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Scalp Melanoma Pathological diagnosis Stage III3/no lymph nodes
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Scalp Melanoma Pathological diagnosis Stage III3/no lymph nodes

› Forums › Cutaneous Melanoma Community › Scalp Melanoma Pathological diagnosis Stage III3/no lymph nodes

  • Post
    • October 1, 2020 at 9:11 pm
    mrbill16323
    Participant
      Today was my first oncology doctor visit, with Dr. Ding Wang of Henry Ford Hospital. The Scalp Wide Excision and SLNB pathology results were discussed and treatment recommended and being booked. I’m sharing this info to help others who may want to learn from my journey. My good news for today was no metastisis in my lymph nodes detected. The less positive news was that the removed melanoma was down to the subcutis level. Reconstruction surgery is a go for tomorrow October 2 with Dr. Garcia-Rodriguez of Henry Ford.

      The pathology report:
      of 19 lymph nodes (17 Sentinel) biopsied , they were all negative for metastasis
      The nodular tumor Breslow Thickness: 7.5mm
      Macroscopic Satellite Nodule: not identified
      Ulceration: present
      Anatomic Clark Level: V (invades subcutis)
      Microsatellites: Present
      No identified invasion in Lymphovascular, Neurotropism. No Tumor-Infiltrating lymphocytes
      No identified Tumor Regression
      Margins:
      PERIPHERAL MARGINS: negative for invasive melanoma
      DISTANCE OF INVASIVE MELANOMA FROM CLOSEST PERIPHERAL MARGIN (22.0.mm)
      DEEP MARGIN: negative for invasive melanoma
      Distance of Invasive Melanoma from Deep Margin: .2mm
      Pathologic Stage Classification (pTNM, AJCC 8th Edition): Primary Tumor (pT): PT4b
      Regional Lymph nodes: (pN): pN1c

      Dr. Wang advised that from all these variables, I am at Stage IIIC. He recommended and I agreed to begin Pembrolizumab (Keytruda) within the next week. He described it as a one-hour IV infusion, once every three weeks. Doc will schedule a second PET/CT scan soon, waiting for my surgeries to heal further (My reconstruction is tomorrow). Doc also ordered the molecular study on tumor. I understand that treatment may evolve depending on how I respond. My follow up with Dr. Wang is in four weeks, about ten days after my initial infusion. Waiting now for the scheduler to contact me so I can lock in my first infusion date, and the ongoing schedule. Prayers for all who are on this journey.

    Viewing 5 reply threads
    • Replies
        • October 1, 2020 at 9:12 pm
        mrbill16323
        Participant
          Sorry, the Stage is IIIC
          • October 1, 2020 at 11:20 pm
          tkoss
          Participant
            i am confused. if no LN involved then isn’t this stage 2?
            the only reason i note this is because staging and diagnosis and treatment can get rather confusing.

            https://www.aimatmelanoma.org/stages-of-melanoma/

              • October 1, 2020 at 11:55 pm
              Daisy2018
              Participant
                Is is because of Microsatellites: Present, you are stage 3c?
                • October 1, 2020 at 11:56 pm
                Daisy2018
                Participant
                  Or is it because of 7.5 mm with ulceration?
                  • October 2, 2020 at 5:09 pm
                  mrbill16323
                  Participant
                    The oncologist advised it was the combination of the tumor depth and the micros.
                  • October 2, 2020 at 12:11 am
                  Bubbles
                  Participant
                    Sorry you have to face Stage III, though with that tumor depth, ulceration, and the presence of microsatellites, I agree with that classification. (Not that I matter one whit!!! HA!) I am glad there were no positive nodes and super glad that you will be starting anti-PD-1 via Pembro with no delay! That is great!!!!! So, despite the fact that melanoma sucks in all its forms, I think you are already on the road to recovery and putting it behind you!!! I wish you my very best with your reconstruction and Keytruda infusions. By the time fly fishing trips roll around, you will be ret tah go!!! Hang tough. c
                    • October 2, 2020 at 1:22 am
                    Treadlightly
                    Participant
                      Hey Tom,

                      I am so glad to hear there was no spread of the melanoma to the lymph nodes. That is a very positive sign. Sounds like they have put together a very aggressive treatment plan, which should certainly do the trick.

                      Do your best to keep a positive outlook…It can make all the difference. You have every reason to believe that you will beat this!

                      Best of luck with your reconstruction procedures!
                      Mark (2A)

                      • October 2, 2020 at 1:49 am
                      MikeInAK
                      Participant
                        Mr. Bill, thanks for sharing your report, and status. Actually, I agree its good news that no metastasis indicated in the LN. Follow the advice of your team, have faith, and move forward. I know the fear and worry, had the same for me, but I’m blessed my adjuvant therapy worked and am NED. Relax and take it one day at a time.
                        • October 2, 2020 at 2:50 am
                        tkoss
                        Participant
                          at 3c, my area of expertise, i was prescribed nivo(opvido) 2x a month for a year. . 240mg. thru a port, which requires anesthetic and surgery.
                          otherwise it take about 1 hour for infusion and 1/2 hour prior for blood tests.

                          no side effects what-so -ever.

                          easy peasy

                            • October 2, 2020 at 5:12 pm
                            mrbill16323
                            Participant
                              Yes, similar schedule for me. Although at this point Doc says lets try without the port. He said it was a problem for some of his patients who are swimmers. He’s encouraging me to be active, once I get this hole on my head to heal up LOL. Be well.
                              • October 2, 2020 at 5:58 pm
                              Bubbles
                              Participant
                                While a port is a blessing for many dealing with infusions, I made it through 2 1/2 years of nivo infusions without one. I think giving your therapy a try without a port is worth it, knowing you can always opt for one if you need to. Hope today goes great! c
                                • October 3, 2020 at 7:22 pm
                                MikeInAK
                                Participant
                                  I agree with Bubbles, you might want to start without a port and see how it goes. I did 26 bi-weekly infusions of Optivo without a port. Additionally, was doing blood draws for Labs each time, so that was 52 pokes. Worked out OK, my preference over having a port put in.
                                  • October 3, 2020 at 11:51 pm
                                  Edwin
                                  Participant
                                    I received 4 1/2 years of immunotherapy infusions without a port.
                                    • October 7, 2020 at 9:07 pm
                                    mrbill16323
                                    Participant
                                      Thanks to everyone who has replied.
                                Viewing 5 reply threads

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