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new…looking for info…

Forums Cutaneous Melanoma Community new…looking for info…

  • Post
    justme123
    Participant

      Hi, new here and looking for some info, input, people's 2cents etc.  As you can see below, I have quite a few questions!

      Hi, new here and looking for some info, input, people's 2cents etc.  As you can see below, I have quite a few questions!

      my husband was diagnosed with melanoma just over a month ago.  Clark level II, Breslow 0.19mm  so pretty small.  But it is on his face… so they have done a wide excision biopsy and skin graft.  Healing well.   The pathology came back a few days ago saying that the wide excision biopsy has no evidence of residual in situ or malignant melanoma.  However, they didn't do a sentinel lymph node biopsy because it is on his face… so we don't actually know whether or not there is any cancer in his lymph nodes.

      However, we just got a call from our local cancer centre saying that the radiation oncologist wants to meet with him… no other information.  So as I now sit around wondering…

      Does anybody have any input or info about a similar type/stage of melanoma?  what is normally done for treament if the wide exision biopsy comes back clear? from what I read online, it should just be done with now (aside from long term monitoring), so I am really confused about this oncologist appointment… Has anyone here had radiation therapy for melanoma?

       

      thanks a bunch!

    Viewing 23 reply threads
    • Replies
        justlittleoleme
        Participant

          My husband had radiation to the area where they took 43 lymph nodes and the parotid gland.  My understanding is that radiation in normal doses (2 grey) isn't effective against melanoma.  My husband's radiation oncologist did 5 treatments total at 6 grey. 

          Ask lots of questions before you sign on for radiation.  There are some side effects that are life long.  My husband has fibrosis in the area they did the radiation.  He has permanent hair loss.  He is still trying to regain strength in the shoulder below the radiation site.  That's not to say he wouldn't do it all over again.  Because I am pretty sure he would. 

          Are you seeing a melanoma specialist?  Before I would do anything else, I would seek their opinion.  Melanoma is a different cancer than any other and regular oncologists just don't know it like a melanoma specialist.

          Did they stage him at all?

            justme123
            Participant

              I feel like I don't know anything… My understanding is that at Breslow 0.19 and Clark II he is Type1a, however, without the sentinel lymph node biopsy I don't think there is any way to accurately stage is there?  We don't live in a large centre (only about 200,000 people)… I don't know if there are specifically any melanoma specialists in our city.  …and we're in Canada, so we pretty much just have to take whatever treatment we can get, unless we choose to go to the US.  Next week will be his first meeting with an oncologist, so hopefully that will give us some more info. 

              Thanks for the reply.

              justme123
              Participant

                I feel like I don't know anything… My understanding is that at Breslow 0.19 and Clark II he is Type1a, however, without the sentinel lymph node biopsy I don't think there is any way to accurately stage is there?  We don't live in a large centre (only about 200,000 people)… I don't know if there are specifically any melanoma specialists in our city.  …and we're in Canada, so we pretty much just have to take whatever treatment we can get, unless we choose to go to the US.  Next week will be his first meeting with an oncologist, so hopefully that will give us some more info. 

                Thanks for the reply.

                justme123
                Participant

                  I feel like I don't know anything… My understanding is that at Breslow 0.19 and Clark II he is Type1a, however, without the sentinel lymph node biopsy I don't think there is any way to accurately stage is there?  We don't live in a large centre (only about 200,000 people)… I don't know if there are specifically any melanoma specialists in our city.  …and we're in Canada, so we pretty much just have to take whatever treatment we can get, unless we choose to go to the US.  Next week will be his first meeting with an oncologist, so hopefully that will give us some more info. 

                  Thanks for the reply.

                justlittleoleme
                Participant

                  My husband had radiation to the area where they took 43 lymph nodes and the parotid gland.  My understanding is that radiation in normal doses (2 grey) isn't effective against melanoma.  My husband's radiation oncologist did 5 treatments total at 6 grey. 

                  Ask lots of questions before you sign on for radiation.  There are some side effects that are life long.  My husband has fibrosis in the area they did the radiation.  He has permanent hair loss.  He is still trying to regain strength in the shoulder below the radiation site.  That's not to say he wouldn't do it all over again.  Because I am pretty sure he would. 

                  Are you seeing a melanoma specialist?  Before I would do anything else, I would seek their opinion.  Melanoma is a different cancer than any other and regular oncologists just don't know it like a melanoma specialist.

                  Did they stage him at all?

                  justlittleoleme
                  Participant

                    My husband had radiation to the area where they took 43 lymph nodes and the parotid gland.  My understanding is that radiation in normal doses (2 grey) isn't effective against melanoma.  My husband's radiation oncologist did 5 treatments total at 6 grey. 

                    Ask lots of questions before you sign on for radiation.  There are some side effects that are life long.  My husband has fibrosis in the area they did the radiation.  He has permanent hair loss.  He is still trying to regain strength in the shoulder below the radiation site.  That's not to say he wouldn't do it all over again.  Because I am pretty sure he would. 

                    Are you seeing a melanoma specialist?  Before I would do anything else, I would seek their opinion.  Melanoma is a different cancer than any other and regular oncologists just don't know it like a melanoma specialist.

                    Did they stage him at all?

                    goldengirls2011
                    Participant

                      I also am Clarks level II with Breslow depth of .20mm. I go to the derm every 3 months for checkups & full body checks. My understanding is that a SNB isn't needed unless the depth is above .75mm. Also, seeing an oncologists is only needed if there was active disease. Since my WLE I have had a few biopsies, blood work & a chest xray.

                      You caught it early! Good luck to you, and hopefully someone with more experience will chime in with more info.

                      goldengirls2011
                      Participant

                        I also am Clarks level II with Breslow depth of .20mm. I go to the derm every 3 months for checkups & full body checks. My understanding is that a SNB isn't needed unless the depth is above .75mm. Also, seeing an oncologists is only needed if there was active disease. Since my WLE I have had a few biopsies, blood work & a chest xray.

                        You caught it early! Good luck to you, and hopefully someone with more experience will chime in with more info.

                        goldengirls2011
                        Participant

                          I also am Clarks level II with Breslow depth of .20mm. I go to the derm every 3 months for checkups & full body checks. My understanding is that a SNB isn't needed unless the depth is above .75mm. Also, seeing an oncologists is only needed if there was active disease. Since my WLE I have had a few biopsies, blood work & a chest xray.

                          You caught it early! Good luck to you, and hopefully someone with more experience will chime in with more info.

                          Janner
                          Participant

                            Typically for a lesion that small, the wide excision is all that is done.  There is no SNB because the odds that it has spread at that depth are very small.  I am not sure why a radiation oncologist would want to talk to you.  If the margins were clear and adequate, that's considered the entire treatment for stage IA/IB.  (You didn't mention what the mitosis is from the pathology report – that's the missing piece to determine stage IA vs IB).  Radiation isn't overly effective against melanoma, but it can be used to cleanup areas – especially those where margins might be questionable.  I would think radiation would also cause problems with the skin graft healing.  I honestly have never heard of anyone having radiation for a lesion like yours.  Typically it might be done after a lymph node removal where there might have been extracapsular extension – or possibly on a local recurrence.  I just haven't seen it used as a first line treatment for a lesion like that.  (I've been stage I for 20 years (3 primaries) and monitoring these boards for over 10 years).  I would definitely want a second opinion before I'd consider any radiation treatment as it definitely seems out of the norm.

                            Best wishes,

                            Janner

                            .58mm/Clark II in 1992

                            in situ in 2000

                            .88mm/Clark III in 2001

                            No SNB for any of them

                            Janner
                            Participant

                              Typically for a lesion that small, the wide excision is all that is done.  There is no SNB because the odds that it has spread at that depth are very small.  I am not sure why a radiation oncologist would want to talk to you.  If the margins were clear and adequate, that's considered the entire treatment for stage IA/IB.  (You didn't mention what the mitosis is from the pathology report – that's the missing piece to determine stage IA vs IB).  Radiation isn't overly effective against melanoma, but it can be used to cleanup areas – especially those where margins might be questionable.  I would think radiation would also cause problems with the skin graft healing.  I honestly have never heard of anyone having radiation for a lesion like yours.  Typically it might be done after a lymph node removal where there might have been extracapsular extension – or possibly on a local recurrence.  I just haven't seen it used as a first line treatment for a lesion like that.  (I've been stage I for 20 years (3 primaries) and monitoring these boards for over 10 years).  I would definitely want a second opinion before I'd consider any radiation treatment as it definitely seems out of the norm.

                              Best wishes,

                              Janner

                              .58mm/Clark II in 1992

                              in situ in 2000

                              .88mm/Clark III in 2001

                              No SNB for any of them

                              Janner
                              Participant

                                Typically for a lesion that small, the wide excision is all that is done.  There is no SNB because the odds that it has spread at that depth are very small.  I am not sure why a radiation oncologist would want to talk to you.  If the margins were clear and adequate, that's considered the entire treatment for stage IA/IB.  (You didn't mention what the mitosis is from the pathology report – that's the missing piece to determine stage IA vs IB).  Radiation isn't overly effective against melanoma, but it can be used to cleanup areas – especially those where margins might be questionable.  I would think radiation would also cause problems with the skin graft healing.  I honestly have never heard of anyone having radiation for a lesion like yours.  Typically it might be done after a lymph node removal where there might have been extracapsular extension – or possibly on a local recurrence.  I just haven't seen it used as a first line treatment for a lesion like that.  (I've been stage I for 20 years (3 primaries) and monitoring these boards for over 10 years).  I would definitely want a second opinion before I'd consider any radiation treatment as it definitely seems out of the norm.

                                Best wishes,

                                Janner

                                .58mm/Clark II in 1992

                                in situ in 2000

                                .88mm/Clark III in 2001

                                No SNB for any of them

                                  justme123
                                  Participant

                                    mitotic rate was <1  So I think 1A.  

                                     

                                    Worst part right now is not knowing… I am hoping the radiation oncologist is just going to send him for CT or PET or MRI or something?? 

                                     

                                    Thanks all for your comments.  very helpful!

                                    justme123
                                    Participant

                                      mitotic rate was <1  So I think 1A.  

                                       

                                      Worst part right now is not knowing… I am hoping the radiation oncologist is just going to send him for CT or PET or MRI or something?? 

                                       

                                      Thanks all for your comments.  very helpful!

                                      Janner
                                      Participant

                                        It's also not common to have any type of scans for a stage IA lesion – so I guess you'll just have to wait and wonder.   I can't even guess what would be proposed.  Please let us know what happens at the appointment.

                                        Best wishes,

                                        Janner

                                        Janner
                                        Participant

                                          It's also not common to have any type of scans for a stage IA lesion – so I guess you'll just have to wait and wonder.   I can't even guess what would be proposed.  Please let us know what happens at the appointment.

                                          Best wishes,

                                          Janner

                                          Janner
                                          Participant

                                            It's also not common to have any type of scans for a stage IA lesion – so I guess you'll just have to wait and wonder.   I can't even guess what would be proposed.  Please let us know what happens at the appointment.

                                            Best wishes,

                                            Janner

                                            justme123
                                            Participant

                                              mitotic rate was <1  So I think 1A.  

                                               

                                              Worst part right now is not knowing… I am hoping the radiation oncologist is just going to send him for CT or PET or MRI or something?? 

                                               

                                              Thanks all for your comments.  very helpful!

                                            scots
                                            Participant
                                              I recieved 5 treatments of radiation to a local area on the back of my head. My scalp melanoma was 3.7mm, high mitotic rate, WLE clear margins, snb also clear. Good luck

                                              Scot

                                              scots
                                              Participant
                                                I recieved 5 treatments of radiation to a local area on the back of my head. My scalp melanoma was 3.7mm, high mitotic rate, WLE clear margins, snb also clear. Good luck

                                                Scot

                                                scots
                                                Participant
                                                  I recieved 5 treatments of radiation to a local area on the back of my head. My scalp melanoma was 3.7mm, high mitotic rate, WLE clear margins, snb also clear. Good luck

                                                  Scot

                                                  justme123
                                                  Participant

                                                    Thanks all for your comments!

                                                    So I have done a bunch more reading on this… I have access to all scientific journals etc which is really nice.   It looks like there are a number of recent (2010-2012) papers citing that adjuvent radiation therapy is being recommended for even type I melanoma after wide excision biopsy.  About 45- >50 Gy total dose, fractionated in 1.8-2Gy doses.  This is especially for head/neck melanoma's since lymph node disection or even biopsy isn't recommended.  Will be interesting to see what the oncologist has to say next week.

                                                    justme123
                                                    Participant

                                                      Thanks all for your comments!

                                                      So I have done a bunch more reading on this… I have access to all scientific journals etc which is really nice.   It looks like there are a number of recent (2010-2012) papers citing that adjuvent radiation therapy is being recommended for even type I melanoma after wide excision biopsy.  About 45- >50 Gy total dose, fractionated in 1.8-2Gy doses.  This is especially for head/neck melanoma's since lymph node disection or even biopsy isn't recommended.  Will be interesting to see what the oncologist has to say next week.

                                                        JC
                                                        Participant

                                                          Did radiation end up being administered for this thin early lesion?  I have never heard of this before, but I wonder if I should be looking into that?

                                                          JC
                                                          Participant

                                                            Did radiation end up being administered for this thin early lesion?  I have never heard of this before, but I wonder if I should be looking into that?

                                                            JC
                                                            Participant

                                                              Did radiation end up being administered for this thin early lesion?  I have never heard of this before, but I wonder if I should be looking into that?

                                                            justme123
                                                            Participant

                                                              Thanks all for your comments!

                                                              So I have done a bunch more reading on this… I have access to all scientific journals etc which is really nice.   It looks like there are a number of recent (2010-2012) papers citing that adjuvent radiation therapy is being recommended for even type I melanoma after wide excision biopsy.  About 45- >50 Gy total dose, fractionated in 1.8-2Gy doses.  This is especially for head/neck melanoma's since lymph node disection or even biopsy isn't recommended.  Will be interesting to see what the oncologist has to say next week.

                                                              lhaley
                                                              Participant

                                                                They do not recommend SNB's unless the Breslow is at least .75 or at least a high miotic rate.  Yours is very thin. Continue to go to a dermatologist and watch your skin for future issues.

                                                                Consider it as a warning.

                                                                Best of luck

                                                                Linda

                                                                mel since 1979, now stage IV  Live life and enjoy everyday!

                                                                lhaley
                                                                Participant

                                                                  They do not recommend SNB's unless the Breslow is at least .75 or at least a high miotic rate.  Yours is very thin. Continue to go to a dermatologist and watch your skin for future issues.

                                                                  Consider it as a warning.

                                                                  Best of luck

                                                                  Linda

                                                                  mel since 1979, now stage IV  Live life and enjoy everyday!

                                                                  lhaley
                                                                  Participant

                                                                    They do not recommend SNB's unless the Breslow is at least .75 or at least a high miotic rate.  Yours is very thin. Continue to go to a dermatologist and watch your skin for future issues.

                                                                    Consider it as a warning.

                                                                    Best of luck

                                                                    Linda

                                                                    mel since 1979, now stage IV  Live life and enjoy everyday!

                                                                    JerryfromFauq
                                                                    Participant

                                                                      Hard to add much to what Janner said.  She covered the subject quite well.  Radiation is usely just effective as a kind of "mop up" for possible escaped miscellanous cells or to reduce a tumor burden to allow for an operation.

                                                                      JerryfromFauq
                                                                      Participant

                                                                        Hard to add much to what Janner said.  She covered the subject quite well.  Radiation is usely just effective as a kind of "mop up" for possible escaped miscellanous cells or to reduce a tumor burden to allow for an operation.

                                                                        JerryfromFauq
                                                                        Participant

                                                                          Hard to add much to what Janner said.  She covered the subject quite well.  Radiation is usely just effective as a kind of "mop up" for possible escaped miscellanous cells or to reduce a tumor burden to allow for an operation.

                                                                          justme123
                                                                          Participant

                                                                            Hi Everyone, thanks for the info.   They decided to just put us on a "watch and see"  schedule.  No radiatoin, no biopsy.  We are supposed to just keep an eye on things now.   thanks all for the input!

                                                                            justme123
                                                                            Participant

                                                                              Hi Everyone, thanks for the info.   They decided to just put us on a "watch and see"  schedule.  No radiatoin, no biopsy.  We are supposed to just keep an eye on things now.   thanks all for the input!

                                                                              justme123
                                                                              Participant

                                                                                Hi Everyone, thanks for the info.   They decided to just put us on a "watch and see"  schedule.  No radiatoin, no biopsy.  We are supposed to just keep an eye on things now.   thanks all for the input!

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