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Need help with biopsy recommendation

Forums General Melanoma Community Need help with biopsy recommendation

  • Post
    Eugenia
    Participant

    I was diagnosed with malignant melanoma (stage 3c) 2 1/l2 years ago (still NED!!) and found great comfort and advice from members of this board.  I am back because my SIL went to her general practitioner a week ago with a lesion that had every aspect of the ABCDEs.  SIL says her gp kept commenting on how she was sure the lesion was "nothing" and would be surprised if it came back as abnormal, and told my SIL she was doing a shave biopsy. Lesion is on back of SIL's leg, so impossible to see what doc was doing, but a nurse asked the doc at one point

    I was diagnosed with malignant melanoma (stage 3c) 2 1/l2 years ago (still NED!!) and found great comfort and advice from members of this board.  I am back because my SIL went to her general practitioner a week ago with a lesion that had every aspect of the ABCDEs.  SIL says her gp kept commenting on how she was sure the lesion was "nothing" and would be surprised if it came back as abnormal, and told my SIL she was doing a shave biopsy. Lesion is on back of SIL's leg, so impossible to see what doc was doing, but a nurse asked the doc at one point if she had the right blade.  Last night, gp calls my SIL and says results are back it is melanoma and be in my office on Monday morning at 8:00 to do a punch biopsy.  SIL called me and I went right over.  She showed me the lesion and there is a definite circle where the biopsy was taken.  It looks to me like the same type of wound left after my punch biopsy years ago–like a straw was stuck through the top middle of the lesion.

    I have been frantically trying to get caught up on what is current best practices with biopsies.  I told my SIL that the lesion needs to come off–completey with excision.  She said her doc told her that they would eventually take it off for sure, but needed to do the punch for depth.  I recommended to SIL that she go to the doc Monday morning, get a copy of the path report and run like hell.  I think she needs a surgical oncologist next and a wide local excision.  It scares me to have this doc mess with the lesion any more before it is taken off.  Am I off base?  Does she need the punch biopsy?

    Thanks so much for your help with this!

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  • Replies
      dawn dion
      Participant

      Run do not walk to surgical onc – my gp did the same thing to me telling me it was nothing until it was something.  just go straight to having the excision don't mess around.

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      dawn dion
      Participant

      Run do not walk to surgical onc – my gp did the same thing to me telling me it was nothing until it was something.  just go straight to having the excision don't mess around.

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      Carol Taylor
      Participant

      Eugenia,

      You're so right!  I agree with Dawn.  You two get running as fast as you can. Can you, maybe, get her an appt with your surgical onc? But yeah, put your running shoes on and please make sure she doesn't go back!

      Lord, in Your mercy, open doors! Amen.

      Grace and peace,

      Carol

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      Carol Taylor
      Participant

      Eugenia,

      You're so right!  I agree with Dawn.  You two get running as fast as you can. Can you, maybe, get her an appt with your surgical onc? But yeah, put your running shoes on and please make sure she doesn't go back!

      Lord, in Your mercy, open doors! Amen.

      Grace and peace,

      Carol

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      Janner
      Participant

      Get the path report and at least go to a specialist – either derm or surgical onc.  The reason the PCP wants to do a punch first is to see if the depth warrants a SNB.  That's why he isn't jumping right to an excisional biopsy or WLE (wide local excision).  If the WLE is done now, it may alter the drainage paths and make doing the SNB later a problem.   So I can see why the PCP is choosing this course of action and it is logical.  However, it really make more sense to move on to a specialist at this point and let them take charge of her care.

      Best wishes,

      Janner

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      Janner
      Participant

      Get the path report and at least go to a specialist – either derm or surgical onc.  The reason the PCP wants to do a punch first is to see if the depth warrants a SNB.  That's why he isn't jumping right to an excisional biopsy or WLE (wide local excision).  If the WLE is done now, it may alter the drainage paths and make doing the SNB later a problem.   So I can see why the PCP is choosing this course of action and it is logical.  However, it really make more sense to move on to a specialist at this point and let them take charge of her care.

      Best wishes,

      Janner

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      MichaelFL
      Participant

      You are correct, and as the others have said, at this point she needs to see a derm and possibly a surgical onc to discuss a WLE, and possibly a SNB based on the Breslow depth of the lesion. Next time she needs to have a biopsy, go to a derm instead of a GP too. Not surprising, thius has been discussed several time before on this board.

      You may wish to get a copy of the pathology report and post it here. The main concern at this point is the Breslow depth, and to make sure the tumors Breslow depth is accurate and was not transected or cut through. Hopefully, even though a shave was done (perhpas poorly) the Breslow depth will still be accurate.

      If you read the path report, it will say something like the Breslow depth is at least so and so in MM. That will be the clue.

      Hopefully though the entire lesion was removed and the Breslow depth was accurate, and you vcan take it from there.

      Good luck and keep us posted.

      Michae stage 1b

       

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      MichaelFL
      Participant

      You are correct, and as the others have said, at this point she needs to see a derm and possibly a surgical onc to discuss a WLE, and possibly a SNB based on the Breslow depth of the lesion. Next time she needs to have a biopsy, go to a derm instead of a GP too. Not surprising, thius has been discussed several time before on this board.

      You may wish to get a copy of the pathology report and post it here. The main concern at this point is the Breslow depth, and to make sure the tumors Breslow depth is accurate and was not transected or cut through. Hopefully, even though a shave was done (perhpas poorly) the Breslow depth will still be accurate.

      If you read the path report, it will say something like the Breslow depth is at least so and so in MM. That will be the clue.

      Hopefully though the entire lesion was removed and the Breslow depth was accurate, and you vcan take it from there.

      Good luck and keep us posted.

      Michae stage 1b

       

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      Eugenia
      Participant

      Thank you all–you are awesome!!!  Will post path report when I get a copy.  SIL told her doc this AM not to touch it (the biopsy wound is infected so she will be on oral antibiotic) and asked for recommendation to a cancer center.  She now has an appt. Wednesday.  I would love to have her go to my doc but about 6 months after I finished my high dose INF, my doc got a job as head of research and clinical trials in St. Louis, which is 600+ miles from us.  :(

      SIL read me the path report over the phone.  No way to determine margins because of the shave, mel. described as in situ, letiginous (sp?) with no evidence of mitosis, etc.  but will post more details when I get it to see what you all think.

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      Eugenia
      Participant

      Thank you all–you are awesome!!!  Will post path report when I get a copy.  SIL told her doc this AM not to touch it (the biopsy wound is infected so she will be on oral antibiotic) and asked for recommendation to a cancer center.  She now has an appt. Wednesday.  I would love to have her go to my doc but about 6 months after I finished my high dose INF, my doc got a job as head of research and clinical trials in St. Louis, which is 600+ miles from us.  :(

      SIL read me the path report over the phone.  No way to determine margins because of the shave, mel. described as in situ, letiginous (sp?) with no evidence of mitosis, etc.  but will post more details when I get it to see what you all think.

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      Eugenia
      Participant

      Thank you all–you are awesome!!!  Will post path report when I get a copy.  SIL told her doc this AM not to touch it (the biopsy wound is infected so she will be on oral antibiotic) and asked for recommendation to a cancer center.  She now has an appt. Wednesday.  I would love to have her go to my doc but about 6 months after I finished my high dose INF, my doc got a job as head of research and clinical trials in St. Louis, which is 600+ miles from us.  :(

      SIL read me the path report over the phone.  No way to determine margins because of the shave, mel. described as in situ, letiginous (sp?) with no evidence of mitosis, etc.  but will post more details when I get it to see what you all think.

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        MichaelFL
        Participant

        In-situ is the best place to be as far as melanoma is concerned. It means in place, and has no Breslow depth. If this is the case, most likely the original biopsy got all the tumor, and seeing a cancer center will most likely not be needed as a WLE-or what is called a wide local excision is standard procedure for a melanoma in-situ.

        Tell her to try some antibiotic ointment as well.

        Michael

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        MichaelFL
        Participant

        In-situ is the best place to be as far as melanoma is concerned. It means in place, and has no Breslow depth. If this is the case, most likely the original biopsy got all the tumor, and seeing a cancer center will most likely not be needed as a WLE-or what is called a wide local excision is standard procedure for a melanoma in-situ.

        Tell her to try some antibiotic ointment as well.

        Michael

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      Eugenia
      Participant

      Thank you all–you are awesome!!!  Will post path report when I get a copy.  SIL told her doc this AM not to touch it (the biopsy wound is infected so she will be on oral antibiotic) and asked for recommendation to a cancer center.  She now has an appt. Wednesday.  I would love to have her go to my doc but about 6 months after I finished my high dose INF, my doc got a job as head of research and clinical trials in St. Louis, which is 600+ miles from us.  :(

      SIL read me the path report over the phone.  No way to determine margins because of the shave, mel. described as in situ, letiginous (sp?) with no evidence of mitosis, etc.  but will post more details when I get it to see what you all think.

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