Diagnosed today with nodular melanoma pt2A

Chris I am very sorry that you have received this diagnosis. Trust me there are plenty of marvelous treatments available now. I was given a 4.1 mm nodular diagnosis back in 2008. Yes I had some surgeries, radiation and the Yervoy / Opdivo treatment. Right now I am 6.5 years free of cancer. There will be plenty of good and also bad days coming up for you. Find the best melanoma clinic and please accept the prayers that I will be dedicating to you. Welcome to the board, many, many patients here with so much information to share.

Hi Chris, 

Sorry for what you are going through. Try not to read online too much. My diagnosis was 2 1/2 years ago. My nodular mel was 8 mm, mitotic rate was 10. (Not decimal errors) My bump was thought to be benign fibroma so I’d been ignoring it for a good long while. 

Surprisingly my lymph nodes were clear, And I required only monitoring after my WLE. (So far so good)

Still concerned about but have kind of adjusted to the possibility of recurrence or spread at some time. After all no one has a certain future. 

You aren’t a statistic, and reading rates of recurrence etc isn’t too helpful to us as patients we just have to walk the path in front of us and take next best step with the info we have. (Same as everyone really)

Wishing you the best possible results from your tests next week-

Joyce

OK, the first thing is to understand that treatment for melanoma has really advanced so its one of the first cancers that is becoming very treatable, even at stage 4.

The second thing is to understand that the nodular subtype is a bit nastier than others because it is kind of like a carrot – a bump on top but with a tendency to grow deeper. This is kind of shown in the clark level, the vertical growth found, and the Breslow thickness. The Breslow is most important, and yours is past that 0.75mm or 1mm point where you wouldn't need an SLNB because the odds of spread are so low. There is a chance – a small chance – your lymph nodes will be affected. Its still a fairly thin melanoma.

The third thing is mitotic rate has been dropped from the diagnostic criteria for melanoma AFAIK. It was considered important, now not so much. The fact that there is no ulceration is good news.

I think you have good odds of a clear SLNB, but no-ne can guess. The main thing is that it is found and treated as nodular is considered faster and more aggressive than other types:

https://www.dermnetnz.org/topics/nodular-melanoma/

In short, it's not great to be diagnosed with this particular type of melanoma, but hopefully the wide level excision/SLNB is the enough to get you in the clear.

Chris, welcome to the club no one really wants to belong to. There are a lot of really GREAT people here, and they have a ton of experience they can share. Remember that no one is exactly the same, and that treatments and surgeries and everything can be different for each individual person. As everyone here can tell you, keep your chin up. Take it one step at a time, because honestly that's all you can do. Take it one step at a time, and find the joy in each day, each moment. 

The most important part to remember? You are not alone. 

Hi Chris,

Sorry for the delay in posting, but wanted to share my husbands diagnosis since it was shocking in terms of size as well, so wanted you to hear a positive story to date.  He was diagnosed with nodular melanoma (stage 4 but because there was no overlying skin component when they look at his biopsy)  in February 2014.  His depth was 22mm (2 cm) mass on upper left shoulder (like Joyce, we aren't missing a decimal point) with mitotic rate of 8. There was no overlying skin in his biopsy (so they couldn't tell if this was original  or metastasized from unknown primary), however, he had a weird skin thing there for years that regressed at one point.  It was HUGE, I remember sobbing when I saw it (my daughter actually saw it when they were swimming at the pool and my husband said he woke up one night after that and felt like he was lying on a golf ball).  But he just had surgery and sentinel lymph node biopsy (WLE, SLNB).  Both came back clear.  He has had ultrasounds of the lymph nodes in the same area (first year after surgery) and scans every 3 months, now 6 months.  We are about 5 years out from surgery. My husband went to work the day after surgery (despite the humongous scar the length of back and arm pits).  He hasn't given it much thought (so he says) but I have researched everything and every component of his diagnosis/pathology from type of mutation, type of cells, depth, etc. so understand that he had all the "bad" criteria for prognosis (depth, type, etc).   Yet here we are.  As much as I LOVE data, I've come to realize what others on this board understand far better, that each person is unique and not a statistic 🙂  I'm wishing you the absolute best and no further evidence of this ridiculous disease. 

I still remember seeing my own primary care doctor a few days before my husband had surgery and mentioned what was going on and the first thing she said, "depth is what you have to be worried about"  Mind you, not a melanoma doctor and I could barely breathe, was sure that the cancer had spread throughout his body.  He was also complaining of headaches and being dizzy right before the surgery so was convinced he had brain metastases. He did not and has had brain MRIs since.  Just goes to show you can't correlate everything.  I was a mess.