as a WLE? Wide Local Excision? I assume that's what they'll do? And if so, am I right that there will be a NEW pathology report that talks about "margins" and what that report says help us to know whether they got it all?
(3) Sentinel Lobe stuff: What all is involved in that? I'm assuming the WLE and this test are basically out-patient? Is there anything about those procedures that should make me plan to be out for a few days, or is it the type of thing where physically you bounce back that day and can go do whatever you had planned to do? (I know that I can ask all this of the surgical oncologist, but I may not hear from them until later this week and it'll probably be 2-3 weeks before I get in for the WLE and SN biopsy per my Derm's office.)
Thanks to all who read and monitor. or answer It looks like, depending on lobe involvement, I'm Stage IIC at best or Stage III or IV at worst, but I'm going to assume and hope for the best until I hear otherwise. I'm so thankful there's a place like this where I can express my concerns and get some answers from those who have trod down this path before. I hate to wait, and it helps me psychologically to scout out some of this info so that I know how to work my way through the minefield. Thanks again for your help.
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- August 28, 2017 at 8:40 pm
Hi JimChief, I have two links for you if interested that covers the basic questions you have. The first video is pretty good but I am not a fan of one of the options ( interferon) that he gives for patients that are considered stage 3 after SNB proves progression. https://www.youtube.com/watch?v=cnqNDRqChrk The second link is really good at the beginning to expain WLE procedure and SLNB. https://www.youtube.com/watch?v=YrW4UdkCu8I
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- August 28, 2017 at 9:04 pm
Shave biopsies can get the whole lesion but they also sometimes don’t vet it all. I also had a shave on a good sized mole and it did get it all. The path report usually says something like “extends to margins” and “at least this depth”, if you share what the path report says we can better tell if the shave biopsies got it all or most of the lesion.The WLE is the removal of tissue down to the muscle in an eclipse shape excision. Yes there will be a separate path report from that, if there is anymore tumor(mole) left it will state how much. Be aware that if your shave biopsy did bisect the tumor, then you won’t ever have a real idea of how deep it is, you can’t just add the first depth to the second, it doesn’t work that way.
The sentinel lymph node biopsy is where one or more lymph nodes closest to the primary site (biopsy site) are taken out and looked at to see if they contain any melanoma cells. If your primary is on a leg then the groin is usually the place of the snlb if it’s an arm then armpit usually and if on upper back sometimes armpit and/or neck. To give some idea of where it might be performed. To find the sentinel node they will have you go to nuclear medicine the morning of your surgery and they will inject a radioactive dye around your biopsy site. You’ll wait a bit for it to drain and they’ll scan you under a machine and you’ll see one or more “glowing beans” (what I call them), those are the sentinel nodes, the first point of drainage from the primary tumor. They’ll mark the area and during surgery will be able to find which lit up and they will remove them.
Recovery time will depend a lot on where the primary location is. Mine was on my calf, so the WLE area was tight and I had to be careful and slow with walking for a bit. My slnb was in my groin and that was pretty uncomfortable for a few days, no major pain, I was back to work after 4 days of resting. If I had a very physical job I would have taken more time off.
Hope that helped answer some questions. Sorry you had to officially join this club but we’re definitely here to help, the beginning is full of unknowns and what it’s.
Best,
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- August 28, 2017 at 10:31 pm
1/2. I only became aware that MM was some serious skin cancer after my WLE/Sentinel surgery path report came out. My MD introduced at that time that I was staged at IIIB and fully resected – along with the historic odds. Passed right out.
I was probably a little too inattentive and ignorant to that point, sounds like you are right on target in gaining information. Have your surgeon be clear about how s/he wants to communicate the results to you. I don't see the point in looking further ahead at this time. You could be on either side of a no-brainer question of what is next, so here's hoping to clean nodes in the meantime.
3. I got seriously dosed with General Anesthesia (compared with later CLNR surgery anyway) and it was a long day of admission/nuclear and then surgery in the afternoon. I was not functional the next day, and really was glad for 2 days off + the weekend. A later start would have made it hard to leave before they would have just held me overnight, because I was slow in coming to. And if you do physical labor, much more caution required for site surgery scar. They can really chunk you.
Best of luck.
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- August 28, 2017 at 11:45 pm
If the shave biopsy cut through the lesion, you will never know the true depth. You can't just "add" the biopsy depth to what is left because the samples won't line up. However, when it comes to staging, there are no categories for depth beyond 4mm. 4mm or 8mm+ are treated the same for staging. The depth means less and the SNB results mean more when you pass 4mm. Margins for the WLE will be at least 2cm all around the lesion. Just so you know, that will mean the lesion will be long… in order to take a big hole out, you need to make an elliptical cut to be able to close that lesion. Ed's videos might stress that but that is something that sometimes catches people offguard. Good luck!
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- August 29, 2017 at 6:35 am
A full day at the hospital sounds about right, mine was located on my lower back, however to my girlfriends surprise I left with a drain that had to be monitored for 48hrs, 26 staples and a bag of high end painkillers. I narrowly escaped a skin graft, they shaved my thigh in theatre, my mole was the size of a couple of loonies.
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Tagged: cutaneous melanoma
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