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Help-Where do I currently stand?

Forums Cutaneous Melanoma Community Help-Where do I currently stand?

  • Post
    bandj5
    Participant

      Hello! Can someone help me make sense of where I currently stand? I just received my surgical pathology report. I am confused on the findings and how it relates to my original pathology report. What staging is correct? Am I free and clear? What does “Invasive Type: Invasive. Microscopic focus of residual tumor is present in block B4” mean? Any information you can provide would be much appreciated. Thank you!

      Original Dermatopathology Report:

      Skin, Left Lateral Lower Leg, Shave Biopsy

      Malignant melanoma, superficial spreading.

      Breslow measurement: 1.2 millimeters, transected at the base.

      Clark’s level: Al least IV, transected at the base.

      Surface ulceration: Absent.

      Precursor lesion: Not identified.

      Regression: Not identified.

      Lymphocytic response: Non-brisk.

      Mitotic index: 7 per square millimeter.

      Lymphovascular channel involvement: Not identified.

      Neurotropism: Not identified.

      Satellite lesions: Not identified.

      Margins: Tumor extends to the deep and lateral margins.

      Tumor staging: At least pT2aNX

      Surgical Pathology Report

      “Part B is labeled "left lateral leg melanoma short 12 o'clock proximal and long stitch at 3 o'clock posterior". Submitted is an ellipsoid segment of light tan and dark blue skin and yellow-tan thick subcutaneous
      tissue measuring 5.5 cm 12-6 o'clock and 3 cm 3-9 o'clock. It is uniformly thick at 1.2 cm. Centrally located is a shallow ulcer type lesion measuring 0.7 cm in diameter, the 12 o'clock margin measures 2 cm, 3 o'clock margin 0.7 cm, 6 o'clock 2 cm and 9 o'clock 1 cm away from the ulcerated area. The surgical margins are painted as follows: 12 o'clock blue, 3 o'clock yellow, 6 o'clock green, 9 o'clock red and deep is black. Upon sectioning the deep margin measures 1 cm from the ulcer. It is sampled and representative sections are submitted as follows: the lesion in its entirety including the 3 o' clock, deep and 9 o'clock margins in cassettes B1-B4; cassette B5 is the perpendicular section of the 12 o'clock tip; and B6 is the perpendicular section of the 6 o'clock tip.”

      CAP SYNOPTIC REPORT MELANOMA
      Site: Left lateral leg

      Procedure: Wide local excision and excision of three sentinel lymph nodes

      Laterality: Left

      Invasive Type: Invasive. Microscopic focus of residual tumor is present in block B4

      Maximum Tumor Thickness (Breslow): 0.15 mm, please see prior shave biopsy report also which may have shown greater depth of invasion

      Anatomic Level: II to III, please see prior shave biopsy report also which may have shown greater depth of invasion

      Ulceration: Not identified

      Mitotic Rate: Not identified, please see prior shave biopsy report also

      Lymph-Vascular Invasion: Not identified

      Perineural Invasion: Not identified

      Tumor Growth Phase: Vertical

      Tumor Regression: Not identified

      Tumor Infiltrating Lymphocytes: Not identified

      Satellite Nodules: Not identified

      Surgical Margins:

      Skin Peripheral Margin: Free of tumor, 0.9 cm from 3 o' clock/ posterior margin
      Deep Margin: Free of tumor, 1.0 cm away

      PATHOLOGIC STAGING:
      pT1a, please see prior shave biopsy report also which may have shown greater depth of invasion

      pN0 (sn): Number of Lymph Nodes Examined: 3. Number of Lymph Nodes Positive: 0

      HMB 45 and Melan A IHC stains are examined on lymph node blocks and are negative for metastasis. All IHC controls are satisfactory.

      Ancillary Studies: Please order any necessary ancillary tests on prior shave biopsy specimen as the tumor volume in the current specimen is too scant for molecular tests.

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    • Replies
        stars
        Participant

          I am sorry you are going through this. My best guess is that original shave biopsy of a suspected melanoma (never accept this – always demand a proper excisional biopsy in future) has made it nigh on impossible to ever guess the real depth of your melanoma. because hte shave biopsy bisected the base. What residual found on the WLE is impossible to 'match' with the original stupid shave excision so I would take the first path report as leading, but unfortunately with 'at least' 1.2mm. Either way, treatement is the same… perhaps a further exicision is needed and probalby a SLNB.

            bandj5
            Participant

              Thank you so much! I was afraid of that, having to have another surgery. So they never got it all the first time, correct? They did the SLNB the first time, taking out 3 lymph nodes, which were negative. 

              SOLE
              Participant

                And the negative node result is very encouraging despite going through melanoma. I also had a “at least” depth reported of my original lesion 2.5 years ago. I you are up for it and you want to push hard on the advocacy for your care, try to get in some clinical trial with some proven immunotherapy agents like Yervoy or Opdivo or Keytruda. I so know how difficult this is. We all get it here. Your odds of making it may not be bad at all. You could end up a early stage 2 at worst I think. Look up AJCC 8th edition on melanoma for up to date odds. My best to you. 

                bandj5
                Participant

                  Ok, I’m pretty upset right now. The plastic surgeon called a little bit ago and gave me the results, which I already had thanks to patient portal and what you have seen above. He tells me everything looks good. I asked him about the microscopic melanoma found and he said all I need to do going forward is to see my Dermatologist every 6 months. How do you leave melanoma behind? What, it’s just going to sit there for the rest of my life and do nothing? Now what? Help me make sense out of this one because I can’t see it right now!

                  Jamie1960
                  Participant

                    Don't leave anything behind; if you are not satisfied, seek a second opinion and resect.

                    Too many people on this board have been victims of half measures, albeit well-intentioned; your best advocate will always be yourself.

                    Jamie1960
                    Participant

                      Don't leave anything behind; if you are not satisfied, seek a second opinion and resect.

                      Too many people on this board have been victims of half measures, albeit well-intentioned; your best advocate will always be yourself.

                    cancersnewnormal
                    Participant

                      The second surgery is noted to have clear margins at .9 cm and 1 cm at the deepest point. Lymph nodes are negative (which is good). The reason for the confusion, is that your original shave removal did not get the entire lesion. That report stated a 2a stage. The wide margin excision which included 3 lymph nodes shows a more shallow depth, because the only measurement was on the little sliver that had been left behind from the FIRST shave biopsy. In other words… the remaining tid bit was only a stage 1a… sooooo…. your original shave got MOST of it. Based upon the two path reports here, you are currently clear of mutant cells. The ancillary studies they're seeking would presumably be for what type of melanoma it is… ex: superficial spreading, nodular, etc…  There wasn't enough tumor left behind for them to test such things with the second surgical sample. This appears to me, that you are staged at 2a… meaning derm appointments every 3-6 months to watch for anything new. That said… you are your best watchdog, and you know you better than any doc who is going to see you a couple of times each year. So if something new or changing crops up, it's up to YOU to point it out. ALLLLLL of that aside… if you feel there may be an error on the reports, or the docs haven't clearly detailed explanations for any of your questions, you can have the slides sent to another lab for a second opinion. Looking over all of this, my only question for the doc would be "Are .9cm and 1cm sufficient margins?"  Standard 'treatment' for stage 2a is as follows: "The tumor is 1–2 mm in thickness and ulcerated, OR the tumor is 2–4 mm in thickness and not ulcerated. There is no evidence the tumor has spread to lymph nodes or other organs. The tumor and some surrounding tissue are removed surgically. Sentinel lymph node biopsy (SLNB) may be recommended. Usually no further treatment is necessary; however, skin examination to evaluate for a new melanoma or other skin cancer should continue."

                        Bubbles
                        Participant

                          I agree with Niki, above!  Wishing you my best.  Celeste

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