› Forums › General Melanoma Community › just diagnosed without full pathology report
- This topic has 26 replies, 4 voices, and was last updated 14 years, 4 months ago by
alexandra.
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- July 18, 2011 at 11:11 pm
Hi –
Hi –
I got my results today. The doctor's office said melanoma stage II. She said that I should come in today to see her. Unfortunately I'm away from home and can't make it until next Monday. The doctor was totally fine with that and said that I can come in even in 2 weeks. They couldn’t tell me any details over the phone and the only thing they said is that this is a very early stage. Now, I'm schedule for an appointment for next Monday and the doctor said that I'll have more skin removed. I'm worried, because everywhere I read they say that if it's a stage II I should have a biopsy of my lymph nodes as well. She never said anything like that. She's also a dermatologist and I'm wondering if the second procedure shouldn’t be done by a surgeon. I'm sorry for asking so many questions, but I have a 2 month old baby and a 3 year old and I'm really worried.
Also, I'm from Canada and I'm wondering if they have different procedures. Like for example they don't refer you to a surgeon until a further stage.
Thank you so much for your replies!
Alexandra
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- July 18, 2011 at 11:18 pm
First off, I'm wondering if you are confusing "stage" and "Clark's Level". If the lesion is considered "very early", then I suspect you have a Clark's Level II lesion which is probably going to be stage I. Clark's Level is the level of skin invaded. Staging is a clinical diagnosis. Since all they are planning on doing is removing more skin (WLE – wide local excision), that is also the protocol for a stage I Clark's Level II lesion.
Canada can be behind the times in respect to what you might read – it depends on where you are located. We do have a decent Canadian contingent here and it might be helpful if you post where you are from. But I really think you might be stage I instead of stage II. These things are very often confused by the newly diagnosed. If you go to my website (linked in my signature) and choose Newly Diagnosed and scroll to the bottom of the page, you can see a more "official" explanation of this very common Stage/Clar'k's Level confusion. I'd also ask your doctor for a copy of your pathology report. If you can't get that before your WLE is scheduled, call and ask for Breslow Depth and Clark's Level. This will tell you if you are on the right track or not.
Best wishes,
Janner
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- July 18, 2011 at 11:18 pm
First off, I'm wondering if you are confusing "stage" and "Clark's Level". If the lesion is considered "very early", then I suspect you have a Clark's Level II lesion which is probably going to be stage I. Clark's Level is the level of skin invaded. Staging is a clinical diagnosis. Since all they are planning on doing is removing more skin (WLE – wide local excision), that is also the protocol for a stage I Clark's Level II lesion.
Canada can be behind the times in respect to what you might read – it depends on where you are located. We do have a decent Canadian contingent here and it might be helpful if you post where you are from. But I really think you might be stage I instead of stage II. These things are very often confused by the newly diagnosed. If you go to my website (linked in my signature) and choose Newly Diagnosed and scroll to the bottom of the page, you can see a more "official" explanation of this very common Stage/Clar'k's Level confusion. I'd also ask your doctor for a copy of your pathology report. If you can't get that before your WLE is scheduled, call and ask for Breslow Depth and Clark's Level. This will tell you if you are on the right track or not.
Best wishes,
Janner
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- July 25, 2011 at 7:34 pm
Hello Janner –
Here's the pathology report.
Micro examination: This excisional biopsy measured 9 x 6 x 1 mm. and is cut in three sections and submitted in toto. In parts of the lesion there are typical features of dysplastic nevus with lentigunous proliferation of nests and single atypical pigmented melanocytes along the dermo-epidermal junction with fibroplasias in the dermal papillae. However, there are areas in lesion of epithelioid pigmented melanocytes in the epidermis. There is some upward migration of single cells. As well as there are similar nests of atypical melanocytes infiltrating the papillary dermis with a dense infiltrate of lymphocytes and melanophages. The morphology is compatible with a malignant melanoma, level 2 invasion developing in a dysplastic nevus. The vertical height measurement is 0.47mm. and there is no ulceration. The lesion is completely excited in the plane of section examined. The mitotic index is two mitoses per 1mm. squared.
Diagnosis: Malignant melanoma developing in a dysplastic nevus, level 2 invasion, vertical height 0.47mm.
I was referred to a surgeon and will have WLE sometime in 2 weeks. The doctor said that it's an early stage and that I don't need the lymph biopsy. I'm also checking with another doctor to make sure I don't miss anything.
Today's visit was short and she didn't check for any other suspicious moles. She said to come back in 4 months and she'll examine my whole body. I'm really confused and not sure if this is good news.
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- July 25, 2011 at 7:34 pm
Hello Janner –
Here's the pathology report.
Micro examination: This excisional biopsy measured 9 x 6 x 1 mm. and is cut in three sections and submitted in toto. In parts of the lesion there are typical features of dysplastic nevus with lentigunous proliferation of nests and single atypical pigmented melanocytes along the dermo-epidermal junction with fibroplasias in the dermal papillae. However, there are areas in lesion of epithelioid pigmented melanocytes in the epidermis. There is some upward migration of single cells. As well as there are similar nests of atypical melanocytes infiltrating the papillary dermis with a dense infiltrate of lymphocytes and melanophages. The morphology is compatible with a malignant melanoma, level 2 invasion developing in a dysplastic nevus. The vertical height measurement is 0.47mm. and there is no ulceration. The lesion is completely excited in the plane of section examined. The mitotic index is two mitoses per 1mm. squared.
Diagnosis: Malignant melanoma developing in a dysplastic nevus, level 2 invasion, vertical height 0.47mm.
I was referred to a surgeon and will have WLE sometime in 2 weeks. The doctor said that it's an early stage and that I don't need the lymph biopsy. I'm also checking with another doctor to make sure I don't miss anything.
Today's visit was short and she didn't check for any other suspicious moles. She said to come back in 4 months and she'll examine my whole body. I'm really confused and not sure if this is good news.
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- July 27, 2011 at 5:32 pm
Hi Alexandra, I know you asked Janner this question, but I think this is good news hun; initially you thought you might be a stage 2 and now it appears you are a 1B due to the mitoses. (Same stage as me – although I had a 1.81 mm with three mitoses per 1mm. squared – and I've been alive and kicking for 4 years -now:)
I don't want to scare you, but if I were you I'd be tempted to see if the staging qualified me for a SNB – perhaps post a new question here if you are curious. All the best, linda
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- July 27, 2011 at 5:32 pm
Hi Alexandra, I know you asked Janner this question, but I think this is good news hun; initially you thought you might be a stage 2 and now it appears you are a 1B due to the mitoses. (Same stage as me – although I had a 1.81 mm with three mitoses per 1mm. squared – and I've been alive and kicking for 4 years -now:)
I don't want to scare you, but if I were you I'd be tempted to see if the staging qualified me for a SNB – perhaps post a new question here if you are curious. All the best, linda
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- July 28, 2011 at 12:57 am
Thank you, Linda! Honestly, I don’t feel like being excited about the results. I’m happy, but I’m so exhausted and still stressed out I can’t think about anything else. I asked the dermatologist about the SNB and she said that I don't qualify. I’m checking with one more doctor to make sure, but I guess if they say no, there’s not much I can do. You have no idea how grateful I am for all the support I got from you and other people on the forum. You have been an amazing help for me. Thank you so much!
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- July 28, 2011 at 12:57 am
Thank you, Linda! Honestly, I don’t feel like being excited about the results. I’m happy, but I’m so exhausted and still stressed out I can’t think about anything else. I asked the dermatologist about the SNB and she said that I don't qualify. I’m checking with one more doctor to make sure, but I guess if they say no, there’s not much I can do. You have no idea how grateful I am for all the support I got from you and other people on the forum. You have been an amazing help for me. Thank you so much!
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- July 19, 2011 at 4:18 am
Alexandra – I was diagnosed in 2006 with Stage II – margins were cleared with surgery. I was told that since the area was 0.7 in size at the time that I didn't meet the customary requirements for a node biopsy. Just last week I was diagnosed with a reoccurence found within the left groin lymph nodes. It is hard to say that if I opted for a node biopsy in 2006 if this would have surfaced earlier but looking back I wished I had more information and researched further. Talk this option over with your doctor at your next appointment. You are doing everything you can right now by just becoming more educated. God Bless – take care.
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- July 19, 2011 at 2:31 pm
Thank you for this information. I wonder what the doctor will say on Monday. I'm worried because last time she came in and didn't say much. The whole procedure took 3 min. She didn't even sit down. I wish I trusted her more. I'm trying to find out as much as I can on my own and have all the questions written down. Thank you again for taking the time to reply. Good luck to you as well. God Bless!
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- July 19, 2011 at 2:31 pm
Thank you for this information. I wonder what the doctor will say on Monday. I'm worried because last time she came in and didn't say much. The whole procedure took 3 min. She didn't even sit down. I wish I trusted her more. I'm trying to find out as much as I can on my own and have all the questions written down. Thank you again for taking the time to reply. Good luck to you as well. God Bless!
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- July 19, 2011 at 3:19 pm
Type out your questions and hand them to her. Make yourself a copy too. Then she knows exactly what you want to ask, and you get to spend time listening to the answer instead of worrying if you'll remember your next question. Doctors can look at the questions and figure out how best to budget their time with you – answering the most important stuff with more emphasis. I've found this to be very effective and I'm less stressed because I know I've got the important stuff spelled out on my sheet.
Please get a copy of your pathology report. Post it here if you can. There aren't much in the way of melanoma specialists in Canada unless you're in the Toronto area. So you have to learn to be your own best advocate!
Best wishes,
Janner
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- July 19, 2011 at 3:19 pm
Type out your questions and hand them to her. Make yourself a copy too. Then she knows exactly what you want to ask, and you get to spend time listening to the answer instead of worrying if you'll remember your next question. Doctors can look at the questions and figure out how best to budget their time with you – answering the most important stuff with more emphasis. I've found this to be very effective and I'm less stressed because I know I've got the important stuff spelled out on my sheet.
Please get a copy of your pathology report. Post it here if you can. There aren't much in the way of melanoma specialists in Canada unless you're in the Toronto area. So you have to learn to be your own best advocate!
Best wishes,
Janner
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- July 24, 2011 at 10:32 pm
Hi Alexandra, I'm from Victoria BC. Janner is right, we really need to self advocate. I was initially referred to a plastic surgeon who said I needed a next day WLE (When what I needed at stage 1B was a WLE with a lymph node biopsy (SNB). Lucky for me his secretary failed to convince anyone to reschedule and I became aware enough to push for an experienced cancer surgeon.)
I realise you've tried phoning to get your results, but is there any chance you could visit the office of the doctor who referred you to the dermatologist – before your derm appointment? They'll likely have a copy of the pathology and may be willing to share since the derms office has given you the 'gist' of it over the phone. (Another option would be to try the local cancer centre – I was able to go down and obtain a copy of my pathology very easily.)
Our Canadian system has its problems, but if you know what you need it can often be possible to make it work:) Good luck to you and keep us posted, linda
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- July 25, 2011 at 7:47 pm
Thank you, Linda. I was so stressed out with today's visit. I had all my questions written down, but didn't ask most of them. I'm getting second opinion from another doctor. I'll get the WLE within 2 weeks. She said that I don't need the lymph node biopsy, but after reading so much on-line I really need a second opinion.
Thank you so much for replying to my post and giving me very useful information.
God Bless,
Alexandra
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- July 25, 2011 at 7:47 pm
Thank you, Linda. I was so stressed out with today's visit. I had all my questions written down, but didn't ask most of them. I'm getting second opinion from another doctor. I'll get the WLE within 2 weeks. She said that I don't need the lymph node biopsy, but after reading so much on-line I really need a second opinion.
Thank you so much for replying to my post and giving me very useful information.
God Bless,
Alexandra
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- July 24, 2011 at 10:32 pm
Hi Alexandra, I'm from Victoria BC. Janner is right, we really need to self advocate. I was initially referred to a plastic surgeon who said I needed a next day WLE (When what I needed at stage 1B was a WLE with a lymph node biopsy (SNB). Lucky for me his secretary failed to convince anyone to reschedule and I became aware enough to push for an experienced cancer surgeon.)
I realise you've tried phoning to get your results, but is there any chance you could visit the office of the doctor who referred you to the dermatologist – before your derm appointment? They'll likely have a copy of the pathology and may be willing to share since the derms office has given you the 'gist' of it over the phone. (Another option would be to try the local cancer centre – I was able to go down and obtain a copy of my pathology very easily.)
Our Canadian system has its problems, but if you know what you need it can often be possible to make it work:) Good luck to you and keep us posted, linda
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- July 19, 2011 at 4:18 am
Alexandra – I was diagnosed in 2006 with Stage II – margins were cleared with surgery. I was told that since the area was 0.7 in size at the time that I didn't meet the customary requirements for a node biopsy. Just last week I was diagnosed with a reoccurence found within the left groin lymph nodes. It is hard to say that if I opted for a node biopsy in 2006 if this would have surfaced earlier but looking back I wished I had more information and researched further. Talk this option over with your doctor at your next appointment. You are doing everything you can right now by just becoming more educated. God Bless – take care.
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