› Forums › Cutaneous Melanoma Community › Newly Diagnosed – contemplating next step
- This topic has 33 replies, 4 voices, and was last updated 13 years, 2 months ago by
JC.
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- October 27, 2012 at 6:13 pm
I have two doctors with differing referals for my next procedure. The md who performed the removal referred me to dermatology surgeon. She specializes metobolic balancing/anti aging/hormone balancing/vitamin deficency. My family practice md of 20 years strongly suggests oncology surgeon. Both doctors recommend Seattle Cancer Care Alliance after final dignostic procedures.
I have two doctors with differing referals for my next procedure. The md who performed the removal referred me to dermatology surgeon. She specializes metobolic balancing/anti aging/hormone balancing/vitamin deficency. My family practice md of 20 years strongly suggests oncology surgeon. Both doctors recommend Seattle Cancer Care Alliance after final dignostic procedures.
I can have wide excision w dermotogist Nov 1. I have not seen this dr previously. I should hear from the Oncologist in the next couple days. From some reading on this site, it sounds like i may need to have first lymph noid tested before wide local excision. Does a dermatologist do this procedure? I also have other moles/sites that need to be looked at/tested that have not been looked at by a dr. Will an oncologist do this?
Any anwers/advice/suggestions. Feeling overwhelmed with decision and some pressure to hurry to have the rest of the bad cells removed.
Lab report:
Malignant melanoma in situ with associated atypical compound nevus.
Immunohistochemistry reveals a maturation pattern and low proliferation rate compatible with a melanocytic nevus in the dermal compound of the lesion. The lesion extends to the peripheral margins of the specimen. Complete removal is recommended.
Received specimen is 1.4 x 0.8 x 0.3 cm portion of skin.
Sections show skin with a poorly-circumscribed and asymmetrical proliferation of cytologically atypical melanocytes in the epidermis and in the dermis. Inreaepidermal atypical melanocytes are present in superficial epidermal layers in several area. The dermal componant of the lesion appears biphenotypic having either a small nevoid or larger epithelioid cell appearance. The lesion extends to the peripheral margins of the specimen.
HMB-45 strongly labels junctional melanocytes highlighting the cells present in superficial epidermal layers. Labeling decresaes with progressive decent in the dermal component. MIB-1 Labels the nuclei of some keratinocytes, but very few of the melanocytes in the dermal component of lesion are labeled. This represents a maturation pattern and low proliferation rate compatible with a nevus in the dermal compoent of the lesion.
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- October 27, 2012 at 6:52 pm
You have what is called a melanoma insitu. Insitu means no depth, so the melanoma has not yet gone throught your five layers of skin. This is as good as it gets as far as a melanoma daignosis is concerned as it has virtually a 100% survival rate after what is called the WLE or wide local excision is done.
You do not need a SNB or what is called a sentinel node biopsy either. This is performed when the melanoma has a depth of at least .75 mm or 1.0 mm. (called Breslow depth) The cutoff is .75 mm depth if ulcerated, or 1.0 mm depth if not. Since yours is insitu, it has no depth and a SNB is not needed.
You do not need a oncologist either. After your WLE results comes back, you will be looking for clear margins. Then just be vigilant and keep up your 6 month derm visits!
Be happy-you caught this early, as early as it can be caught.
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- October 29, 2012 at 2:46 am
Thank-you for your response! I am wondering w hat you see as the depth of my lesion? The way I read it, from Dr’s labeling, is the depth is .3 cm or 3mm? -
- October 29, 2012 at 2:46 am
Thank-you for your response! I am wondering w hat you see as the depth of my lesion? The way I read it, from Dr’s labeling, is the depth is .3 cm or 3mm? -
- October 29, 2012 at 3:02 am
Your lesion has NO DEPTH. The .3cm is the width of the biopsy sample and has nothing to do with the depth. In situ means a lesion is totally confined to the epidermis. Depth is measured from below the epidermis as it extends into the skin. So in situ, by definition, has no depth at all. This is why it basically has a 100% cure rate – because it is on the surface of the skin and doesn't invade into the skin where there are blood or lymph vessels. If you have to have melanoma, in situ is what you want to see!
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- October 29, 2012 at 3:02 am
Your lesion has NO DEPTH. The .3cm is the width of the biopsy sample and has nothing to do with the depth. In situ means a lesion is totally confined to the epidermis. Depth is measured from below the epidermis as it extends into the skin. So in situ, by definition, has no depth at all. This is why it basically has a 100% cure rate – because it is on the surface of the skin and doesn't invade into the skin where there are blood or lymph vessels. If you have to have melanoma, in situ is what you want to see!
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- October 29, 2012 at 3:16 am
Thank-you…I am confused by the ‘in situ” and that “it” extends to the margins and references to dermis? -
- October 29, 2012 at 3:16 am
Thank-you…I am confused by the ‘in situ” and that “it” extends to the margins and references to dermis? -
- October 29, 2012 at 3:16 am
Thank-you…I am confused by the ‘in situ” and that “it” extends to the margins and references to dermis? -
- October 29, 2012 at 3:22 am
All the jargon in the description is justifying the diagnosis. You have atypical cells in the dermis. Atypical cells do not have to be melanoma cells. Basically, you have an existing mole that had some atypical features. The cancerous portion is in the epidermis. The non-cancerous portions are in the dermis. These are some non-cancerous cells that show some atypical features in the dermis, but THESE ARE NOT CANCER. The "extends to the margins" comment means that there are still some melanoma cells at the edges of the lesion. This has nothing to do with depth and won't change the diagnosis. The next surgery where they remove larger margins will take care of those remaining cells.
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- October 29, 2012 at 3:22 am
All the jargon in the description is justifying the diagnosis. You have atypical cells in the dermis. Atypical cells do not have to be melanoma cells. Basically, you have an existing mole that had some atypical features. The cancerous portion is in the epidermis. The non-cancerous portions are in the dermis. These are some non-cancerous cells that show some atypical features in the dermis, but THESE ARE NOT CANCER. The "extends to the margins" comment means that there are still some melanoma cells at the edges of the lesion. This has nothing to do with depth and won't change the diagnosis. The next surgery where they remove larger margins will take care of those remaining cells.
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- October 29, 2012 at 3:22 am
All the jargon in the description is justifying the diagnosis. You have atypical cells in the dermis. Atypical cells do not have to be melanoma cells. Basically, you have an existing mole that had some atypical features. The cancerous portion is in the epidermis. The non-cancerous portions are in the dermis. These are some non-cancerous cells that show some atypical features in the dermis, but THESE ARE NOT CANCER. The "extends to the margins" comment means that there are still some melanoma cells at the edges of the lesion. This has nothing to do with depth and won't change the diagnosis. The next surgery where they remove larger margins will take care of those remaining cells.
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- October 29, 2012 at 3:48 am
So sounds going to the dermatologist who wants to do the WLE Nov 1st and not going to Oncologist is a good plan? The voice head that nags at me is the doctor who is insisting on oncology, has been right on a couple of big diagnoses over the years (epilepsy, high risk pregnancy) when I debated that his original diagnosis were extreme without conclusive testing, they ended up being right on the money in the end. Thank you again for the discussion! You have helped my stress from indecision and lack of information significantly. do you know if it is common to have multiple sites at the time of diagnosis? I have several spots that are similar to the 1 that was removed in the same location …on my hips. they were not as large or dark as the 1 removed. but have not been looked at by a physician/dermatologist. I haven’t had through skin check in 5 yrs but fall in to risk categories : Scandinavian and Dutch descent, fair skin, blue eyes, lots of moles freckles, Sun burns and childhood, and Sun/beach lover. -
- October 29, 2012 at 3:48 am
So sounds going to the dermatologist who wants to do the WLE Nov 1st and not going to Oncologist is a good plan? The voice head that nags at me is the doctor who is insisting on oncology, has been right on a couple of big diagnoses over the years (epilepsy, high risk pregnancy) when I debated that his original diagnosis were extreme without conclusive testing, they ended up being right on the money in the end. Thank you again for the discussion! You have helped my stress from indecision and lack of information significantly. do you know if it is common to have multiple sites at the time of diagnosis? I have several spots that are similar to the 1 that was removed in the same location …on my hips. they were not as large or dark as the 1 removed. but have not been looked at by a physician/dermatologist. I haven’t had through skin check in 5 yrs but fall in to risk categories : Scandinavian and Dutch descent, fair skin, blue eyes, lots of moles freckles, Sun burns and childhood, and Sun/beach lover. -
- October 29, 2012 at 3:48 am
So sounds going to the dermatologist who wants to do the WLE Nov 1st and not going to Oncologist is a good plan? The voice head that nags at me is the doctor who is insisting on oncology, has been right on a couple of big diagnoses over the years (epilepsy, high risk pregnancy) when I debated that his original diagnosis were extreme without conclusive testing, they ended up being right on the money in the end. Thank you again for the discussion! You have helped my stress from indecision and lack of information significantly. do you know if it is common to have multiple sites at the time of diagnosis? I have several spots that are similar to the 1 that was removed in the same location …on my hips. they were not as large or dark as the 1 removed. but have not been looked at by a physician/dermatologist. I haven’t had through skin check in 5 yrs but fall in to risk categories : Scandinavian and Dutch descent, fair skin, blue eyes, lots of moles freckles, Sun burns and childhood, and Sun/beach lover. -
- October 29, 2012 at 4:06 am
It's rare to have more than one primary. Basically, about 8% of the melanoma population have more than one. The thing to watch for is CHANGE. If any of your moles look different from all the others (ugly duckling), if they change or itch, THESE are the moles that are suspect. Even changing moles do not have to be melanoma, but they are higher risk. When you say "I have several similar spots"…. to me that means that a spot is not an ugly duckling.
I have had 3 early primaries and do not see an oncologist. I see a dermatologist who specializes in skin cancer. I see no reason to see an oncologist. They have nothing to offer me. You are stage 0. I am stage IB. There are no treatments besides the WLE for your or my stage. If I thought an oncologist would be of benefit, I would go. But basically, most oncologists wouldn't even see a stage 0 patient – just so you know. They reserve their time for individuals who are high risk or seeking treatment and need their help. That is not a stage 0 patient.
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- October 29, 2012 at 4:06 am
It's rare to have more than one primary. Basically, about 8% of the melanoma population have more than one. The thing to watch for is CHANGE. If any of your moles look different from all the others (ugly duckling), if they change or itch, THESE are the moles that are suspect. Even changing moles do not have to be melanoma, but they are higher risk. When you say "I have several similar spots"…. to me that means that a spot is not an ugly duckling.
I have had 3 early primaries and do not see an oncologist. I see a dermatologist who specializes in skin cancer. I see no reason to see an oncologist. They have nothing to offer me. You are stage 0. I am stage IB. There are no treatments besides the WLE for your or my stage. If I thought an oncologist would be of benefit, I would go. But basically, most oncologists wouldn't even see a stage 0 patient – just so you know. They reserve their time for individuals who are high risk or seeking treatment and need their help. That is not a stage 0 patient.
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- October 29, 2012 at 4:06 am
It's rare to have more than one primary. Basically, about 8% of the melanoma population have more than one. The thing to watch for is CHANGE. If any of your moles look different from all the others (ugly duckling), if they change or itch, THESE are the moles that are suspect. Even changing moles do not have to be melanoma, but they are higher risk. When you say "I have several similar spots"…. to me that means that a spot is not an ugly duckling.
I have had 3 early primaries and do not see an oncologist. I see a dermatologist who specializes in skin cancer. I see no reason to see an oncologist. They have nothing to offer me. You are stage 0. I am stage IB. There are no treatments besides the WLE for your or my stage. If I thought an oncologist would be of benefit, I would go. But basically, most oncologists wouldn't even see a stage 0 patient – just so you know. They reserve their time for individuals who are high risk or seeking treatment and need their help. That is not a stage 0 patient.
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- October 29, 2012 at 3:02 am
Your lesion has NO DEPTH. The .3cm is the width of the biopsy sample and has nothing to do with the depth. In situ means a lesion is totally confined to the epidermis. Depth is measured from below the epidermis as it extends into the skin. So in situ, by definition, has no depth at all. This is why it basically has a 100% cure rate – because it is on the surface of the skin and doesn't invade into the skin where there are blood or lymph vessels. If you have to have melanoma, in situ is what you want to see!
-
- October 29, 2012 at 2:46 am
Thank-you for your response! I am wondering w hat you see as the depth of my lesion? The way I read it, from Dr’s labeling, is the depth is .3 cm or 3mm?
-
- October 27, 2012 at 6:52 pm
You have what is called a melanoma insitu. Insitu means no depth, so the melanoma has not yet gone throught your five layers of skin. This is as good as it gets as far as a melanoma daignosis is concerned as it has virtually a 100% survival rate after what is called the WLE or wide local excision is done.
You do not need a SNB or what is called a sentinel node biopsy either. This is performed when the melanoma has a depth of at least .75 mm or 1.0 mm. (called Breslow depth) The cutoff is .75 mm depth if ulcerated, or 1.0 mm depth if not. Since yours is insitu, it has no depth and a SNB is not needed.
You do not need a oncologist either. After your WLE results comes back, you will be looking for clear margins. Then just be vigilant and keep up your 6 month derm visits!
Be happy-you caught this early, as early as it can be caught.
-
- October 27, 2012 at 6:52 pm
You have what is called a melanoma insitu. Insitu means no depth, so the melanoma has not yet gone throught your five layers of skin. This is as good as it gets as far as a melanoma daignosis is concerned as it has virtually a 100% survival rate after what is called the WLE or wide local excision is done.
You do not need a SNB or what is called a sentinel node biopsy either. This is performed when the melanoma has a depth of at least .75 mm or 1.0 mm. (called Breslow depth) The cutoff is .75 mm depth if ulcerated, or 1.0 mm depth if not. Since yours is insitu, it has no depth and a SNB is not needed.
You do not need a oncologist either. After your WLE results comes back, you will be looking for clear margins. Then just be vigilant and keep up your 6 month derm visits!
Be happy-you caught this early, as early as it can be caught.
-
- October 27, 2012 at 8:30 pm
"proliferation of cytologically atypical melanocytes in the epidermis and in the dermis" Is this still in situ, if in the dermis? Maybe another pathology opinion?
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- October 27, 2012 at 9:01 pm
"Malignant melanoma in situ with associated atypical compound nevus."
"atypical melanocytes in the epidermis and in the dermis"
Atypical melanocytes and atypical compound nevus are not yet melanoma.
Sounds like they are calling it Melanoma insitu to cover themselves. Playing it safe.
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- October 27, 2012 at 9:01 pm
"Malignant melanoma in situ with associated atypical compound nevus."
"atypical melanocytes in the epidermis and in the dermis"
Atypical melanocytes and atypical compound nevus are not yet melanoma.
Sounds like they are calling it Melanoma insitu to cover themselves. Playing it safe.
-
- October 27, 2012 at 9:01 pm
"Malignant melanoma in situ with associated atypical compound nevus."
"atypical melanocytes in the epidermis and in the dermis"
Atypical melanocytes and atypical compound nevus are not yet melanoma.
Sounds like they are calling it Melanoma insitu to cover themselves. Playing it safe.
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- October 29, 2012 at 2:52 am
Can I request to have the tissue samples sent to another lab? If Yes; is there a preferred lab in WA state to use? -
- October 29, 2012 at 2:52 am
Can I request to have the tissue samples sent to another lab? If Yes; is there a preferred lab in WA state to use? -
- October 29, 2012 at 2:52 am
Can I request to have the tissue samples sent to another lab? If Yes; is there a preferred lab in WA state to use?
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Tagged: cutaneous melanoma
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