- June 4, 2018 at 4:05 pm
I am new to this forum. A quick history, I was diagnosed with Melanoma in Situ back in April of 2018. It was Lentigo Maligna on my left jaw line. Since then I have been trying to be as diligent as possible with suscreen and seeing my Dermatologist. I even saw an Oncologist just to make sure I was not missing something. The overall consensus from my Dermatologist and Oncologist is that after the WLE, with 1.5 x 1.7 margins, there is nothing more to do ecxept be diligent and vigilant. Yes, those are larger than the prescribed margins, but that is what I requested. Yes, they were clear.
I have being reading and researching as much as I can, but there will still be tons of questions. My question today is about lymph nodes. If the in situ spreads, which I know is unlikely, will it move to the nearest lymph node? I ask for two reasons. First, I have a reactive lymph node behind my right ear that is always palpable. It has been that way for decades. Right now, it is slightly swollen. If the melanoma spread to this lymph node it would be difficult to tell because it is so often skewed. Would melanoma move to a closer lymph node, one on the left side of my face? Second question, which way to do lymph nodes flow? I read they do not ciculate throughout the body like blood, that they are prone to stay in their "region". I understand that, but what is a region and does it flow towards the heart or away from it?
So many questions and so much to worry about. You all seem to have the answers. Thank you.
- June 4, 2018 at 6:40 pm
From what I've been told is that if Melanoma spreads via lymph nodes that it usually spreads to the lymph nodes closest to the primary Melanoma. Would be unlikely to spread to the opposite side of your face. I had my first primary Melanoma 3 and a half years ago. It was a Lentigo Maligna(in situ) and was center chest. I had a WLE and everything came back clear margins and I was happy. Fast forward to April of 2018 the dermatologist removed a small freckle on my scar. It came back as a reccurent Melanoma In situ. I had a palaple lymph node in my left axilla that had been there for 2 years so I immediatly thought Melanoma. They did tell me the way lymph drains that center chest would drain most likely to either axilla. Had an ultrasound and they were actually normal size. Im thin so i can feel them more. I went to a melanoma specialist to make sure I didnt miss something. I mean MIS coming back as MIS again seems really strange. Basically I was told that Lentigo Maligna has a higher recurrence rate than any other subtypes and the typical margins are sometimes inadequaute for that type. They did the standard 5 mm or something with my first one and it wasnt enough. I asked, then how come I got clear margins. They said sometimes rogue cells can be left behind, the freckle/mole on LM alot of times has what they call tentacles that reach well beyond the mole. Also something with pathologists doing a technique called bread loafing where it slices the tissue like a piece of bread and sometimes some cells are left in the 'bread piece' that isnt looked at. Needless to say it was overwhelming. I opted to do a modified MOHS technique where he basically did a WLE, cut out the entire scar plus like 7 ro 8 mm outside of the scar and did the MOHS on the rest. Took 6 hours being it takes the stains a while to show melanoma cells but I got clear margins and didnt have to get any more cut so Im Melanoma free. My dermatologist said the past few years she has been removing between 7 and 8 mm margins for Lentigo maligna. When I had mine nearly 4 years ago they were still only doing the 5. I dont think that palaple node on the other side of your face has anything to do with Melanoma. If it were you would likely notice it getting bigger and bigger and it would probably get hard and unmoveable.. Melanoma in situ doesnt have the ability to spread unless theres a rare case like mine that cells were left behind. well wishes to you, Tset
- June 4, 2018 at 7:58 pm
Thank you so much for sharing. When my Dermatologist performed my WLE, he was going to do the 1 cm x 1 cm margins. I told him better too much than too little, and he did 1.5 cm x 1,7 cm. The Oncologist I saw said those were fantastic margins. He had said that .5 cm x .5 cm were minimum, but 1 cm x 1cm were preferred, I am hoping everything was caught and removed. I asked my Dermatologist and he said that if the original biopsy or the WLE showed something more than in situ, they would have advised us. I can only trust and Pray that was correct. I had not heard of the other Pathology technique you discussed. Sounds thorough!
The interesting thing about Lentigo Maligna is that it can remain for years as noninvasive (in situ). I even heard of a case where it remained that way for over twenty-years before it became invasive. I also read that Lentigo Maligna usually presents on the face or arms, areas with frequent sun exposure. It also is generally found on older people. When i read that I was like…"Hey, I am only 50"…but I guess that is old…in a way.
I appreciate the information on the lymph nodes. I could not find anything specific other than melanoma flows to the nearest lymph node and stays within a region. It sounds like you have some reactive lymph nodes (or "shotty" as they were once called) as do I. It makes them easy to feel, but can also lend itself to paranoia in that they are very palpable and, then, not that reliable because they are so skewed.
I am glad you caught your Melanoma so early, and I Pray you have no more recurrences or new occurences.
- June 4, 2018 at 9:16 pm
They called mine reactive as well but were still just a normal size. Ive read that too about LM. My dermatologist also said that many of them do not ever turn invasive but because they dont know who it will or wont they treat them all the same. I guess after almost 4 years mine grew back basically in the same spot give or take a mm and was still noninvasive. I was only 34 when I got diagnosed but I do have a sundamaged chest but I didnt think it was that bad. I told the MOHS surgeon to take out more if needed because if one of these cancer cells are left behind again I may not be so lucky next time. Its hard not to worry and it does make one paranoid for sure. We just have to stay postitve and live life to the fullest:)
- June 4, 2018 at 9:32 pm
Well said. Just remain diligent is all that can be done right now. My Dermatologist told me there are some elderly people who do not want their Lentigo Maligna's removed for one reason or the other, only having them removed when and if they become invasive. Otherwise, no one really know how long Lentigo Malgina can remain in situ, and no one really wants to be the test case.
Blessings to you.
Tagged: cutaneous melanoma
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