Difference between recurrent Melanoma and second primary?

Hello Dave,

I have melanoma of the scalp and had a wide excision (2 cm around the primary) with a skin graft one year ago. Had clear margins. Seven months later, the melanoma returned to the same spot, right smack in the middle of my skin graft as well as on the edges of the skin graft. Biopsies were done with clear margins for the biopsies. More spots occured in the same area. I am now doing radiation to try to kill the cancer cells in that area and prevent future recurrances.

Here is what little I know….

*  They decide between "local recurrance" and "second primary" by how far away from the original primary the new spot is.

*  Yes, the mm can come back whenever and however it wants. My onc says it is because of "seeds", the small cancer cells which are too small to show under a microscope. So pathology reports that the margins are clear to the best of their knowledge and technology but they can't see these "seed" cells.

* You need to call your oncologist now and let her know of your concerns. She may also be concerned and move up the tests. My onc is so wonderful, she wants me to call with any and all concerns cuz she knows that the worry is not gonna help the cancer any.

Let it be known, I am probably the least informed on this forum, if anyone overrules my statements, listen to THEM.

Nicki, Stage 3b, scalp

Hello Dave,

I have melanoma of the scalp and had a wide excision (2 cm around the primary) with a skin graft one year ago. Had clear margins. Seven months later, the melanoma returned to the same spot, right smack in the middle of my skin graft as well as on the edges of the skin graft. Biopsies were done with clear margins for the biopsies. More spots occured in the same area. I am now doing radiation to try to kill the cancer cells in that area and prevent future recurrances.

Here is what little I know….

*  They decide between "local recurrance" and "second primary" by how far away from the original primary the new spot is.

*  Yes, the mm can come back whenever and however it wants. My onc says it is because of "seeds", the small cancer cells which are too small to show under a microscope. So pathology reports that the margins are clear to the best of their knowledge and technology but they can't see these "seed" cells.

* You need to call your oncologist now and let her know of your concerns. She may also be concerned and move up the tests. My onc is so wonderful, she wants me to call with any and all concerns cuz she knows that the worry is not gonna help the cancer any.

Let it be known, I am probably the least informed on this forum, if anyone overrules my statements, listen to THEM.

Nicki, Stage 3b, scalp

Dave,

I have multiple primaries and also have recurrant melanoma, oh yeah, have kehloids also. 

Clear margins are great but that is no guarantee that there wasn't a loose cell out there .  A primary comes from a mole, a recurrance does not. Basically pathology is the final determentant.  If it is an obvious new mole, growing slow and looks normal  than I would consider waiting till the appointment, otherwise I would play it on the safe side and call your Dr.  Back before my recurrance I even called for an emergency appointment only to find out that there was an ingrown hair trying to come through the mole.   Always safer to be sure.  If You have to travel to mayo and it's a huge issu then you might want to look for a good local dermatologist.

Let us know how it turns out,

Linda

Stage IV

Appointment on Tuesday hoping to be told that this stomach pain is just gallbladder!!!!

Dave,

I have multiple primaries and also have recurrant melanoma, oh yeah, have kehloids also. 

Clear margins are great but that is no guarantee that there wasn't a loose cell out there .  A primary comes from a mole, a recurrance does not. Basically pathology is the final determentant.  If it is an obvious new mole, growing slow and looks normal  than I would consider waiting till the appointment, otherwise I would play it on the safe side and call your Dr.  Back before my recurrance I even called for an emergency appointment only to find out that there was an ingrown hair trying to come through the mole.   Always safer to be sure.  If You have to travel to mayo and it's a huge issu then you might want to look for a good local dermatologist.

Let us know how it turns out,

Linda

Stage IV

Appointment on Tuesday hoping to be told that this stomach pain is just gallbladder!!!!

A new primary is totally unique and not related to the first melanoma.  It would have its own Breslow depth and other characteristics.  Metastatic lesions have different characteristics.  The pathology is what tells them apart, not location.  New primaries can be located anywhere on the body.  If you were to have new pigmented lesion inside the scar area or very close to the original primary, you would most likely be thinking recurrent lesion, not a new primary.  Doesn't mean it has to be a metastasis, but new primaries aren't common and you have to rule out the obvious.  I have scar areas that have pigment in them that aren't a recurrence, they are freckles.  I have a lot of freckles in the area and it is common for them to form in scar areas.  I also have pigment in scars (not melanoma) where I have no freckles.  Your darker area doesn't have to be a recurrence, it could be part of the scaring or keloid as well.  And while your WLE was "clear", it's not a guarantee against a recurrence.  They don't analyze the WLE tissue as closely as they do the biopsy.  It is possible that single cells could be missed.

If you think the area is pigmented again, then it may be worth an early derm visit for peace of mind.

Best wishes,

Janner

A new primary is totally unique and not related to the first melanoma.  It would have its own Breslow depth and other characteristics.  Metastatic lesions have different characteristics.  The pathology is what tells them apart, not location.  New primaries can be located anywhere on the body.  If you were to have new pigmented lesion inside the scar area or very close to the original primary, you would most likely be thinking recurrent lesion, not a new primary.  Doesn't mean it has to be a metastasis, but new primaries aren't common and you have to rule out the obvious.  I have scar areas that have pigment in them that aren't a recurrence, they are freckles.  I have a lot of freckles in the area and it is common for them to form in scar areas.  I also have pigment in scars (not melanoma) where I have no freckles.  Your darker area doesn't have to be a recurrence, it could be part of the scaring or keloid as well.  And while your WLE was "clear", it's not a guarantee against a recurrence.  They don't analyze the WLE tissue as closely as they do the biopsy.  It is possible that single cells could be missed.

If you think the area is pigmented again, then it may be worth an early derm visit for peace of mind.

Best wishes,

Janner