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Husband just diagnosed 1b and pathology report confusing
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Husband just diagnosed 1b and pathology report confusing

› Forums › General Melanoma Community › Husband just diagnosed 1b and pathology report confusing

  • Post
    • June 21, 2019 at 11:59 am
    StephH19
    Participant
      On Tuesday my husband received a call that his biopsy came back as Melanoma. That evening my husband went up to the office to have his stitches removed and the P.A. gave him his pathology report. She didn’t say much to him besides don’t google and freak yourself out. She told him it was the beginning stages, not very deep, probably superficial spreading Melanoma. We have been referred to a plastic surgeon for a wide local excision and sentinel node biopsy. My husband’s consultation appointment is Monday. In the meantime I’ve been trying to wrap my head around all of this and gain as much information to prepare myself for whatever lies ahead. In my opinion the pathology report seems very vague and I am confused if the margins on the biopsy were clear. I’m not too certain on what I am supposed to. Is it normal for a us to be referred to a plastic surgeon? Do I find an oncologist as well? I will post the biopsy report and any information or help will be greatly appreciated. I don’t know if I am overreacting but I am terrified. My husband is 33.

      R. Inferior medial midback, biopsy by punch method

      Melanoma, spindle cell type, coming to within 0.5mm of the biopsy margin arising in Melanoma in Situ, Involving the biopsy side margin
      Breslow depth: 0.64
      Clark level: 4
      Mitotic rate: approximately 1 per mm squared
      ulceration: not identified
      tumor infiltrating lymphocytes: not identified
      microsatellitosis: not identified
      lymphovascular invasion: not identified
      perineural invasion: not identified
      regression: not identified
      macroscopic satellite nodules: not identified
      pathologic stage: pt1b, nx,mx

      Microscopic description:

      There is a population of atypical spindled melanocytes in the dermis. An epidermal proliferation of melanocytes is also present with pagetoid spread. The biopsy margins are free. Intradepartmental consultation was obtained.

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    • Replies
        • June 21, 2019 at 2:50 pm
        Debbiem
        Participant
          It is scary to get that first call and hear you or your spouse has cancer. Sorry to hear about your husband.
          Many doctors refer out to plastic surgeons as they have more experience.
          I would recommend going to a dermatologist who has experience with melanoma and an Oncologist who specializes in melanoma if there’s one in your area.

          My first melanoma diagnosis was in 2005 and I wish I would have done these two things. I was rediagnosed last year but my previous dermatologist missed several melanomas for years. She was not a melanoma dermatologist.

          Regarding the lab report, melanoma in Situ is the top layer of skin which requires surgery for removal. They take about 1/2” around the tumor to get clear margins. They are checking a lymph node to make sure it hasn’t spread. This is a conservative (good) approach. Breslow depth is the thickness of it. Clark’s level is rating its invaseness.
          If the staging stays 1b, they can completely remove the cancer by surgery which is good.

          There are some great people on this site who have articles with more info so hopefully others will respond.

          I want to encourage you as I’ve had over 40 surgeries in 10 months for many melanomas. My case is extremely rare though. The medical community has been advancing melanoma treatment since my first diagnosis in 2005 and it’s pretty awesome to see how far treatment has come.

          I pray your husband’s surgery goes well.
          Debbie

            • June 22, 2019 at 5:17 am
            StephH19
            Participant
              Debbie,

              Thank you for your kind words and prayers are always appreciated.

              I am still trying to understand the pathology report. Does it sound to you as if there is Melanoma in situ and stage 1 Melanoma located together? I don’t know why they would say margins are free under the microscopic section if there are still bad cells.

              I hate this waiting game and I hope Monday gets here fast. I have so many questions. In your opinion do I wait for the plastic surgeon to refer us to an oncologist or is it up to us to make that call? I have no clue how any of this works.

              My husband is so laid back and doesn’t seem too worried. I am over here worrying enough for both of us.

              • June 23, 2019 at 4:26 am
              casagrayson
              Participant
                I wouldn’t worry about seeing an oncologist until you have the WLE and the sentinel node biopsy. If the nodes are clear, then there will be no need for an oncologist. All that will be required is more frequent dermatological checks (every 3 months for a year).
                • June 23, 2019 at 3:15 pm
                Debbiem
                Participant
                  I understand the worrying part. My husband had stage 4 cancer in 2006 and I worried a lot until I prayed and finally had peace about it. He’s 13 years clear and going strong. 🙂

                  Regarding the lab report, it looks like the 1b melanoma came out of the melanoma in Situ. I don’t know if they gave you the detailed lab report. Sometimes it helps bring clarity to what is going on. They give as much detail as possible so the doctors know how to treat it. The summary you shared seems to indicate that there was a melanoma in Situ (top layer of skin) that ended up going into the next layer of skin. The good news is that Monday is almost here. Hang in there!

                  I hope his appointment goes well tomorrow and that surgery will take care of it.

                  Blessings,
                  Debbie

                  • June 23, 2019 at 3:15 pm
                  Debbiem
                  Participant
                    I understand the worrying part. My husband had stage 4 cancer in 2006 and I worried a lot until I prayed and finally had peace about it. He’s 13 years clear and going strong. 🙂

                    Regarding the lab report, it looks like the 1b melanoma came out of the melanoma in Situ. I don’t know if they gave you the detailed lab report. Sometimes it helps bring clarity to what is going on. They give as much detail as possible so the doctors know how to treat it. The summary you shared seems to indicate that there was a melanoma in Situ (top layer of skin) that ended up going into the next layer of skin. The good news is that Monday is almost here. Hang in there!

                    I hope his appointment goes well tomorrow and that surgery will take care of it.

                    Blessings,
                    Debbie

                    • June 24, 2019 at 6:56 pm
                    StephH19
                    Participant
                      Debbie,

                      How wonderful your husband is doing so well!

                      I feel better after today I suppose. I don’t care for the plastic surgeon we saw today. He had a cocky smile on his face the whole appointment. He seemed to think it was ridiculous I was so concerned. No one had really explained anything to us!

                      The game plan seems to be that the original biopsy will be sent off for some sort of genetic testing that will take 2-3 weeks. After the results there will be a WLE with 2cm margins. The surgeon seemed confindent that would be all that is needed. As of right now he doesn’t plan on doing a sentinel node biopsy. I guess it really just depends on the gene test. The doctor referred us to an Oncologist that my husband will see on Monday. Maybe, she has heard of Spindle Cell Melanoma because the surgeon sure hadn’t. It looks like nothing will be done for at least 3 weeks until we get back from vacation.

                    • April 15, 2021 at 10:23 am
                    Anders
                    Participant
                      I just found this thread after searching around. I am also stage 1b spindle cell melanoma. How is your husband doing?? I see this is an older post. I was dx Oct 2020, on my thigh, had WLE and 2 SLNB’s both negative. Hope all is well!
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