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Just diagnosed with nodular melanom and do not quite understand pathology report

Forums Cutaneous Melanoma Community Just diagnosed with nodular melanom and do not quite understand pathology report

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    Jamie Martini
      Diagnosed with nodular melanoma in March, the mole was first noticed 4 years ago. Had surgery and sentinel node biopsy today. I still don’t know how to decipher this original pathology report. I am scared, should i be? Surgical oncologist said don’t worry, that’s really not very clear i don’t think. Cam anyone be real with me? I am 48 and terrified.

      Silver Falls Dermatology, Salem, OR; SF21-3977 (03/02/2021):
      Skin, right anterior proximal upper arm, shave biopsy:
      Malignant melanoma with the following features:
      1. Histologic subtype: Nodular
      2. Approximate Breslow thickness: At least 6.3 mm
      3. Clark’s Level: At least IV
      4. Ulceration: Present
      5. Mitotic rate: 8/mm2
      6. Lymphocapillary invasion: Not identified
      7. Satellitosis: Not identified
      8. Perineural invasion: Not identified
      9. Lymphocytic infiltrate: Present, non-brisk
      10. Regression: Not identified
      11. Margins: Melanoma in situ present at peripheral margin; invasive melanoma is present broadly at the deep aspect
      12. Melanoma in situ: Present
      13. Stage: pT4b (per AJCC 8th edition)
      14. See commen

      Outside provided Melan-A immunohistochemical stain highlights melanoma in situ, as well as extent of deep margin involvement.

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          Sorry you have to be here Jamie.  Given that report, I don’t think you should go into panic mode, but I don’t think it is “nothing to worry about either”.  Given that it was a shave biopsy in this report, obviously the thickness of the lesion is unclear.  I am glad you have quickly undergone what I assume must have been a WLE (wide local excision) and SLNB (sentinel lymph node biopsy).  Technically, SLNB is not recommended unless the lesion is 0.8mm or greater, but given that yours was certainly deeper than 6.3mm removed, the T4 designation and the fact that the lesion was ulcerated – I think it was a very good move.  Here is a post that addresses some of that if you are interested (with the second article being most pertinent): 

          Now that you’ve done all that – it is a waiting game for the SLN results.  If that node is positive, you will become Stage III.  Aim at Melanoma has the best breakdown of melanoma staging that I have found –

          Hopefully, that Stage III designation with not be applied to you.  However, if it is – there is HOPE!!!!  Currently, there are several treatment options (should you choose treatment) for melanoma patients in that group.  It is considered adjuvant care – treatment when all the obvious melanoma lesion has been removed.  Here is more than you probably will ever want to know about that:

          To that end – a lot of this may seem like complete gibberish!  Here is a post that explains basic melanoma treatments and how they work.  A glossary of terms is linked at the end:

          In melanoma world knowledge is power.  Don’t let all this craziness frighten you!!  Take heart.  I was diagnosed as Stage IIIb in 2003.  Given that there were no effective treatments at that time I did progress to Stage IV with brain and lung mets in 2010.  BUT!!!!  With effective treatment, I’m still here!!!  18 years post my original diagnosis.  11 years Stage IV and I remain NED (having no evidence of disease) from melanoma.  Ask more questions as you have the need.  There are many smart and caring peeps on this forum.  Wishing you my best.  Celeste

            Hello, I am on the same boat here. Recently diagnosed and stage 4. It is nodular but I just can’t believe my mole was only 3mm! I didn’t get it checked out until it became more raised 🙁 How fast did yours grow? I am Terrified but hopeful… Celeste, do you mind me asking what treatment options you chose? I am afraid it might have spread to my brain already since I have been feeling tinnitus on my left ear.

            Best wishes!

              Hi Anie,

              Sorry you have these worries and must deal with melanoma.  To be clear, I have cutaneous, rather than specifically nodular melanoma.  I was in a Phase 1 trial of nivolumab (Opdivo) for 2 1/2 years, plus several years of follow-up, that began in Dec of 2010.  My full story is on my blog, but the shorter version  =   Diagnosed with Stage IIIb melanoma in 2003 after a lesion to my back and lymph node to right axilla were positive.  No treatment other that interferon (which does nothing to significantly improve survival and makes you sick for a year) and surgery were available as current therapies were not FDA approved until 2011.  Ipi was not even in trials.  In 2003 I had another lesion to my left forearm removed, there were no positive  nodes.  I had various random follow-up – CT’s, MRI, PET, depending of the whim of my onc – as nobody really knew what to do with me.  A basic chest X-ray as follow-up in early 2010 showed “something” in my lung.  As an asthmatic, it was assumed that was the cause since “melanoma doesn’t look like that” per my onc as the lesion was located in my bronchus rather than out in lung tissue.  When the lesion never improved, a bronchoscopy was done  – and YEP – melanoma.  Given that little ta-dah, an MRI of my brain was completed and YEP – brian met.  Still no approved treatments available.  Had my brain lesion zapped with SRS (stereotactic radiation) and the upper lobe of my right lung removed.  Casting about for treatment, a few things were in trials, but required ‘measurable disease’ which I had just gone through a great deal to remove!  In October, my throat felt very strange.  Took a peek.  Sure enough, a large black lump was visible to my right tonsillar pillar.  Melanoma – again!  Had that surgically removed, though we – briefly – considered leaving it in order to have measurable disease!  HA!!  However, since swallowing and breathing were rapidly becoming impeded we decided against it.  Finally, in calling with questions about another trial all together, my husband found the nivo trial I ended up participating in as it had an arm for Stage IV peeps with advanced disease and those with their disease removed.  It was a bit of a leap of faith as ipi was to be approved for use in the coming 3-4 months (It was FDA approved in March – I think – of 2011.) and at that time, the rule was, if you had already had nivolumab, you could NOT have ipi after it.  Crazy times.  Anyhow – that’s the story.

              So – what does all that tell you?  I guess it depends on who you are and what questions you have.  To me the valuable points are these –

              Most brain mets are asymptomatic.  When they are very large or are in very specific places, folks can have symptoms.  I never did.  BUT!!!!!  If you have concerns, get them checked!!!!!

              Advocate for yourself.  Not easy, but essential – unfortunately.

              Adjuvant treatment (treatment when all obvious signs of disease are removed) works!  I am living proof.  The results of the study I was in, as well as others, led to the approval of nivo for melanoma patients with active disease in 2014.  It was approved for use as adjuvant in Stage III/IV melanoma patients in 2018.  Here is a report that covers that history:

              Here is a report from earlier this year about all the outcomes of various adjuvant treatments:

              But most of all – to me – my history says – LIVE!!!  Each day.  Every day.

              Hope that helps.  I wish you my best.  Celeste

                What an incredible story!! I am so happy to hear that you are doing well after all. Did you have multiple brain mets or just one? It is so scary for me just to even think about it…. You could still start the trial after you had the tumors removed? I still have a derm appointment today to see how deep my lesion is and wide excision from there. I am just starting this and I am extremely anxious and worried, but there is hope! You are proof of it. I just need to be strong… I have a baby girl to look after. I really hope God brings me to the right treatment and I can survive this. How long did you receive treatment before being declared cancer free or NED? Thank you for sharing your hope!
                  Also, where can I find your Blog? Thank you 🙏🏽
                    If you click on the links I gave you, they explain all about adjuvant care – treatment for melanoma without the presence of tumors….as in Stage IV and Stage III patients who have had their tumors removed via surgery or radiation.  And….if you click on the links – that is my blog.  I had 2 or three brain mets depending on which radiologist you believe.  Only one irradiated.  The others went away after treatment.  Technically, I was NED (having no evidence of disease that was measurable) at the start of the trial and remain so for melanoma to this day.  I had two kiddos aged 10 and 12 at the start of my melanoma journey so I understand.

                    See your derm.  Determine if a sentinel lymph node biopsy is needed when you get your WLE.  Then you will have your stage and you can go from there.

                    The search bubble on my blog may prove helpful.  Take care.  c

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