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Melanoma arising in a spitzoid nevus

Forums General Melanoma Community Melanoma arising in a spitzoid nevus

  • Post
    feich
    Participant

      Hello All.

      I was very recently diagnosed with melanoma arising in a Spitz Nevus. However, my story is a little confusing, and I am hoping to get some answers that my doctor wasn't able to provide.

      Hello All.

      I was very recently diagnosed with melanoma arising in a Spitz Nevus. However, my story is a little confusing, and I am hoping to get some answers that my doctor wasn't able to provide.

      I got a slightly itchy mole removed from my back. After removing the mole, I came back in two weeks later to get stitches removed. The doctor said they had to send my results out for a second opinion. The doctor that gave the second opinion said that while the first biopsy had come back negative, an area of my mole he felt was melanoma arising from a spitz nevus. The small, nodular dermal  (slightly more than a millimeter in thickness) had melanocytes that had small uniform nuclei and finely granular pigmented cytoplasm. They formed as confluent collections forming a non maturing module.

      The doctor finally concluded that based on the nodular dermal component he cannot defend any diagnosis but a tiny focus of melanoma arising in what appeared to be a pre-existing spitz nevus.

      Since this was from a referring pathologist and not my actual doctor, my actual doctor didnt seem to have many answers for me. They scheduled me in for an excision but said it would take 2-3 weeks to get in. He also said they would check the lymph nodes when I went in. I will go nuts waiting 2-3 weeks to get more answers. Im just wondering a few things:

      Since they don't definitevely say that I have melanoma, is there a chance this is benign and they are just being cautious? (if so I would rather be safe than sorry)

      If I get it excised and it hasn't spread to the lymph nodes, will that take care of it?

      Is there a large history of these changing into metastes (sp?) moles over time even if it is excised?

      If it has spread, what is the treatment and or prognosis?

      Does 2-3 weeks seem like a long time to wait to get in and get this taken care of?

      Any help anyone could give me in terms of answers or just clarification, would be extremely helpful. Thank you all for your time.

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        bcl
        Participant

          Hi there,  I was diagnosed with a 1.81mm spitz melanoma 3 1/2 years ago ( itchy like yours)  I understand the pathology is difficult, and yes, from what I read,  sometimes they err on the side of caution. However that said, I also read the diagnosis is less controversial in adults ( as it is more likely to be melanoma.)  Some posters have their slides sent to Dr Boris Bastian of  Sloan Kettering http://www.mskcc.org/mskcc/html/99334.cfm   He is a world expert on the DNA differences between spitz melanoma and spitz nevi. ( He was formerly at UCSF so they have the skills there too) You will find quite a lot of spitz posts if you search the archived board.

          Your 2 -3 week wait for a sentinel node biopsy (SNB) and wide excision (WLE)  sounds pretty normal to me.  ( I had a chest X-ray and some blood tests while waiting for the surgery, likely you will too) It is good they are doing both at the same time – hopefully yours will come back negative, then you will only have to worry about skin cks and derm appointments.  (And maybe following up with a leading spitz expert:)  

          At the depth of your primary you have little chance of it metastasizing, but if it has moved to your nodes, the board can help you work your way thorough the treatment choices. Let us know how it goes,  linda

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          bcl
          Participant

            Hi there,  I was diagnosed with a 1.81mm spitz melanoma 3 1/2 years ago ( itchy like yours)  I understand the pathology is difficult, and yes, from what I read,  sometimes they err on the side of caution. However that said, I also read the diagnosis is less controversial in adults ( as it is more likely to be melanoma.)  Some posters have their slides sent to Dr Boris Bastian of  Sloan Kettering http://www.mskcc.org/mskcc/html/99334.cfm   He is a world expert on the DNA differences between spitz melanoma and spitz nevi. ( He was formerly at UCSF so they have the skills there too) You will find quite a lot of spitz posts if you search the archived board.

            Your 2 -3 week wait for a sentinel node biopsy (SNB) and wide excision (WLE)  sounds pretty normal to me.  ( I had a chest X-ray and some blood tests while waiting for the surgery, likely you will too) It is good they are doing both at the same time – hopefully yours will come back negative, then you will only have to worry about skin cks and derm appointments.  (And maybe following up with a leading spitz expert:)  

            At the depth of your primary you have little chance of it metastasizing, but if it has moved to your nodes, the board can help you work your way thorough the treatment choices. Let us know how it goes,  linda

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            Tad
            Participant

              I was diagnosed a year ago with melanoma (1.9mm Breslow, Clark IV, 2 mitoses/mm2, nonulcerated) that evolved from a Spitz nevus (and itched — funny symptom for us all so far).  My understanding is that this is a very difficult diagnosis since the microscopic features of early stage melanoma and a Spitz nevus are similar.  My biopsy slides reviewed by three dermopathologists, and all agreed on malignant melanoma, although they disagreed on the exact depth.

              From what it sounds like, you may want to seek a third opinion on the pathology.  While you're right that it's better to be safe than sorry, avoiding unnecessary surgery is not a bad thing (just a WLE vs WLE/SNB).

              I waited about six weeks between diagnosis and surgery to have blood work, X-rays, and CT scans completed before surgery.  Two to three weeks doesn't sound out of the ordinary to me at all.

              Not much I can offer on metastasis and lymph node involvement, other than to say it's uncommon in relatively thin tumors like the one you describe.  With luck, once the excision is complete, you will be free of melanoma and will just have to be vigilant in your skin checks and doctor's appointments.

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              Tad
              Participant

                I was diagnosed a year ago with melanoma (1.9mm Breslow, Clark IV, 2 mitoses/mm2, nonulcerated) that evolved from a Spitz nevus (and itched — funny symptom for us all so far).  My understanding is that this is a very difficult diagnosis since the microscopic features of early stage melanoma and a Spitz nevus are similar.  My biopsy slides reviewed by three dermopathologists, and all agreed on malignant melanoma, although they disagreed on the exact depth.

                From what it sounds like, you may want to seek a third opinion on the pathology.  While you're right that it's better to be safe than sorry, avoiding unnecessary surgery is not a bad thing (just a WLE vs WLE/SNB).

                I waited about six weeks between diagnosis and surgery to have blood work, X-rays, and CT scans completed before surgery.  Two to three weeks doesn't sound out of the ordinary to me at all.

                Not much I can offer on metastasis and lymph node involvement, other than to say it's uncommon in relatively thin tumors like the one you describe.  With luck, once the excision is complete, you will be free of melanoma and will just have to be vigilant in your skin checks and doctor's appointments.

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