Spouse of new patient – Questions

So, one cell was outside the recommended melanoma free margins?  Hard to know whether to be concerned or not.  How deep was the lesion?  What were the exact margins?  Many people don't get copies of their path reports unless they ask for it.  It's not "standard issue" by many derms.  But it is yours to ask for.  And having that info would help.  If the lesion was Lentigo Maligna melanoma, that type often spreads on the surface long before it becomes invasive.  However, it has a high local recurrence rate.  So I wouldn't like to have margins that aren't as big as suggested on that type.  However, if he meant superficial spreading (the most common type) I'd want to know more info. 

I wouldn't normally consider bumps on the scalp related to a shoulder melanoma.  Kind of going "against the grain" or really "against the drain" in how melanoma drains to the lymph nodes.  Shoulder drains to neck or clavicle or armpit.  Scalp drains only to neck, but you wouldn't often see melanoma going upstream from shoulder through neck nodes to scalp.  Can't say never but maybe the spots are not related at all.  Good thing to get them checked out, and good to have more than one person at the appointment.  My father was hard of hearing and he often missed important parts of conversations.  As he got older, we went to all his appointments just so we knew nothing was missed.

The scalp, the legs and the arms are end points.  Basically, they would drain TOWARD the nearest lymph node basin.  So the scalp drains toward the neck.  Arms drain toward the armpits.  Legs drain toward the groin.  You don't typically see something on the arm draining to the groin nodes.  You don't see things skipping a lymph node basin.  Going toward the scalp is going "upstream" to  be the most descriptive.  So it would make more sense that whatever is going on in the scalp is a PRIMARY location, not secondary from somewhere else.  This isn't a hard and fast rule because if someone is stage IV, it could go anywhere.  But in general, something from another location on the body wouldn't just head to the scalp.  Anything is possible, just some things are really more unlikely than others.  Does this make sense?

The scalp, the legs and the arms are end points.  Basically, they would drain TOWARD the nearest lymph node basin.  So the scalp drains toward the neck.  Arms drain toward the armpits.  Legs drain toward the groin.  You don't typically see something on the arm draining to the groin nodes.  You don't see things skipping a lymph node basin.  Going toward the scalp is going "upstream" to  be the most descriptive.  So it would make more sense that whatever is going on in the scalp is a PRIMARY location, not secondary from somewhere else.  This isn't a hard and fast rule because if someone is stage IV, it could go anywhere.  But in general, something from another location on the body wouldn't just head to the scalp.  Anything is possible, just some things are really more unlikely than others.  Does this make sense?

The scalp, the legs and the arms are end points.  Basically, they would drain TOWARD the nearest lymph node basin.  So the scalp drains toward the neck.  Arms drain toward the armpits.  Legs drain toward the groin.  You don't typically see something on the arm draining to the groin nodes.  You don't see things skipping a lymph node basin.  Going toward the scalp is going "upstream" to  be the most descriptive.  So it would make more sense that whatever is going on in the scalp is a PRIMARY location, not secondary from somewhere else.  This isn't a hard and fast rule because if someone is stage IV, it could go anywhere.  But in general, something from another location on the body wouldn't just head to the scalp.  Anything is possible, just some things are really more unlikely than others.  Does this make sense?

So, one cell was outside the recommended melanoma free margins?  Hard to know whether to be concerned or not.  How deep was the lesion?  What were the exact margins?  Many people don't get copies of their path reports unless they ask for it.  It's not "standard issue" by many derms.  But it is yours to ask for.  And having that info would help.  If the lesion was Lentigo Maligna melanoma, that type often spreads on the surface long before it becomes invasive.  However, it has a high local recurrence rate.  So I wouldn't like to have margins that aren't as big as suggested on that type.  However, if he meant superficial spreading (the most common type) I'd want to know more info. 

I wouldn't normally consider bumps on the scalp related to a shoulder melanoma.  Kind of going "against the grain" or really "against the drain" in how melanoma drains to the lymph nodes.  Shoulder drains to neck or clavicle or armpit.  Scalp drains only to neck, but you wouldn't often see melanoma going upstream from shoulder through neck nodes to scalp.  Can't say never but maybe the spots are not related at all.  Good thing to get them checked out, and good to have more than one person at the appointment.  My father was hard of hearing and he often missed important parts of conversations.  As he got older, we went to all his appointments just so we knew nothing was missed.

So, one cell was outside the recommended melanoma free margins?  Hard to know whether to be concerned or not.  How deep was the lesion?  What were the exact margins?  Many people don't get copies of their path reports unless they ask for it.  It's not "standard issue" by many derms.  But it is yours to ask for.  And having that info would help.  If the lesion was Lentigo Maligna melanoma, that type often spreads on the surface long before it becomes invasive.  However, it has a high local recurrence rate.  So I wouldn't like to have margins that aren't as big as suggested on that type.  However, if he meant superficial spreading (the most common type) I'd want to know more info. 

I wouldn't normally consider bumps on the scalp related to a shoulder melanoma.  Kind of going "against the grain" or really "against the drain" in how melanoma drains to the lymph nodes.  Shoulder drains to neck or clavicle or armpit.  Scalp drains only to neck, but you wouldn't often see melanoma going upstream from shoulder through neck nodes to scalp.  Can't say never but maybe the spots are not related at all.  Good thing to get them checked out, and good to have more than one person at the appointment.  My father was hard of hearing and he often missed important parts of conversations.  As he got older, we went to all his appointments just so we knew nothing was missed.