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

Forums General Melanoma Community Need advise re: in situ – with family history of mel

  • Post
    Rocco
    Participant

      A dear friend of mine just notifed me her Derm gave her a dx of melanoma in situ.  Very concerned as her brother just recently passed away from mel.  I'm not familiar with in situ and what all tests they'll run on her, etc  Her path info is as follows:

      "Malignant melanoma, predominantly insitu, superficial spreading type.  Dept of invasion is 0.29mm, Clark's level II.  Melanoma is in a horizontal growth phase."

      Her next step is surgery – assuming to get clear margins, etc..  She has an upcoming consult with Dr. Amod Sarnaik, surgical Onc at Moffit in Tampa. 

       Can anyone chime in on what she should request given the family history and/or what she should expect.  Also any input on Moffit in Tampa and/or Dr. Sarnaik would be appreciated.

      Thanks –

      Rocco

       

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    • Replies
        Janner
        Participant

          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.

          Janner
          Participant

            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.

            Janner
            Participant

              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.

              Bubbles
              Participant

                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

                 

                 

                 

                Bubbles
                Participant

                  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

                   

                   

                   

                  Bubbles
                  Participant

                    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

                     

                     

                     

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