- December 23, 2018 at 8:52 am
So I’ll try to make this short lol. New lesion grew on lower Leg that looked like a sun spot. It darkened over time however recently it became elevated with multi pigment. I am a nurse,psych, btw. I made an appt with a local derm that I have never been too due to them being able to see me within a few days. I am a very anxious person with mild white coat syndrome. I don’t get it myself because I work with doctors but aye I dunno man lol. So after An hour wait in the waiting room the medical assistant called me and I show her what I’m therefore and she said that’s it I said yes but while I’m here can I do a whole body check I haven’t had one in years she said well yes get undressed the physician assistant walks in very straightforward no personality looks at my lesion does a quick scan of my body in a minute and asked me if I go tanning I told her no I did as a child unfortunately but I haven’t gone in 20 years I am outside a lot there with my kids I told her I was a nurse myself she looked at the Legion and said OK we’re going to take this off I’m going to shave it no I’ve done my research I did not want to shave biopsy due to the fact of not proper staging history. She legit looked st the clock and said she didn’t have time and she will do a deeper shave. I still said no please I have read so much about shaves and my mole looks like classic melanoma and excisional biopsy would be best. She said she knows what she’s doing and she’s been doing it for 11 years and they can stage it with a shave. She said if it’s melanoma they have to go back in away and a shave will result in a better scar. At this point I just said whatever get it off my leg because you’re the expert. 2 seconds later it was off and she told me come back in 6 months and she will call me for an appt as she can not give results over the phone. Well 7 days later I got a call from her saying it was malignant melanoma and first words were I was able to get deep enough and went on and on saying it was caught early and she was setting me up for wle with snb with oncologist and surgeon in the city 45 minutes away. Um. She said it looked good no mitosis but because of my age and .75mm breslow she said just to be safe. I’ll show my path report.. it looks really good so I am so confused. Any of y’all help me either reading this or any insight? Please and thank you
- December 23, 2018 at 9:06 am
Sorry i don’t know how to send pic
MALIGNANT MELANOMA INVASIVE EXTENDING TO TISSUE EDGES
procedure SHAVE BIOPSY
location R CENTRAL SHIN
type SUPERFICIAL SPREADING
anatomic level 3
greatest breslow 0.75MM
radial growth PRESENT
vertical growth PRESENT EPITHELIOD
margins EXTENDING TO PERIPHERAL TISSUE EDGES
mitosis 0 per square MM
til PRESENT NON BRISK
neural vascular regression and microsat ABSENT
path stage pT1A
says ki/67 shows high proliferation in dermal component multiple tissue levels examined
bottom says recieced piece of roughened skin measuring 0.8 x 0.7 x 0.2 cm. Specimen is inked black at the surgical resection margin, quadrisected and submitted in cassette
- December 23, 2018 at 4:22 pm
As the other poster said, the shave was not an issue because it was deeper than the lesion, i.e. the base of the lesion was not involved. So depth information is preserved. Width was not wide enough. Mitosis isn't used in staging anymore and typically anything over .8mm requires a SLNB. You're borderline.
Having had 2 melanomas on my shins, get prepared for the WLE to be quite tight. The SLNB was not offered for my lesions – staging was different at that time and 1mm was the cutoff. The SLNB will be in your groin and typically isn't too bad. Looks like you really did catch this fairly early and hopefully the procedures will be all you need to go through – and that you'll continue to be stage 1a.
- December 27, 2018 at 9:19 am
Grrrr I am angry at your derm! I cannot believe that YOU told HER the gold standard (excisional biopsy) but SHE railroaded YOU into an (incomplete) shave. Luckily she preserved depth, but missed the edges which is a concern but of course less of a concern than bisecting the base. It really is borderline for SLNB, in Australia you would not qualify as there is no concerning features (ulceration, mitosis). Just a straight WLE and you are on your way. I still want to slap that derm though… I don't think age is very interesting or has any prognostic value. For me it would be yes to the WLE, no to the SLNB oh and did I mention… your derm is arrogant beyond words. Sorry but that just makes me livid.
- December 29, 2018 at 2:31 am
Thank you!! I’m still so angry! I am not an emotional person at all but I legit left there crying and felt like complete shit. I knew it was melanoma. I took pics and I just knew but nope. I understand she was rushed and so far behind but if she didn’t get deep enough I would’ve been even more livid. I’m very grateful she did thank god. They’ve set me up for WLE and biopsy due to vertical growth and new staging or something. I have a team of doctors I have to meet with in a few days.
MichelleRHGParticipantThe way I look at it, she may have gotten deep enough but not wide enough since the melanoma extends TO the peripheral edges. Also, my derm has said she can actually get deeper with a shave than a punch sometimes because she can maneuver and do a wedge dissection. Regardless, your doctor was rude! Hoping after you have the wider excision there will be nothing more to worry about. Someone else here may have more/better input. Good luck!!
- December 23, 2018 at 1:10 pm
Tagged: cutaneous melanoma
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