Need advise re: in situ – with family history of mel

The diagnosis isn't in situ (stage 0), but stage I.  Any depth — in this case Clark Level II and 0.29mm — means it is invasive into the dermis and not stage 0.  However, radial growth phase (horizontal) is much better than vertical growth phase and does carry a prognosis very similar to stage 0.  WIthout confirmation of the entire path report, and given the radial growth phase most likely implies 0 mitosis, I suspect this lesion is stage IA.

She should expect WLE only.  Nothing else.  No scans, only periodic skin checks.  Family history won't play much role in her treatment.  This is caught very early and the risk of another primary is higher than the risk of a recurrence.

The diagnosis isn't in situ (stage 0), but stage I.  Any depth — in this case Clark Level II and 0.29mm — means it is invasive into the dermis and not stage 0.  However, radial growth phase (horizontal) is much better than vertical growth phase and does carry a prognosis very similar to stage 0.  WIthout confirmation of the entire path report, and given the radial growth phase most likely implies 0 mitosis, I suspect this lesion is stage IA.

She should expect WLE only.  Nothing else.  No scans, only periodic skin checks.  Family history won't play much role in her treatment.  This is caught very early and the risk of another primary is higher than the risk of a recurrence.

The diagnosis isn't in situ (stage 0), but stage I.  Any depth — in this case Clark Level II and 0.29mm — means it is invasive into the dermis and not stage 0.  However, radial growth phase (horizontal) is much better than vertical growth phase and does carry a prognosis very similar to stage 0.  WIthout confirmation of the entire path report, and given the radial growth phase most likely implies 0 mitosis, I suspect this lesion is stage IA.

She should expect WLE only.  Nothing else.  No scans, only periodic skin checks.  Family history won't play much role in her treatment.  This is caught very early and the risk of another primary is higher than the risk of a recurrence.

Hey Rocco,

Sorry your friend is having to deal with this.  Janner's assessment and advice is sound as always.  Your friend's family history, with having had a brother pass from melanoma, is concerning both for her emotional out look and in light of a study just out:

Patterns of changing cancer risks with time since diagnosis of a sibling.  Lee, Czene, Reboa and Reilly.  Int J Cancer.  2014 September 30 [Epup ahead of print]

Researchers reviewed siblings of cancer patients and siblings of matched cancer-free controls from Swedish population registers, effects of age and time since diagnosis on sibling risks were examined for colorectal, breast, prostate and melanoma cancers.  "Case siblings had higher cancer incidence than control siblings for all cancers at all ages, with overall incidence rate ratios of 3.20 for melanoma.  Risks were highest in siblings who were young when the first cancer was diagnosed in the family."

So….whatever that's worth.  I still agree with Janner about what wil be recommended and that watchful observation will follow.

As for Moffitt Cancer Center:  It is a world class facility that treats a large number of melanoma patients.  Truly state of the art.  I have been a patient there since 2010.  I travel from TN to be seen there.

I wish your friend my best.  Celeste

Hey Rocco,

Sorry your friend is having to deal with this.  Janner's assessment and advice is sound as always.  Your friend's family history, with having had a brother pass from melanoma, is concerning both for her emotional out look and in light of a study just out:

Patterns of changing cancer risks with time since diagnosis of a sibling.  Lee, Czene, Reboa and Reilly.  Int J Cancer.  2014 September 30 [Epup ahead of print]

Researchers reviewed siblings of cancer patients and siblings of matched cancer-free controls from Swedish population registers, effects of age and time since diagnosis on sibling risks were examined for colorectal, breast, prostate and melanoma cancers.  "Case siblings had higher cancer incidence than control siblings for all cancers at all ages, with overall incidence rate ratios of 3.20 for melanoma.  Risks were highest in siblings who were young when the first cancer was diagnosed in the family."

So….whatever that's worth.  I still agree with Janner about what wil be recommended and that watchful observation will follow.

As for Moffitt Cancer Center:  It is a world class facility that treats a large number of melanoma patients.  Truly state of the art.  I have been a patient there since 2010.  I travel from TN to be seen there.

I wish your friend my best.  Celeste

Hey Rocco,

Sorry your friend is having to deal with this.  Janner's assessment and advice is sound as always.  Your friend's family history, with having had a brother pass from melanoma, is concerning both for her emotional out look and in light of a study just out:

Patterns of changing cancer risks with time since diagnosis of a sibling.  Lee, Czene, Reboa and Reilly.  Int J Cancer.  2014 September 30 [Epup ahead of print]

Researchers reviewed siblings of cancer patients and siblings of matched cancer-free controls from Swedish population registers, effects of age and time since diagnosis on sibling risks were examined for colorectal, breast, prostate and melanoma cancers.  "Case siblings had higher cancer incidence than control siblings for all cancers at all ages, with overall incidence rate ratios of 3.20 for melanoma.  Risks were highest in siblings who were young when the first cancer was diagnosed in the family."

So….whatever that's worth.  I still agree with Janner about what wil be recommended and that watchful observation will follow.

As for Moffitt Cancer Center:  It is a world class facility that treats a large number of melanoma patients.  Truly state of the art.  I have been a patient there since 2010.  I travel from TN to be seen there.

I wish your friend my best.  Celeste