› Forums › General Melanoma Community › Newly Diagnosed Melanoma Stage 4
- This topic has 21 replies, 6 voices, and was last updated 11 years, 2 months ago by
dian in spokane.
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- March 3, 2013 at 1:11 am
My aunt just received a Stage 4 Melanoma diagnosis after having a biopsy at the dermatologist. She had a shave biopsy that was 4.1mm all Melanoma. The mitotic index was 8. Does anyone know what the mitotic index of 8 means? We understand that is the rate at which the cells are dividing, but what is bad and what is good?My aunt just received a Stage 4 Melanoma diagnosis after having a biopsy at the dermatologist. She had a shave biopsy that was 4.1mm all Melanoma. The mitotic index was 8. Does anyone know what the mitotic index of 8 means? We understand that is the rate at which the cells are dividing, but what is bad and what is good?
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- March 3, 2013 at 1:25 am
WAIT! Stage IV can't be determined from a skin biopsy. CLARK'S LEVEL IV can. They are not the same thing. Stage IV means your aunt has had scans and it has been determined the melanoma has spread to the internal organs. CLARK'S LEVEL IV means the melanoma primary tumor has invaded the fourth layer of skin. Two distinctly different things and often confused by the newly diagnosed.
So if your aunt has just had the skin biopsy, she is not stage IV at this time.
4.1 mm is a deep primary, however. Mitosis of 8 isn't ideal. 0 is best. But in terms of prognosis, mitotis is only used to distinguish stage IA and stage IB and your aunt would be a minimum of stage II at this point. I have yet to see any data that says a higher mitosis for other stages results in a worse prognosis.
Your aunt next needs a sentinel node biopsy (SNB) to determine if the melanoma has spread to her lymph nodes. At the same setting, she will have a wide local excision (WLE) to remove larger margins around the primary tumor. After the SNB is done and/or scans, THEN they can determine stage. Right now, before further testing, it appears she is stage II.
Best wishes,
Janner
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- March 3, 2013 at 1:25 am
WAIT! Stage IV can't be determined from a skin biopsy. CLARK'S LEVEL IV can. They are not the same thing. Stage IV means your aunt has had scans and it has been determined the melanoma has spread to the internal organs. CLARK'S LEVEL IV means the melanoma primary tumor has invaded the fourth layer of skin. Two distinctly different things and often confused by the newly diagnosed.
So if your aunt has just had the skin biopsy, she is not stage IV at this time.
4.1 mm is a deep primary, however. Mitosis of 8 isn't ideal. 0 is best. But in terms of prognosis, mitotis is only used to distinguish stage IA and stage IB and your aunt would be a minimum of stage II at this point. I have yet to see any data that says a higher mitosis for other stages results in a worse prognosis.
Your aunt next needs a sentinel node biopsy (SNB) to determine if the melanoma has spread to her lymph nodes. At the same setting, she will have a wide local excision (WLE) to remove larger margins around the primary tumor. After the SNB is done and/or scans, THEN they can determine stage. Right now, before further testing, it appears she is stage II.
Best wishes,
Janner
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- March 3, 2013 at 1:25 am
WAIT! Stage IV can't be determined from a skin biopsy. CLARK'S LEVEL IV can. They are not the same thing. Stage IV means your aunt has had scans and it has been determined the melanoma has spread to the internal organs. CLARK'S LEVEL IV means the melanoma primary tumor has invaded the fourth layer of skin. Two distinctly different things and often confused by the newly diagnosed.
So if your aunt has just had the skin biopsy, she is not stage IV at this time.
4.1 mm is a deep primary, however. Mitosis of 8 isn't ideal. 0 is best. But in terms of prognosis, mitotis is only used to distinguish stage IA and stage IB and your aunt would be a minimum of stage II at this point. I have yet to see any data that says a higher mitosis for other stages results in a worse prognosis.
Your aunt next needs a sentinel node biopsy (SNB) to determine if the melanoma has spread to her lymph nodes. At the same setting, she will have a wide local excision (WLE) to remove larger margins around the primary tumor. After the SNB is done and/or scans, THEN they can determine stage. Right now, before further testing, it appears she is stage II.
Best wishes,
Janner
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- March 3, 2013 at 1:56 am
Janner,
If I readd your note correctly, your Aunt had a "shaved" biopsy. I would talk with the doctor immediately and have the entire mole removed properly if it has not been already done. My "mole" was discovered in 2000 and I had a shaved biopsy done which showed no cancer. By 2004, the mole was dark and cancerous (after removal and biopsy) according to my new dermatologist. Perhaps having the entire mole removed in 2000 instead of having a shaved biopsy I would not have stage 4 Melanoma today.
Jim
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- March 3, 2013 at 2:04 am
Jim, I'm not the original poster. It was posted anonymously. But you are right that the "aunt" needs a sentinel node biopsy and the wide excision to remove the entire tumor. Most of us dislike shave biopsies when it comes to melanoma because they can cut through the lesion. But that's done. The next step is testing the lymph nodes AND removing the rest of the skin around the area. They have to be done in order with the lymph node test coming before they remove more skin in order to get the best information possible on staging.
Janner
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- March 3, 2013 at 2:04 am
Jim, I'm not the original poster. It was posted anonymously. But you are right that the "aunt" needs a sentinel node biopsy and the wide excision to remove the entire tumor. Most of us dislike shave biopsies when it comes to melanoma because they can cut through the lesion. But that's done. The next step is testing the lymph nodes AND removing the rest of the skin around the area. They have to be done in order with the lymph node test coming before they remove more skin in order to get the best information possible on staging.
Janner
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- March 3, 2013 at 2:04 am
Jim, I'm not the original poster. It was posted anonymously. But you are right that the "aunt" needs a sentinel node biopsy and the wide excision to remove the entire tumor. Most of us dislike shave biopsies when it comes to melanoma because they can cut through the lesion. But that's done. The next step is testing the lymph nodes AND removing the rest of the skin around the area. They have to be done in order with the lymph node test coming before they remove more skin in order to get the best information possible on staging.
Janner
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- March 3, 2013 at 1:56 am
Janner,
If I readd your note correctly, your Aunt had a "shaved" biopsy. I would talk with the doctor immediately and have the entire mole removed properly if it has not been already done. My "mole" was discovered in 2000 and I had a shaved biopsy done which showed no cancer. By 2004, the mole was dark and cancerous (after removal and biopsy) according to my new dermatologist. Perhaps having the entire mole removed in 2000 instead of having a shaved biopsy I would not have stage 4 Melanoma today.
Jim
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- March 3, 2013 at 1:56 am
Janner,
If I readd your note correctly, your Aunt had a "shaved" biopsy. I would talk with the doctor immediately and have the entire mole removed properly if it has not been already done. My "mole" was discovered in 2000 and I had a shaved biopsy done which showed no cancer. By 2004, the mole was dark and cancerous (after removal and biopsy) according to my new dermatologist. Perhaps having the entire mole removed in 2000 instead of having a shaved biopsy I would not have stage 4 Melanoma today.
Jim
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- March 5, 2013 at 4:34 pm
Well.. melanoma will take you all on a roller coaster ride. So, even though Janner's right (there's NO WAY to diagnose stage IV melanoma with a biopsy) Your aunt's condition could still be rather serious. Over 4 mm on that shave biopsy, means it's actually deeper than that, and with a brisk miotic rate, it could be fairly serious. But you won't know that thill further testing is done.
Hopefully the oncologist in Dallas will be much more clear about the actual situation and the next steps she needs to go through. This will likely mean more surgery at the biopsy site, possibly an attempt at a sentinal node biopsy, and some kind of scans to look for more wide spread disease.
SO, we will all keep our fingers crossed for your aunt. We hope you'll come back and give us good news about her outcome.
Dian in Spokane
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- March 5, 2013 at 4:34 pm
Well.. melanoma will take you all on a roller coaster ride. So, even though Janner's right (there's NO WAY to diagnose stage IV melanoma with a biopsy) Your aunt's condition could still be rather serious. Over 4 mm on that shave biopsy, means it's actually deeper than that, and with a brisk miotic rate, it could be fairly serious. But you won't know that thill further testing is done.
Hopefully the oncologist in Dallas will be much more clear about the actual situation and the next steps she needs to go through. This will likely mean more surgery at the biopsy site, possibly an attempt at a sentinal node biopsy, and some kind of scans to look for more wide spread disease.
SO, we will all keep our fingers crossed for your aunt. We hope you'll come back and give us good news about her outcome.
Dian in Spokane
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- March 5, 2013 at 4:34 pm
Well.. melanoma will take you all on a roller coaster ride. So, even though Janner's right (there's NO WAY to diagnose stage IV melanoma with a biopsy) Your aunt's condition could still be rather serious. Over 4 mm on that shave biopsy, means it's actually deeper than that, and with a brisk miotic rate, it could be fairly serious. But you won't know that thill further testing is done.
Hopefully the oncologist in Dallas will be much more clear about the actual situation and the next steps she needs to go through. This will likely mean more surgery at the biopsy site, possibly an attempt at a sentinal node biopsy, and some kind of scans to look for more wide spread disease.
SO, we will all keep our fingers crossed for your aunt. We hope you'll come back and give us good news about her outcome.
Dian in Spokane
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- March 3, 2013 at 4:51 am
Yeah, I went through the same scare. Clark level is not the same as stage. Derms tend to confuse the terms which pisses me off to no end…… They just whip out level 4 and don't bother to clarify anything more other than you need a referal to an oncologist.
Always do the SNB prior to the WLE but they can usually done at the same appt / surgery.
If there was mention of ulceration that would furtther upstage your aunt. I hope all goes well but she has a high risk tumor.
Take care.
Kim
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- March 3, 2013 at 4:51 am
Yeah, I went through the same scare. Clark level is not the same as stage. Derms tend to confuse the terms which pisses me off to no end…… They just whip out level 4 and don't bother to clarify anything more other than you need a referal to an oncologist.
Always do the SNB prior to the WLE but they can usually done at the same appt / surgery.
If there was mention of ulceration that would furtther upstage your aunt. I hope all goes well but she has a high risk tumor.
Take care.
Kim
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- March 3, 2013 at 3:43 pm
On my first visit with my oncologist (I no longer see that Dr.), he sat me down and matter of factly announced that I had a Level 4 melanoma. I didn't know very much about cancer, but I too throught he was talking stage. I will never forget the sick feeling that flooded through me as I thought he was handing me my death sentence (I now know that even though I am not at stage 4, it of itself is not a death sentence).
After I had the sentinel lymph node biopsy (SLNB) it was determine I was a stage 3a. The same Dr. suggested a clinical trial which I was not eligible for. Because of this board I found a clinical trial that sounded promising that I was eligible for. I also realized that I needed an oncologist that knew more about melanoma than my first oncologist.
I would highly suggest that your aunt find an oncologist specializing in melanoma.
– Paul.
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- March 3, 2013 at 3:43 pm
On my first visit with my oncologist (I no longer see that Dr.), he sat me down and matter of factly announced that I had a Level 4 melanoma. I didn't know very much about cancer, but I too throught he was talking stage. I will never forget the sick feeling that flooded through me as I thought he was handing me my death sentence (I now know that even though I am not at stage 4, it of itself is not a death sentence).
After I had the sentinel lymph node biopsy (SLNB) it was determine I was a stage 3a. The same Dr. suggested a clinical trial which I was not eligible for. Because of this board I found a clinical trial that sounded promising that I was eligible for. I also realized that I needed an oncologist that knew more about melanoma than my first oncologist.
I would highly suggest that your aunt find an oncologist specializing in melanoma.
– Paul.
-
- March 3, 2013 at 3:43 pm
On my first visit with my oncologist (I no longer see that Dr.), he sat me down and matter of factly announced that I had a Level 4 melanoma. I didn't know very much about cancer, but I too throught he was talking stage. I will never forget the sick feeling that flooded through me as I thought he was handing me my death sentence (I now know that even though I am not at stage 4, it of itself is not a death sentence).
After I had the sentinel lymph node biopsy (SLNB) it was determine I was a stage 3a. The same Dr. suggested a clinical trial which I was not eligible for. Because of this board I found a clinical trial that sounded promising that I was eligible for. I also realized that I needed an oncologist that knew more about melanoma than my first oncologist.
I would highly suggest that your aunt find an oncologist specializing in melanoma.
– Paul.
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- March 3, 2013 at 4:51 am
Yeah, I went through the same scare. Clark level is not the same as stage. Derms tend to confuse the terms which pisses me off to no end…… They just whip out level 4 and don't bother to clarify anything more other than you need a referal to an oncologist.
Always do the SNB prior to the WLE but they can usually done at the same appt / surgery.
If there was mention of ulceration that would furtther upstage your aunt. I hope all goes well but she has a high risk tumor.
Take care.
Kim
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