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Janner and all Stage 1 B’s can you help me?

Forums General Melanoma Community Janner and all Stage 1 B’s can you help me?

  • Post
    Francesca
    Participant

    Hi,

     

    I am 33 year old Canadian newly diagnosed Stage 1B, had my WLE and SLNB last month and while all the tissue and nodes were clear I still have some questions about original pathology.

    Originally, I had a shave biopsy which was bisected; one pathologist reported 1 mm and other 1.45 not ulcerated Clark 3  (one patholgist said deeper levels of skin show involvement of deep and lateral resection margins which were not reviewed by other pathologist) Surgeon didnt seem concerned when I pointed this out. 

    Hi,

     

    I am 33 year old Canadian newly diagnosed Stage 1B, had my WLE and SLNB last month and while all the tissue and nodes were clear I still have some questions about original pathology.

    Originally, I had a shave biopsy which was bisected; one pathologist reported 1 mm and other 1.45 not ulcerated Clark 3  (one patholgist said deeper levels of skin show involvement of deep and lateral resection margins which were not reviewed by other pathologist) Surgeon didnt seem concerned when I pointed this out. 

    Since it was a shave biopsy I  expected depth to increase but onc surgeon told me there was absolutely no evidence of melanoma in wle tissue so depth remains 1.45 (seems like this never happens with shave biopsies, am I right). Surgeon said they throughly examine tissue with hundreds of slides and hence 3 week wait for results!! She said I should be reassured it didnt have any further melanoma in wle. But somehow I am not.

    Histologic Type: Other – Lentiginous. Now is this the same as "lentigo maligna melanoma" because that is rare  associated with elderly/sun damaged and slow evolving which is not my case. Noticed it on posterior upper shoulder/arm in shower 6 months ago. It was brown and symmetrical ( glad I insisted I get it off soon!)

    I have also read its difficult to decipher between lentigo maligna and lentigo maligna melanoma. Just seems funny because pics Ive seen online dont look anything at all like mine.

    Mitosis is listed as 3 by one pathologist and >1mm2 by the other. Peripherl margins say both involved by invasive melanoma and involved by melanoma in situ. Even though I should be relatively pleased with my surgery outcome (though realize no guarantee) I am now wondering if I should ask for another pathologist to examine orginal tumor. Will it change my staging – probably not but I am so scared because 1.45 seems relatively risky. What is your opinion? Thanks and best wishes to you all.

    Francesca

     

     

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  • Replies
      LynnLuc
      Participant

      I am not stage 1…I am stage 4 since 2009…but NED for 2 years…but your post stood out because  my primary was lentigo maligna melanoma and I was dx'ed when in my 30's. Lentiginous is NOT the same…it just means its a flat brownish pigmented spot on the skin, which could end up being other kinds of skin cancer or none at all…I have a very large lentiginous mark on the side of my face which is not melanoma or any other thing- in fact mine is harmless .

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      LynnLuc
      Participant

      I am not stage 1…I am stage 4 since 2009…but NED for 2 years…but your post stood out because  my primary was lentigo maligna melanoma and I was dx'ed when in my 30's. Lentiginous is NOT the same…it just means its a flat brownish pigmented spot on the skin, which could end up being other kinds of skin cancer or none at all…I have a very large lentiginous mark on the side of my face which is not melanoma or any other thing- in fact mine is harmless .

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        Francesca
        Participant
        Hi Lynn,

        Thanks for your reply- I am so glad to read your NED. I am so scared about recurrence and progressing. I am beside myself with worry. I also wonder how one will catch a recurrence since scanning is only done if one has symptoms and we know that is not often the case. I suppose lentiginous really isn’t a type like Nodular or SSM- I want to know more about my original tumor although will it really change my fate- probably not. I appreciate the time you took to reply and wish you well!

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        Francesca
        Participant
        Hi Lynn,

        Thanks for your reply- I am so glad to read your NED. I am so scared about recurrence and progressing. I am beside myself with worry. I also wonder how one will catch a recurrence since scanning is only done if one has symptoms and we know that is not often the case. I suppose lentiginous really isn’t a type like Nodular or SSM- I want to know more about my original tumor although will it really change my fate- probably not. I appreciate the time you took to reply and wish you well!

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        Francesca
        Participant
        Hi Lynn,

        Thanks for your reply- I am so glad to read your NED. I am so scared about recurrence and progressing. I am beside myself with worry. I also wonder how one will catch a recurrence since scanning is only done if one has symptoms and we know that is not often the case. I suppose lentiginous really isn’t a type like Nodular or SSM- I want to know more about my original tumor although will it really change my fate- probably not. I appreciate the time you took to reply and wish you well!

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      LynnLuc
      Participant

      I am not stage 1…I am stage 4 since 2009…but NED for 2 years…but your post stood out because  my primary was lentigo maligna melanoma and I was dx'ed when in my 30's. Lentiginous is NOT the same…it just means its a flat brownish pigmented spot on the skin, which could end up being other kinds of skin cancer or none at all…I have a very large lentiginous mark on the side of my face which is not melanoma or any other thing- in fact mine is harmless .

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      9 Sandy
      Participant

      Hi,  I have been 1b for 9 yrs.  I had l.00 with clark level 4, nodes clear.  I was very worried also, mine was a desmoplastic melanoma, very uncommon no color to it at all just a little puffy skin, found it on my left forearm myself.  My Mother and Sister both had one same place, I also found theirs before mine.  As time goes by I don't realy think about it anymore, although I see Derm every 2 mos, because I have had many other skin cancers not melanoma always being biopsied.  Hang in there and try to live a normal life, worry is not good.  Best Wishes,  Sandy

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      9 Sandy
      Participant

      Hi,  I have been 1b for 9 yrs.  I had l.00 with clark level 4, nodes clear.  I was very worried also, mine was a desmoplastic melanoma, very uncommon no color to it at all just a little puffy skin, found it on my left forearm myself.  My Mother and Sister both had one same place, I also found theirs before mine.  As time goes by I don't realy think about it anymore, although I see Derm every 2 mos, because I have had many other skin cancers not melanoma always being biopsied.  Hang in there and try to live a normal life, worry is not good.  Best Wishes,  Sandy

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        Francesca
        Participant
        Thanks Sandy- I will take your advice and go for a jog ( signed up for a 5 K for melanoma marathon so have to start prepping). I suppose everyone has coping mechanisms when diagnosed and mine has been to literally confine myself to my room and read every piece of medical literature. I have a science background and my childhood friend is a clinical trial coordinator for Roche Zelboraf so needless to say we been crying together. I just got married and my husband is in Europe; my plan was to join him in Switzerland and I got my visa just as I was diagnosed. I pushed hard to have an appt with med onc since that isn’t norm for stage 1b and I think I will ask for a second opinion from an actual dermopathologists at princess Margaret hospital ( our big Canadian melanoma centre) . I am just not comfortable with all the differences b/ w the 2 that originally reported. I tried to get transferred there but because I am deemed low risk they wouldn’t accept. To everyone responding your giving me so much support more than you’ll ever know. I will keep you all in my thoughts and prayers.

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        Francesca
        Participant
        Thanks Sandy- I will take your advice and go for a jog ( signed up for a 5 K for melanoma marathon so have to start prepping). I suppose everyone has coping mechanisms when diagnosed and mine has been to literally confine myself to my room and read every piece of medical literature. I have a science background and my childhood friend is a clinical trial coordinator for Roche Zelboraf so needless to say we been crying together. I just got married and my husband is in Europe; my plan was to join him in Switzerland and I got my visa just as I was diagnosed. I pushed hard to have an appt with med onc since that isn’t norm for stage 1b and I think I will ask for a second opinion from an actual dermopathologists at princess Margaret hospital ( our big Canadian melanoma centre) . I am just not comfortable with all the differences b/ w the 2 that originally reported. I tried to get transferred there but because I am deemed low risk they wouldn’t accept. To everyone responding your giving me so much support more than you’ll ever know. I will keep you all in my thoughts and prayers.

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        Francesca
        Participant
        Thanks Sandy- I will take your advice and go for a jog ( signed up for a 5 K for melanoma marathon so have to start prepping). I suppose everyone has coping mechanisms when diagnosed and mine has been to literally confine myself to my room and read every piece of medical literature. I have a science background and my childhood friend is a clinical trial coordinator for Roche Zelboraf so needless to say we been crying together. I just got married and my husband is in Europe; my plan was to join him in Switzerland and I got my visa just as I was diagnosed. I pushed hard to have an appt with med onc since that isn’t norm for stage 1b and I think I will ask for a second opinion from an actual dermopathologists at princess Margaret hospital ( our big Canadian melanoma centre) . I am just not comfortable with all the differences b/ w the 2 that originally reported. I tried to get transferred there but because I am deemed low risk they wouldn’t accept. To everyone responding your giving me so much support more than you’ll ever know. I will keep you all in my thoughts and prayers.

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        LynnLuc
        Participant

        One thing to remember…while I had mine removed  along with every mole on my body 4 years later it showed up in the same spot on my neck . It was removed again along with 5 SLN…they said all clear nothing to worry about…I have never had another spot on my skin………it showed up 9 years later in a lymph node by my heart and it was 6.8 cent at the widest…and so I was stage 4…while going to a derm doc is important…melanoma doesn't always show up on the skin…it just takes one micro cell to pass through sight unsee…to kill a person..

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        LynnLuc
        Participant

        One thing to remember…while I had mine removed  along with every mole on my body 4 years later it showed up in the same spot on my neck . It was removed again along with 5 SLN…they said all clear nothing to worry about…I have never had another spot on my skin………it showed up 9 years later in a lymph node by my heart and it was 6.8 cent at the widest…and so I was stage 4…while going to a derm doc is important…melanoma doesn't always show up on the skin…it just takes one micro cell to pass through sight unsee…to kill a person..

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        LynnLuc
        Participant

        One thing to remember…while I had mine removed  along with every mole on my body 4 years later it showed up in the same spot on my neck . It was removed again along with 5 SLN…they said all clear nothing to worry about…I have never had another spot on my skin………it showed up 9 years later in a lymph node by my heart and it was 6.8 cent at the widest…and so I was stage 4…while going to a derm doc is important…melanoma doesn't always show up on the skin…it just takes one micro cell to pass through sight unsee…to kill a person..

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      9 Sandy
      Participant

      Hi,  I have been 1b for 9 yrs.  I had l.00 with clark level 4, nodes clear.  I was very worried also, mine was a desmoplastic melanoma, very uncommon no color to it at all just a little puffy skin, found it on my left forearm myself.  My Mother and Sister both had one same place, I also found theirs before mine.  As time goes by I don't realy think about it anymore, although I see Derm every 2 mos, because I have had many other skin cancers not melanoma always being biopsied.  Hang in there and try to live a normal life, worry is not good.  Best Wishes,  Sandy

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      Janner
      Participant

      Sorry I'm late to the game, I was offline.

      Since it was a shave biopsy I  expected depth to increase but onc surgeon told me there was absolutely no evidence of melanoma in wle tissue so depth remains 1.45.    First, the depth value will never increase.  There are two issues.  If there is residual melanoma in the WLE, you cannot "add" that to the 1.45mm.  Because of the way biopsies are sliced and sectioned, you can never line up the samples.  So the portion in the WLE maybe be from a different part of the lesion altogether and not "in addition" to the 1.45mm.  When a lesion is bisected, it will always be "at least 1.45mm".  Second, it is fairly common for lesions with involved margins not to show anything in the WLE.  WLE tissue is not analyzed as closely as the biopsy, and "fibrosis", scar tissue and the healing process tend to obscure remaining melanoma.  However, if a significant depth still existed, I'm sure some evidence of it would remain.

      "Lentiginous" basically relates to "sun related".  Lentigo Maligna Melanoma is typically called out specifically if that was the type.  These is no confusion between Lentigo Maligna and Lentigo Maligna melanoma.  Lentigo Maligna is totally confined to the epidermis and considered in situ.  Lentigo Maligna Melanoma is invasive and has a depth.  LMM is often found in the elderly, but it doesn't have to be.  I know 2 women who were in their 30's with this diagnosis. 

      Mitosis is listed as 3 by one pathologist and >1mm2 by the other.   Basically, if it doesn't say 0 or <1, then it is considered >= 1.  The only staging criteria for prognosis is <1.  Since yours isn't, you're lumped with everyone else >=1.  There really is nothing called out for higher mitosis values in terms of prognosis at this time.

      Having your slides read one more time will not change your staging – having a bisected lesion does complicate things.  That's why most of us here don't allow shave biopsies done on lesions suspected of melanoma  It can bisect the lesion and compromise staging.

      The good news here is the negative SNB.  Never a guarantee, but obviously that's what you want to see.  Hope I've helped answer a few questions for you.

      Best wishes,

      Janner

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      Janner
      Participant

      Sorry I'm late to the game, I was offline.

      Since it was a shave biopsy I  expected depth to increase but onc surgeon told me there was absolutely no evidence of melanoma in wle tissue so depth remains 1.45.    First, the depth value will never increase.  There are two issues.  If there is residual melanoma in the WLE, you cannot "add" that to the 1.45mm.  Because of the way biopsies are sliced and sectioned, you can never line up the samples.  So the portion in the WLE maybe be from a different part of the lesion altogether and not "in addition" to the 1.45mm.  When a lesion is bisected, it will always be "at least 1.45mm".  Second, it is fairly common for lesions with involved margins not to show anything in the WLE.  WLE tissue is not analyzed as closely as the biopsy, and "fibrosis", scar tissue and the healing process tend to obscure remaining melanoma.  However, if a significant depth still existed, I'm sure some evidence of it would remain.

      "Lentiginous" basically relates to "sun related".  Lentigo Maligna Melanoma is typically called out specifically if that was the type.  These is no confusion between Lentigo Maligna and Lentigo Maligna melanoma.  Lentigo Maligna is totally confined to the epidermis and considered in situ.  Lentigo Maligna Melanoma is invasive and has a depth.  LMM is often found in the elderly, but it doesn't have to be.  I know 2 women who were in their 30's with this diagnosis. 

      Mitosis is listed as 3 by one pathologist and >1mm2 by the other.   Basically, if it doesn't say 0 or <1, then it is considered >= 1.  The only staging criteria for prognosis is <1.  Since yours isn't, you're lumped with everyone else >=1.  There really is nothing called out for higher mitosis values in terms of prognosis at this time.

      Having your slides read one more time will not change your staging – having a bisected lesion does complicate things.  That's why most of us here don't allow shave biopsies done on lesions suspected of melanoma  It can bisect the lesion and compromise staging.

      The good news here is the negative SNB.  Never a guarantee, but obviously that's what you want to see.  Hope I've helped answer a few questions for you.

      Best wishes,

      Janner

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      Janner
      Participant

      Sorry I'm late to the game, I was offline.

      Since it was a shave biopsy I  expected depth to increase but onc surgeon told me there was absolutely no evidence of melanoma in wle tissue so depth remains 1.45.    First, the depth value will never increase.  There are two issues.  If there is residual melanoma in the WLE, you cannot "add" that to the 1.45mm.  Because of the way biopsies are sliced and sectioned, you can never line up the samples.  So the portion in the WLE maybe be from a different part of the lesion altogether and not "in addition" to the 1.45mm.  When a lesion is bisected, it will always be "at least 1.45mm".  Second, it is fairly common for lesions with involved margins not to show anything in the WLE.  WLE tissue is not analyzed as closely as the biopsy, and "fibrosis", scar tissue and the healing process tend to obscure remaining melanoma.  However, if a significant depth still existed, I'm sure some evidence of it would remain.

      "Lentiginous" basically relates to "sun related".  Lentigo Maligna Melanoma is typically called out specifically if that was the type.  These is no confusion between Lentigo Maligna and Lentigo Maligna melanoma.  Lentigo Maligna is totally confined to the epidermis and considered in situ.  Lentigo Maligna Melanoma is invasive and has a depth.  LMM is often found in the elderly, but it doesn't have to be.  I know 2 women who were in their 30's with this diagnosis. 

      Mitosis is listed as 3 by one pathologist and >1mm2 by the other.   Basically, if it doesn't say 0 or <1, then it is considered >= 1.  The only staging criteria for prognosis is <1.  Since yours isn't, you're lumped with everyone else >=1.  There really is nothing called out for higher mitosis values in terms of prognosis at this time.

      Having your slides read one more time will not change your staging – having a bisected lesion does complicate things.  That's why most of us here don't allow shave biopsies done on lesions suspected of melanoma  It can bisect the lesion and compromise staging.

      The good news here is the negative SNB.  Never a guarantee, but obviously that's what you want to see.  Hope I've helped answer a few questions for you.

      Best wishes,

      Janner

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        Francesca
        Participant
        Thanks so much Janner- sucks that it’s a shave biopsy and may never know triue breslow. Ive had a hard time trying to assess risk of recurrence ( local, nodal, intransit, distal) with my specific stage and pathology. Is there any way to get a clearer understanding of is it too complex? I understand recurrence can happen at any time, carries poor prognosis, and generally happens within first 2 years. Read a study about lymphatic vessel invasion as a predictor of future metastasis (shields index). Are you aware of this? Are there any calculators to predict recurrence? What typically does a local recurrence look like? I haven’t been able to find pictures online ( have seen in transit pictures). Thanks again for all your help and I will pass it on with good deeds to others.
        Cheers,

        Francesca

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        Francesca
        Participant
        Thanks so much Janner- sucks that it’s a shave biopsy and may never know triue breslow. Ive had a hard time trying to assess risk of recurrence ( local, nodal, intransit, distal) with my specific stage and pathology. Is there any way to get a clearer understanding of is it too complex? I understand recurrence can happen at any time, carries poor prognosis, and generally happens within first 2 years. Read a study about lymphatic vessel invasion as a predictor of future metastasis (shields index). Are you aware of this? Are there any calculators to predict recurrence? What typically does a local recurrence look like? I haven’t been able to find pictures online ( have seen in transit pictures). Thanks again for all your help and I will pass it on with good deeds to others.
        Cheers,

        Francesca

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        Francesca
        Participant
        Thanks so much Janner- sucks that it’s a shave biopsy and may never know triue breslow. Ive had a hard time trying to assess risk of recurrence ( local, nodal, intransit, distal) with my specific stage and pathology. Is there any way to get a clearer understanding of is it too complex? I understand recurrence can happen at any time, carries poor prognosis, and generally happens within first 2 years. Read a study about lymphatic vessel invasion as a predictor of future metastasis (shields index). Are you aware of this? Are there any calculators to predict recurrence? What typically does a local recurrence look like? I haven’t been able to find pictures online ( have seen in transit pictures). Thanks again for all your help and I will pass it on with good deeds to others.
        Cheers,

        Francesca

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        Cooper
        Participant

        Actually shave biopsies have been shown in studies to be fine for melanoma pathology to be correct, it is punch biopsies that were shown to mess up the margins.  Here is the article about it:  http://www.sciencedaily.com/releases/2011/05/110523124400.htm 

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        Cooper
        Participant

        Actually shave biopsies have been shown in studies to be fine for melanoma pathology to be correct, it is punch biopsies that were shown to mess up the margins.  Here is the article about it:  http://www.sciencedaily.com/releases/2011/05/110523124400.htm 

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        Cooper
        Participant

        Actually shave biopsies have been shown in studies to be fine for melanoma pathology to be correct, it is punch biopsies that were shown to mess up the margins.  Here is the article about it:  http://www.sciencedaily.com/releases/2011/05/110523124400.htm 

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        Francesca
        Participant
        Thanks Ananymous- I will be seeing a med onc and I want to ask her more about what is known for recurrence rates for stage1b and when does it plateau. Seems there are variety of studies with different rates; and one retrospective study had recurrence rate of 18% for stage 1b patients being followed for a few decades. I read mitosis rate is more associated with size of tumor and that 3 is average for my depth however a lot of studies list ulceration, lymphatic invasion, and high mitosis rate as factors for increasing recurrence rates. Can’t seem to find what high would be my depth? Perhaps 6? If you have a new primary that doesn’t seem to correlate with decreases in survival if caught early however even local recurrence at site of WLE appears to have sig adverse consequences for survival. What exactly do I look for at my scar sight ? Bumps ? With a new scar everything is still settling so not sure if what I’m looking at is result of healing process…thanks for all your continuing help and I wish everyone health and happiness

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        Francesca
        Participant
        Thanks Ananymous- I will be seeing a med onc and I want to ask her more about what is known for recurrence rates for stage1b and when does it plateau. Seems there are variety of studies with different rates; and one retrospective study had recurrence rate of 18% for stage 1b patients being followed for a few decades. I read mitosis rate is more associated with size of tumor and that 3 is average for my depth however a lot of studies list ulceration, lymphatic invasion, and high mitosis rate as factors for increasing recurrence rates. Can’t seem to find what high would be my depth? Perhaps 6? If you have a new primary that doesn’t seem to correlate with decreases in survival if caught early however even local recurrence at site of WLE appears to have sig adverse consequences for survival. What exactly do I look for at my scar sight ? Bumps ? With a new scar everything is still settling so not sure if what I’m looking at is result of healing process…thanks for all your continuing help and I wish everyone health and happiness

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        Francesca
        Participant
        Thanks Ananymous- I will be seeing a med onc and I want to ask her more about what is known for recurrence rates for stage1b and when does it plateau. Seems there are variety of studies with different rates; and one retrospective study had recurrence rate of 18% for stage 1b patients being followed for a few decades. I read mitosis rate is more associated with size of tumor and that 3 is average for my depth however a lot of studies list ulceration, lymphatic invasion, and high mitosis rate as factors for increasing recurrence rates. Can’t seem to find what high would be my depth? Perhaps 6? If you have a new primary that doesn’t seem to correlate with decreases in survival if caught early however even local recurrence at site of WLE appears to have sig adverse consequences for survival. What exactly do I look for at my scar sight ? Bumps ? With a new scar everything is still settling so not sure if what I’m looking at is result of healing process…thanks for all your continuing help and I wish everyone health and happiness

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        Cooper
        Participant

        The depth of your lesion is the number one indicator of how you will do.  There is an article that now states mitosis is actually not a valid measure:  http://markahurt.com/files/documents/20101605hurt-Art-5-mitoses-in-melanoma.pdf 

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        Cooper
        Participant

        The depth of your lesion is the number one indicator of how you will do.  There is an article that now states mitosis is actually not a valid measure:  http://markahurt.com/files/documents/20101605hurt-Art-5-mitoses-in-melanoma.pdf 

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        Cooper
        Participant

        The depth of your lesion is the number one indicator of how you will do.  There is an article that now states mitosis is actually not a valid measure:  http://markahurt.com/files/documents/20101605hurt-Art-5-mitoses-in-melanoma.pdf 

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        JC
        Participant

        But, then others in the same article say, "In my opinion, dermal mitosis in thin melanomas reflects tumorigenic phase and therefore is of great concern." in the same article. . .

         

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        JC
        Participant

        But, then others in the same article say, "In my opinion, dermal mitosis in thin melanomas reflects tumorigenic phase and therefore is of great concern." in the same article. . .

         

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        JC
        Participant

        But, then others in the same article say, "In my opinion, dermal mitosis in thin melanomas reflects tumorigenic phase and therefore is of great concern." in the same article. . .

         

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        Janner
        Participant

        I haven't read the article, but know both methods are fine in terms of generally being able to diagnose melanoma.  Both are widely used for biopsy of pigmented lesions.  Shaves, however, can compromise staging.  That's often the case.  Shave biopsies are easy for docs, quick, require no stitches.  That's why they're often done.  But when they cut through a lesion, you lose the ability to accurately stage someone.  So while I will have punch biopsies, I will never again have a shave biopsy for suspected melanoma.  As depth is the most important factor and punch biopsies rarely compromise depth, that makes the most sense to me.

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        Janner
        Participant

        I haven't read the article, but know both methods are fine in terms of generally being able to diagnose melanoma.  Both are widely used for biopsy of pigmented lesions.  Shaves, however, can compromise staging.  That's often the case.  Shave biopsies are easy for docs, quick, require no stitches.  That's why they're often done.  But when they cut through a lesion, you lose the ability to accurately stage someone.  So while I will have punch biopsies, I will never again have a shave biopsy for suspected melanoma.  As depth is the most important factor and punch biopsies rarely compromise depth, that makes the most sense to me.

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        Janner
        Participant

        I haven't read the article, but know both methods are fine in terms of generally being able to diagnose melanoma.  Both are widely used for biopsy of pigmented lesions.  Shaves, however, can compromise staging.  That's often the case.  Shave biopsies are easy for docs, quick, require no stitches.  That's why they're often done.  But when they cut through a lesion, you lose the ability to accurately stage someone.  So while I will have punch biopsies, I will never again have a shave biopsy for suspected melanoma.  As depth is the most important factor and punch biopsies rarely compromise depth, that makes the most sense to me.

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        Janner
        Participant

        Here's the deal.  No analysis of your pathology reports is going to give you the answer you want.  You cannot deduce whether or not you will have a recurrence or what your particular odds are given your exact factors.  There will always be percentages of high risk individuals who never do, and low risk individuals that do recur.  The factors that have shown to be the most predictive are the ones currently used in staging.  Certainly other factors may be introduced in the future as anaylsis shows other significant factors, but the staging guidelines are the best we have at the moment for predicting your prognosis.  The analysis was done on a large group of people giving you the best information you can have.  Beware reading about studies that only have small population numbers as results may not be the same when done over a large population.  Time will help, but no amount of research is going to answer your question for you.  It sucks, but it's the reality.

        As for "what does it look like", it will look different.  Maybe pigmented, maybe a bump under the skin.  For the first year, your scar will be healing and you may have scar tissues, stitches or just plain healing that causes changes in the scar.  Have any other incisions you watched heal?  You're looking for something that doesn't seem to be a normal part of healing.  If you see something concerning, ask your doctor.  In addition, ask your doctor how to palpate your lymph basin (same as the SNB basin).  You should also pay attention to that area and be looking for swollen/hard lymph nodes.  Be aware that while you are still healing or if you have trauma, lymph nodes will swell and it is most likely unrelated to melanoma.

        I wish I could be more help, but you're not going to find the help you want… an answer to your future.  The more research you do, the more you will know about melanoma – but not how it will apply to you.  Believe me, I know this to be true.  Excessive research causes excessive anxiety (speaking from experience).  Hang in there,

        Janner

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        Cooper
        Participant

        Janner, you should read the article because the thinking on what is a better biopsy has changed.  You would prefer a punch, but in fact punch biopsy gives lousy incorrect margins. A deep shave is proven to give the best margins and depth when compared to a simple shave or punch.  The best biopsy however is always going to be the excisional which takes a stitch or two to close.  It often captures the whole melanoma.

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        Francesca
        Participant
        Can’t express how my all your posts are helping me; I will ask for excisional in the future. I agree Janner there is no crystal ball and have decided instead of being cooped up reading thousands of clinical trials etc in hopes of finding some sort of way to figure out my risk of recurrence/death I am going to focus my efforts elsewhere. I signed up for a melanoma marathon and need to start putting my attention to this commitment. I have a lofty goal $$ set and really want to achieve it! I also will tell everyone I know to check their skin routinely and be aware ( and ask for a biopsy if removal isn’t recommended). I feel selfish for being so preoccupied with my own fears of this cancer. I need to give back to those affected by melanoma to make me feel productive. I truly wish you all happiness and above all else love.

        Francesca

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        Francesca
        Participant
        Can’t express how my all your posts are helping me; I will ask for excisional in the future. I agree Janner there is no crystal ball and have decided instead of being cooped up reading thousands of clinical trials etc in hopes of finding some sort of way to figure out my risk of recurrence/death I am going to focus my efforts elsewhere. I signed up for a melanoma marathon and need to start putting my attention to this commitment. I have a lofty goal $$ set and really want to achieve it! I also will tell everyone I know to check their skin routinely and be aware ( and ask for a biopsy if removal isn’t recommended). I feel selfish for being so preoccupied with my own fears of this cancer. I need to give back to those affected by melanoma to make me feel productive. I truly wish you all happiness and above all else love.

        Francesca

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        Francesca
        Participant
        Can’t express how my all your posts are helping me; I will ask for excisional in the future. I agree Janner there is no crystal ball and have decided instead of being cooped up reading thousands of clinical trials etc in hopes of finding some sort of way to figure out my risk of recurrence/death I am going to focus my efforts elsewhere. I signed up for a melanoma marathon and need to start putting my attention to this commitment. I have a lofty goal $$ set and really want to achieve it! I also will tell everyone I know to check their skin routinely and be aware ( and ask for a biopsy if removal isn’t recommended). I feel selfish for being so preoccupied with my own fears of this cancer. I need to give back to those affected by melanoma to make me feel productive. I truly wish you all happiness and above all else love.

        Francesca

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        Janner
        Participant

        I'm not impressed with the article that justifies shaves as ok.  Maybe you would be fine if your lesion was bisected but i would not even if the WLE was clear.  (I have had a deep shave for melanoma #3 and was lucky I had clear deep margins – I won't do this again).  This article justifies the shave saying the majority aren't upstaged because of the WLE.  But in my mind, you have lost valuable information as once the lesion is bisected, you will never again know the true depth.  And most shaves aren't "deep" shaves.  As for punches, if the lesion can't be contained in a punch, then an excisional biopsy or shave should be used.  Punches aren't great on wide lesions but they do have the advantage of getting several mm of depth.  There are guidelines for each type of biopsy and there are times when one type is better than another including partial biopsies and shaves.  I won't have another shave biopsy because I won't take a chance they bisect my lesion AND because they hurt like hell while healing and look worse afterwards.  I hate shave biopsies.  But for the most part, it's a moot point for me.  Because of my three primaries, my derm only does excisional biopsies on me.  I don't have a lot of biopsies because my moles basically appear to be stable at this time in my life.  But if I was having biopsies done frequently, I wouldn't choose a shave for the pain/scar and excisonal biopsies remove a lot of tissue and leave larger scars.  Punches, to me, are a good choice when a lesion fits inside a punch.  It's always a balancing act and discussing the biopsy type with a doc who is open to discussion (some will only do shaves and I don't see this as open minded) is definitely the best way to go.

        This is my opinion only – yours may vary. 

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        JC
        Participant

        To me. . it's just get the biopsy. .whatever the technique. . maybe your Dr would only do it if it were a simple shave. . otherwise might say "let's wait and watch".  to me, get the darn biopsy done. . however. . so at least if there is something it will be caught and dealt with. 

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        Francesca
        Participant
        Damn I guess no point in asking med onc to send to a dermopathologist since its bisected- I will never know true depth which is troublesome. This may be a stupid question but is it remotely possible it’s actually less mm than what was reported? They wouldn’t be able to tell if it’s depth or diameter if it’s cut… Or is this ridiculous Lol
        Cheers

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        Janner
        Participant

        It's "at least 1.45mm" – not less.  It may have been just 1.45mm.  I'd just go with that and move ahead because there really is no other choice.  Hang in there!

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        Janner
        Participant

        It's "at least 1.45mm" – not less.  It may have been just 1.45mm.  I'd just go with that and move ahead because there really is no other choice.  Hang in there!

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        Janner
        Participant

        It's "at least 1.45mm" – not less.  It may have been just 1.45mm.  I'd just go with that and move ahead because there really is no other choice.  Hang in there!

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        Francesca
        Participant
        Damn I guess no point in asking med onc to send to a dermopathologist since its bisected- I will never know true depth which is troublesome. This may be a stupid question but is it remotely possible it’s actually less mm than what was reported? They wouldn’t be able to tell if it’s depth or diameter if it’s cut… Or is this ridiculous Lol
        Cheers

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        Francesca
        Participant
        Damn I guess no point in asking med onc to send to a dermopathologist since its bisected- I will never know true depth which is troublesome. This may be a stupid question but is it remotely possible it’s actually less mm than what was reported? They wouldn’t be able to tell if it’s depth or diameter if it’s cut… Or is this ridiculous Lol
        Cheers

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        JC
        Participant

        To me. . it's just get the biopsy. .whatever the technique. . maybe your Dr would only do it if it were a simple shave. . otherwise might say "let's wait and watch".  to me, get the darn biopsy done. . however. . so at least if there is something it will be caught and dealt with. 

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        JC
        Participant

        To me. . it's just get the biopsy. .whatever the technique. . maybe your Dr would only do it if it were a simple shave. . otherwise might say "let's wait and watch".  to me, get the darn biopsy done. . however. . so at least if there is something it will be caught and dealt with. 

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        Janner
        Participant

        I'm not impressed with the article that justifies shaves as ok.  Maybe you would be fine if your lesion was bisected but i would not even if the WLE was clear.  (I have had a deep shave for melanoma #3 and was lucky I had clear deep margins – I won't do this again).  This article justifies the shave saying the majority aren't upstaged because of the WLE.  But in my mind, you have lost valuable information as once the lesion is bisected, you will never again know the true depth.  And most shaves aren't "deep" shaves.  As for punches, if the lesion can't be contained in a punch, then an excisional biopsy or shave should be used.  Punches aren't great on wide lesions but they do have the advantage of getting several mm of depth.  There are guidelines for each type of biopsy and there are times when one type is better than another including partial biopsies and shaves.  I won't have another shave biopsy because I won't take a chance they bisect my lesion AND because they hurt like hell while healing and look worse afterwards.  I hate shave biopsies.  But for the most part, it's a moot point for me.  Because of my three primaries, my derm only does excisional biopsies on me.  I don't have a lot of biopsies because my moles basically appear to be stable at this time in my life.  But if I was having biopsies done frequently, I wouldn't choose a shave for the pain/scar and excisonal biopsies remove a lot of tissue and leave larger scars.  Punches, to me, are a good choice when a lesion fits inside a punch.  It's always a balancing act and discussing the biopsy type with a doc who is open to discussion (some will only do shaves and I don't see this as open minded) is definitely the best way to go.

        This is my opinion only – yours may vary. 

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        Janner
        Participant

        I'm not impressed with the article that justifies shaves as ok.  Maybe you would be fine if your lesion was bisected but i would not even if the WLE was clear.  (I have had a deep shave for melanoma #3 and was lucky I had clear deep margins – I won't do this again).  This article justifies the shave saying the majority aren't upstaged because of the WLE.  But in my mind, you have lost valuable information as once the lesion is bisected, you will never again know the true depth.  And most shaves aren't "deep" shaves.  As for punches, if the lesion can't be contained in a punch, then an excisional biopsy or shave should be used.  Punches aren't great on wide lesions but they do have the advantage of getting several mm of depth.  There are guidelines for each type of biopsy and there are times when one type is better than another including partial biopsies and shaves.  I won't have another shave biopsy because I won't take a chance they bisect my lesion AND because they hurt like hell while healing and look worse afterwards.  I hate shave biopsies.  But for the most part, it's a moot point for me.  Because of my three primaries, my derm only does excisional biopsies on me.  I don't have a lot of biopsies because my moles basically appear to be stable at this time in my life.  But if I was having biopsies done frequently, I wouldn't choose a shave for the pain/scar and excisonal biopsies remove a lot of tissue and leave larger scars.  Punches, to me, are a good choice when a lesion fits inside a punch.  It's always a balancing act and discussing the biopsy type with a doc who is open to discussion (some will only do shaves and I don't see this as open minded) is definitely the best way to go.

        This is my opinion only – yours may vary. 

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        Cooper
        Participant

        Janner, you should read the article because the thinking on what is a better biopsy has changed.  You would prefer a punch, but in fact punch biopsy gives lousy incorrect margins. A deep shave is proven to give the best margins and depth when compared to a simple shave or punch.  The best biopsy however is always going to be the excisional which takes a stitch or two to close.  It often captures the whole melanoma.

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        Cooper
        Participant

        Janner, you should read the article because the thinking on what is a better biopsy has changed.  You would prefer a punch, but in fact punch biopsy gives lousy incorrect margins. A deep shave is proven to give the best margins and depth when compared to a simple shave or punch.  The best biopsy however is always going to be the excisional which takes a stitch or two to close.  It often captures the whole melanoma.

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        Janner
        Participant

        Here's the deal.  No analysis of your pathology reports is going to give you the answer you want.  You cannot deduce whether or not you will have a recurrence or what your particular odds are given your exact factors.  There will always be percentages of high risk individuals who never do, and low risk individuals that do recur.  The factors that have shown to be the most predictive are the ones currently used in staging.  Certainly other factors may be introduced in the future as anaylsis shows other significant factors, but the staging guidelines are the best we have at the moment for predicting your prognosis.  The analysis was done on a large group of people giving you the best information you can have.  Beware reading about studies that only have small population numbers as results may not be the same when done over a large population.  Time will help, but no amount of research is going to answer your question for you.  It sucks, but it's the reality.

        As for "what does it look like", it will look different.  Maybe pigmented, maybe a bump under the skin.  For the first year, your scar will be healing and you may have scar tissues, stitches or just plain healing that causes changes in the scar.  Have any other incisions you watched heal?  You're looking for something that doesn't seem to be a normal part of healing.  If you see something concerning, ask your doctor.  In addition, ask your doctor how to palpate your lymph basin (same as the SNB basin).  You should also pay attention to that area and be looking for swollen/hard lymph nodes.  Be aware that while you are still healing or if you have trauma, lymph nodes will swell and it is most likely unrelated to melanoma.

        I wish I could be more help, but you're not going to find the help you want… an answer to your future.  The more research you do, the more you will know about melanoma – but not how it will apply to you.  Believe me, I know this to be true.  Excessive research causes excessive anxiety (speaking from experience).  Hang in there,

        Janner

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        Janner
        Participant

        Here's the deal.  No analysis of your pathology reports is going to give you the answer you want.  You cannot deduce whether or not you will have a recurrence or what your particular odds are given your exact factors.  There will always be percentages of high risk individuals who never do, and low risk individuals that do recur.  The factors that have shown to be the most predictive are the ones currently used in staging.  Certainly other factors may be introduced in the future as anaylsis shows other significant factors, but the staging guidelines are the best we have at the moment for predicting your prognosis.  The analysis was done on a large group of people giving you the best information you can have.  Beware reading about studies that only have small population numbers as results may not be the same when done over a large population.  Time will help, but no amount of research is going to answer your question for you.  It sucks, but it's the reality.

        As for "what does it look like", it will look different.  Maybe pigmented, maybe a bump under the skin.  For the first year, your scar will be healing and you may have scar tissues, stitches or just plain healing that causes changes in the scar.  Have any other incisions you watched heal?  You're looking for something that doesn't seem to be a normal part of healing.  If you see something concerning, ask your doctor.  In addition, ask your doctor how to palpate your lymph basin (same as the SNB basin).  You should also pay attention to that area and be looking for swollen/hard lymph nodes.  Be aware that while you are still healing or if you have trauma, lymph nodes will swell and it is most likely unrelated to melanoma.

        I wish I could be more help, but you're not going to find the help you want… an answer to your future.  The more research you do, the more you will know about melanoma – but not how it will apply to you.  Believe me, I know this to be true.  Excessive research causes excessive anxiety (speaking from experience).  Hang in there,

        Janner

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        Silva
        Participant

        Janner-help …diagnosed 1a. Easy to understand and read on one pathology report. Second path does not make sense.

        my biggest fear is reoccurrence at this point to where

        i have high anxiety and fear. 

         

        Any advise….thanks 

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        Silva
        Participant

        Janner-help …diagnosed 1a. Easy to understand and read on one pathology report. Second path does not make sense.

        my biggest fear is reoccurrence at this point to where

        i have high anxiety and fear. 

         

        Any advise….thanks 

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        Silva
        Participant

        Janner-help …diagnosed 1a. Easy to understand and read on one pathology report. Second path does not make sense.

        my biggest fear is reoccurrence at this point to where

        i have high anxiety and fear. 

         

        Any advise….thanks 

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