Spitzoid Melanoma

Hi Anonymous,

I was diagnosed with Spitzoid melanoma Breslow 1.0mm, high mitotic rate, non-ulcerated, Clark Level IV. T1b. My doctors (surgeon, dermatologist) were not considering neither discussing SLNB, I did have the feeling that it should be done and after seeking advise from a melanoma expert, I decided to go for it. SLNB came back negative.

https://www.melanoma.org/find-support/patient-community/mpip-melanoma-patients-information-page/newly-diagnosed-slnb

As for for your specific case, I do not think the SLNB would have been necessary. For me it was a very personal decision and against the opinon of my doctors; for what I can see my case had worst prognosis than yours though, with risk factors involved (clark level, gender, age, mitotic rate).

This was useful for me:

https://www.skincancer.org/publications/the-melanoma-letter/2018-vol-36-no-1/ajcc-staging-system

"guidelines state that for patients with T1b (<0.8 mm with ulceration or 0.8-1.0 mm with or without ulceration) melanomas, SLNB may be considered and discussed with the patient.22,26"

So unless you had ulceration (for what you said I dont think so), SLNB would not be advised. Furthermore, after WLE has been done, SLNB may be more difficult (less accurate) to perform.

Again, I am not as well informed as other users in the forum. But you seem to be on thin side of melanoma with a very good prognosis.

That being said. I am lost with the Spitzoid myself. I asked about DecisionX factor and was told that due to the type (spitzoid) which as you said is quite rare, it may not be useful in my case, but I was not able to find a lot of info on it. My melanoma was in an area which is not very exposed to the sun and do not have any close cases in my family.

Spitzoid or not, your prognosis at that Breslow level is very good and you should not worry too much (I know is easier said than done, believe me).

Cheers!

I was diagnosed in June 2007 with spitzoid melanoma on the top of my right shoulder. Clarks Level 3, Breslow 0.6 mm, low mitotic rate (1). I was 38 at the time. It was not removed with clear enough margins, and a second excision was done in July 2007. No SLNB. Docs felt it was not needed. No known family history of melanoma, so I was silly to ignore the severity of the diagnosis, and continued to live life sunscreen free as if all was well with my world… as though I'd been "cured". Nope. April 2013, thinking that i was in the best shape of my life, I hit the floor with a very unexpected seizure. That was my welcome to stage IV. I was 44 years old. On the good news side… I'm still here! Unfortunately, my stage IV diagnoses hit prior to the FDA approval of Keytruda or Nivo… aaaaaand… with active brain metastasis, I wasn't able to get into trials for either of them. It was a long road to hoe, but I survived long enough to see Keytruda's FDA approval, and that drug was my saving grace. It worked well on my specific mutation. I've been off treatment since July 2016, and have not seen a recurrence yet. Still keeping tight tabs on the brain and body, but things are looking good thus far, and I'm living at about 90-95% of the normal that I was prior to the stage IV diagnosis. Naturally, being FAR more diligent with sunscreen and protective measures these days! 

Continues with derm checks every 4 months, and be sure to keep close watch over your own body. Nobody can see or feel changes like YOU will be able to note. Any odd lumps or bumps that remain for more than a couple of weeks, or grow rapidly, should be checked. Keep note of anything that feels like asthma or seasonal allergies, and doesn't respond to over the counter meds…. a chest x-ray is realtively inexpensive, and could prove valuable for an early catch. 

Complete panic aside…….. Your statistical odds of metastasis are in the range of 2-4%. Diligence and care with sun exposure may just be what separates you from those of us who become the oddball deviants in that 2-4% pile.