› Forums › General Melanoma Community › Question about Clark’s level
- This topic has 18 replies, 4 voices, and was last updated 11 years ago by
saengery.
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- April 28, 2013 at 2:00 am
Hello
I was diagnosed with melanoma in September of 2012. It has been a huge emotional challenge for me to remain positive despite my good prognosis. Tumour was 0.88mm, no ulceration, low or no mitosis. My Clark’s level was IV, however, and that is what seems to be driving my negativity. Does my Clark’s level move me from 1A to 1B? Also, I don’t quite understand, despite trying to research it myself, how my stage can be good when my Clark’s level is so high? To make matters worse, I am prone to cysts and every time a new one pops up I worry like crazy that its a melanoma growth.
Just to add, I am having another primary removed on May 8. I had this one back in September as well, but no doctor would even entertain it being removed, because they were so focused on the other obvious tumour. But this one has the same texture as the other one, and it is starting to change colour as well, so the oncologist is sure it’s melanoma. I’m hoping for an in situ.
Anyway, thanks for listening. This has been a completely devastating diagnosis for me, despite my knowledge that it could be so much worse. Emotionally it has changed my life.
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- April 29, 2013 at 10:28 am
No, Clark's level does not move you from 1A to 1B. . .that is not part of the staging criteria
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- April 29, 2013 at 1:21 pm
Clark's level is easily confused with melanoma stage but they are really completely different.
Clark's level is an outmoded way of describing how deep the melanoma cells have penetrated into the skin. It's something that a pathologist determines using a microscope. While the Clark's level might be a handy short-hand way for the pathologist to describe what he/she sees under the microscope, it has nothing to do with the stage of the melanoma and is a poor predictor of your prognosis.
The "stage" of a melanoma depends on whether it is just confined to the skin (labeled "P" for primary), or has traveled to local lymph nodes (labeled "N" for nodes), or has spread outside the lymph system to distant organs (labeled "M" for metastatic). The stage of the melanoma can only be determined by doing further testing beyond the biopsy. That testing can mean doing a sentinal node biopsy, feeling for enlarged lymph nodes, or doing imaging like PET, CT, or MRI.
So usually, you have a lesion biopsied to determine 1) whether or not it is melanoma, and 2) how deep the lesion is (Breslow's depth and sometimes also Clark level). Then if the lesion is > 1.0mm deep, a surgeon or oncologist will order additional tests to determine what stage you are.
Try to ignore the Clark's level info– it really gives you no useful information. If you have been diagnosed as Stage Ia, then you are stage Ia, and a very alert and lucky patient!
PS– If you want to know more about the AJCC staging system that replaced Clark's lavels, Google "The New Melanoma Staging System" on the Moffitt Cancer Center website.
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- April 29, 2013 at 1:38 pm
Ok, thanks. I will try to ignore it. This melanoma was in a location on my back that was not viewable easily. I have no explanation as to how my hand ended up feeling it… I actually assumed it was eczema from the texture. My back had been extremely tingly throughout the summer, though. This new primary is smaller, less dark and no tingly-sensations yet, so I am trying to be positive. -
- April 29, 2013 at 1:38 pm
Ok, thanks. I will try to ignore it. This melanoma was in a location on my back that was not viewable easily. I have no explanation as to how my hand ended up feeling it… I actually assumed it was eczema from the texture. My back had been extremely tingly throughout the summer, though. This new primary is smaller, less dark and no tingly-sensations yet, so I am trying to be positive. -
- April 29, 2013 at 1:38 pm
Ok, thanks. I will try to ignore it. This melanoma was in a location on my back that was not viewable easily. I have no explanation as to how my hand ended up feeling it… I actually assumed it was eczema from the texture. My back had been extremely tingly throughout the summer, though. This new primary is smaller, less dark and no tingly-sensations yet, so I am trying to be positive.
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- April 29, 2013 at 1:21 pm
Clark's level is easily confused with melanoma stage but they are really completely different.
Clark's level is an outmoded way of describing how deep the melanoma cells have penetrated into the skin. It's something that a pathologist determines using a microscope. While the Clark's level might be a handy short-hand way for the pathologist to describe what he/she sees under the microscope, it has nothing to do with the stage of the melanoma and is a poor predictor of your prognosis.
The "stage" of a melanoma depends on whether it is just confined to the skin (labeled "P" for primary), or has traveled to local lymph nodes (labeled "N" for nodes), or has spread outside the lymph system to distant organs (labeled "M" for metastatic). The stage of the melanoma can only be determined by doing further testing beyond the biopsy. That testing can mean doing a sentinal node biopsy, feeling for enlarged lymph nodes, or doing imaging like PET, CT, or MRI.
So usually, you have a lesion biopsied to determine 1) whether or not it is melanoma, and 2) how deep the lesion is (Breslow's depth and sometimes also Clark level). Then if the lesion is > 1.0mm deep, a surgeon or oncologist will order additional tests to determine what stage you are.
Try to ignore the Clark's level info– it really gives you no useful information. If you have been diagnosed as Stage Ia, then you are stage Ia, and a very alert and lucky patient!
PS– If you want to know more about the AJCC staging system that replaced Clark's lavels, Google "The New Melanoma Staging System" on the Moffitt Cancer Center website.
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- April 29, 2013 at 1:21 pm
Clark's level is easily confused with melanoma stage but they are really completely different.
Clark's level is an outmoded way of describing how deep the melanoma cells have penetrated into the skin. It's something that a pathologist determines using a microscope. While the Clark's level might be a handy short-hand way for the pathologist to describe what he/she sees under the microscope, it has nothing to do with the stage of the melanoma and is a poor predictor of your prognosis.
The "stage" of a melanoma depends on whether it is just confined to the skin (labeled "P" for primary), or has traveled to local lymph nodes (labeled "N" for nodes), or has spread outside the lymph system to distant organs (labeled "M" for metastatic). The stage of the melanoma can only be determined by doing further testing beyond the biopsy. That testing can mean doing a sentinal node biopsy, feeling for enlarged lymph nodes, or doing imaging like PET, CT, or MRI.
So usually, you have a lesion biopsied to determine 1) whether or not it is melanoma, and 2) how deep the lesion is (Breslow's depth and sometimes also Clark level). Then if the lesion is > 1.0mm deep, a surgeon or oncologist will order additional tests to determine what stage you are.
Try to ignore the Clark's level info– it really gives you no useful information. If you have been diagnosed as Stage Ia, then you are stage Ia, and a very alert and lucky patient!
PS– If you want to know more about the AJCC staging system that replaced Clark's lavels, Google "The New Melanoma Staging System" on the Moffitt Cancer Center website.
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- April 29, 2013 at 4:00 pm
Don't have the actual pathology report in front of me bu ounds like will be very important for you to follow up closely with your dermatologist. You should find out the exact mitotic rate. Mitotic rate is more predictive than Clark's level. If you have any mitosis you might want to consider a sentinel lymph node biopsy. If mitotic rate is 0 then you should be OK there.
Most important thing is to get regular skin checks which sounds like you are doing so you are taking care of yourself there which is really the most important.
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- April 29, 2013 at 4:00 pm
Don't have the actual pathology report in front of me bu ounds like will be very important for you to follow up closely with your dermatologist. You should find out the exact mitotic rate. Mitotic rate is more predictive than Clark's level. If you have any mitosis you might want to consider a sentinel lymph node biopsy. If mitotic rate is 0 then you should be OK there.
Most important thing is to get regular skin checks which sounds like you are doing so you are taking care of yourself there which is really the most important.
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- April 29, 2013 at 4:00 pm
Don't have the actual pathology report in front of me bu ounds like will be very important for you to follow up closely with your dermatologist. You should find out the exact mitotic rate. Mitotic rate is more predictive than Clark's level. If you have any mitosis you might want to consider a sentinel lymph node biopsy. If mitotic rate is 0 then you should be OK there.
Most important thing is to get regular skin checks which sounds like you are doing so you are taking care of yourself there which is really the most important.
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