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- This topic has 12 replies, 4 voices, and was last updated 9 years, 8 months ago by
KimberlyVU.
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- April 5, 2016 at 3:06 am
Hi Everyone! I recently received a diagnosis of melanoma from my dermatologist and had a follow-up appointment with a general surgeon. Even prior to the diagnosis, I wasn't entirely comfortable with the dermatologist (it was my first appointment with her), as she only looked at moles I pointed out and became preoccupied with removing the mole that came back as being melanoma to the point that she didn't examine any of my lower body. She recommended a general surgeon to me, who I followed up with last week and recommended an excision surgery. I feel like neither doctor was very thorough, but I could also be to blame as I was pretty uninformed going into my appointments. In my defense, the dermatologist made it sound like the surgeon was just going to do another quick procedure in the office the day of my appointment. I'm planning to find another dermatologist to follow-up with, but i'm wondering if any other test/procedures should be being considered at this point. I'm also wondering if it's wise to follow-up with someone who specializes in melanoma rather than just a general surgeon. Sorry – I'm feeling overwhelmed by information on the internet and underwhelmed by the information given to me by doctors, thus far. Below are the notes on my diagnosis from the dermatologist:
Microscopic description: The epidermis shows irregular acanthosis with broad rete ridges. There is an increase in number of basal melanocytes with dense melanin pigment. Aggregates of melanocytes with enlarged pleomorphic nuclei are present in papillary dermis. They are occasionally seen in lower epidermis. A dense lymphoid infilitrate is present below the above changes.
MART-I stain is positive in lesional cells.
Pathological diagnosis: melanoma, 0.76mm
Any advice, information, or insight is greatly appreciated! Thanks in advance!
- Replies
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- April 5, 2016 at 5:04 am
So they are just planning to do the WLE – wide local excision, it appears. A SNB (sentinel node biopsy) is typically done for lesions over 1mm. I've had many WLE's done as in office procedures. They use a local and remove a decent chunk of skin. Think 4-5" for a scar – much depends on the location and tension on the skin. But the scar will be long in order to close the wound. Honestly, my derms have all done my WLEs. There is no need for anyone but a surgeon at this point. If you want to find a derm who is more specialized in skin cancer, that might be a good move. Not always easy to find but worth looking for. Cutaneous oncologist. But in terms of just removing the extra margins, they don't need to specialize in melanoma, just in "chunk of skin" removal. Typically, other than monitoring your skin, there really isn't any other followup for stage I. They don't do scans for stage I. Many oncologists don't see stage I individuals. They specialize in treatment and once you are done with surgery, there is no treatment for stage I. If you want to see a melanoma oncologist, however, you can certainly go that route. But they will not be able to offer you more than a good derm. In the end, though, you are the one who has to feel comfortable. If you can find a great derm, then that might be all you need. (That is all I have had for 24 years now, since my first melanoma primary. I do see a cutaneous oncologist now but saw a normal derm for my first two primaries).
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- April 5, 2016 at 5:04 am
So they are just planning to do the WLE – wide local excision, it appears. A SNB (sentinel node biopsy) is typically done for lesions over 1mm. I've had many WLE's done as in office procedures. They use a local and remove a decent chunk of skin. Think 4-5" for a scar – much depends on the location and tension on the skin. But the scar will be long in order to close the wound. Honestly, my derms have all done my WLEs. There is no need for anyone but a surgeon at this point. If you want to find a derm who is more specialized in skin cancer, that might be a good move. Not always easy to find but worth looking for. Cutaneous oncologist. But in terms of just removing the extra margins, they don't need to specialize in melanoma, just in "chunk of skin" removal. Typically, other than monitoring your skin, there really isn't any other followup for stage I. They don't do scans for stage I. Many oncologists don't see stage I individuals. They specialize in treatment and once you are done with surgery, there is no treatment for stage I. If you want to see a melanoma oncologist, however, you can certainly go that route. But they will not be able to offer you more than a good derm. In the end, though, you are the one who has to feel comfortable. If you can find a great derm, then that might be all you need. (That is all I have had for 24 years now, since my first melanoma primary. I do see a cutaneous oncologist now but saw a normal derm for my first two primaries).
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- April 5, 2016 at 2:59 pm
I would consider going to a Melanoma specialist centre if possible. The wider excision should be done in a manner that if you were unlucky enough to have a recurrence locally it is easier to deal with.
Also, you lab report seems to talk about lymphatic tissue underneath the lesion- the melanoma specialist might want to consider a sentinel lymph node biopsy as well ? Did they give you a miotic rate for the lesion ? From what I uderstand this helps calculate the risk of further spread. I know it is tough but getting the most appropriate treatment early on can save an awful lot of pain at a later date – and I've learnt the hard way- specialists are better at making decisions on what tests etc to follow where a lesion has slightly unusual features. Probably not what you want to hear right now- as a small thin lesion is normally sorted by excision- but I would get advice from the most knowledgeable doctor you can find right now.
PS Have a hug over the net from me
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- April 5, 2016 at 2:59 pm
I would consider going to a Melanoma specialist centre if possible. The wider excision should be done in a manner that if you were unlucky enough to have a recurrence locally it is easier to deal with.
Also, you lab report seems to talk about lymphatic tissue underneath the lesion- the melanoma specialist might want to consider a sentinel lymph node biopsy as well ? Did they give you a miotic rate for the lesion ? From what I uderstand this helps calculate the risk of further spread. I know it is tough but getting the most appropriate treatment early on can save an awful lot of pain at a later date – and I've learnt the hard way- specialists are better at making decisions on what tests etc to follow where a lesion has slightly unusual features. Probably not what you want to hear right now- as a small thin lesion is normally sorted by excision- but I would get advice from the most knowledgeable doctor you can find right now.
PS Have a hug over the net from me
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- April 13, 2016 at 6:44 am
Yep, I’m in the same boat here in Canada. Had to fight for my biopsy. I knew something wasn’t right and sure enough it was melanoma. I have gotten all of my questions answered and information given on similar forums to this. My dermatologist was useless and the plastic surgeon is just that. Thankfully I see a melanoma specialist on the 9th of May. Hopefully he is more helpful. I sure feel alone on this one. My family and friends all think melanoma is no big deal. “Just cut it off” sigh…. Meanwhile I’m faking calmness with my husband and fiends that do understand how serious it is. I feel like these groups are the only place I can be honest and say that I am honestly terrified. -
- April 13, 2016 at 6:44 am
Yep, I’m in the same boat here in Canada. Had to fight for my biopsy. I knew something wasn’t right and sure enough it was melanoma. I have gotten all of my questions answered and information given on similar forums to this. My dermatologist was useless and the plastic surgeon is just that. Thankfully I see a melanoma specialist on the 9th of May. Hopefully he is more helpful. I sure feel alone on this one. My family and friends all think melanoma is no big deal. “Just cut it off” sigh…. Meanwhile I’m faking calmness with my husband and fiends that do understand how serious it is. I feel like these groups are the only place I can be honest and say that I am honestly terrified. -
- April 22, 2016 at 12:02 am
Carly
I am in Vancouver and just had my excision of the original lesion and waiting for biopsy results.
I have had a very similar experience with friends and family. If you want to email me directly I'm at Kim.VanUnen@gmail.com
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- April 22, 2016 at 12:02 am
Carly
I am in Vancouver and just had my excision of the original lesion and waiting for biopsy results.
I have had a very similar experience with friends and family. If you want to email me directly I'm at Kim.VanUnen@gmail.com
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- April 22, 2016 at 12:02 am
Carly
I am in Vancouver and just had my excision of the original lesion and waiting for biopsy results.
I have had a very similar experience with friends and family. If you want to email me directly I'm at Kim.VanUnen@gmail.com
-
- April 13, 2016 at 6:44 am
Yep, I’m in the same boat here in Canada. Had to fight for my biopsy. I knew something wasn’t right and sure enough it was melanoma. I have gotten all of my questions answered and information given on similar forums to this. My dermatologist was useless and the plastic surgeon is just that. Thankfully I see a melanoma specialist on the 9th of May. Hopefully he is more helpful. I sure feel alone on this one. My family and friends all think melanoma is no big deal. “Just cut it off” sigh…. Meanwhile I’m faking calmness with my husband and fiends that do understand how serious it is. I feel like these groups are the only place I can be honest and say that I am honestly terrified. -
- April 5, 2016 at 2:59 pm
I would consider going to a Melanoma specialist centre if possible. The wider excision should be done in a manner that if you were unlucky enough to have a recurrence locally it is easier to deal with.
Also, you lab report seems to talk about lymphatic tissue underneath the lesion- the melanoma specialist might want to consider a sentinel lymph node biopsy as well ? Did they give you a miotic rate for the lesion ? From what I uderstand this helps calculate the risk of further spread. I know it is tough but getting the most appropriate treatment early on can save an awful lot of pain at a later date – and I've learnt the hard way- specialists are better at making decisions on what tests etc to follow where a lesion has slightly unusual features. Probably not what you want to hear right now- as a small thin lesion is normally sorted by excision- but I would get advice from the most knowledgeable doctor you can find right now.
PS Have a hug over the net from me
-
- April 5, 2016 at 5:04 am
So they are just planning to do the WLE – wide local excision, it appears. A SNB (sentinel node biopsy) is typically done for lesions over 1mm. I've had many WLE's done as in office procedures. They use a local and remove a decent chunk of skin. Think 4-5" for a scar – much depends on the location and tension on the skin. But the scar will be long in order to close the wound. Honestly, my derms have all done my WLEs. There is no need for anyone but a surgeon at this point. If you want to find a derm who is more specialized in skin cancer, that might be a good move. Not always easy to find but worth looking for. Cutaneous oncologist. But in terms of just removing the extra margins, they don't need to specialize in melanoma, just in "chunk of skin" removal. Typically, other than monitoring your skin, there really isn't any other followup for stage I. They don't do scans for stage I. Many oncologists don't see stage I individuals. They specialize in treatment and once you are done with surgery, there is no treatment for stage I. If you want to see a melanoma oncologist, however, you can certainly go that route. But they will not be able to offer you more than a good derm. In the end, though, you are the one who has to feel comfortable. If you can find a great derm, then that might be all you need. (That is all I have had for 24 years now, since my first melanoma primary. I do see a cutaneous oncologist now but saw a normal derm for my first two primaries).
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Tagged: cutaneous melanoma
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