- May 28, 2022 at 1:13 am
I had a 1A melanoma five years ago and now an atypical spitz tumor within two inches of the melanoma on my rather plump thigh (sorry if that’s too descriptive). There are a number of other litte freckle like markings around there, and my thigh tends to get a lot of aches and pains, but I’m not really able to feel anything like a lymph node. I’m not sure if it’s possible to feel lympph nodes in thighs if they are plump. The doctor wants to do a WLE on the spitz tumor because, as she said, “it’s in a bad neighborhood.” They seem pretty sure that it’s not a melanoma because it’s still expressing p16 (a tumor repression protein, to my understanding). Given the above, I’m wondering if it’s worth asking to see if an ultrasound can/should be done to make sure there isn’t any spread within the thigh. From what I’ve read, ultrasound at a particular frequency can detect metasteses that haven’t travelled to the lymph nodes. I’d appreciate your thoughts.
- May 28, 2022 at 11:49 am
Sorry you are dealing with this. However, I think I like your doc’s approach. No matter what an ultrasound showed, you still wouldn’t know what you were dealing with without a biopsy. That’s just my take.
Here are a couple of reports on ultrasounds and melanoma patients –
For what it’s worth. I wish you my best. Celeste
Thank you, Celeste. That’s helpful. One more question if you don’t mind. Since spitz tumors do commonly metastacize (spelling?) to lymph nodes, and of course melanomas can too, but the outcome between the two if they metastacize is very different, if the doctor did do an SNLB, would they be able to tell if Spitz cells or melanoma was in the lymph nodes? I normally go to UCSF, and I realize they are pretty advanced in their pathology in this area, but I haven’t been able to find anything about someone with both types of growths in the same area. Apparently if Spitz gets to the lymph nodes, it’s probably not that big of a deal, but of course if melanoma does, it is a big deal in terms of how to manage it.
- May 28, 2022 at 5:26 pm
I have only been able to get part of the information from the pathology report from this latest round, so I don’t even know if they would do an SNLB for a Spitz of this depth. I don’t know the mitotic rate or whether it was ulcerated. Below is the path report if that’s helpful. I don’t know if my age makes any difference either, but I am 54. Maybe I’m just getting myself worked up, and really another WLE is all that’s needed. I think it’s the proximity of the two that has me concerned in terms of whether there are any other melanoma cells floating around in there. It’s going to look like I have railroad tracks once the second WLE is done.
Thank you again.
Component Your Value Standard Range Flag
ICD9 Code 238.2
Clinical Text 6 MM CHANGING NEVUS; R/O CHANGING NEVUS
Final Diagnosis LEFT LATERAL THIGH
COMPOUND MELANOCYTIC NEVUS, CLARK’S (DYSPLASTIC) TYPE, RE-EXCISION RECOMMENDED
Diagnosis Comment The findings favor a dysplastic (Clark’s) nevus with spitzoid cytological features, and perhaps even a thin atypical Spitz tumor. The neoplasm extends to within 1 mm. of the peripheral edges of the specimen. A re-excision with 3-5 mm margins seems
Details regarding the work-up performed to date in our laboratory follow below:
Staining with the VE1 antibody, which recognizes the V600e mutant form of BRAF is negative. A positive stain would have put the lesion outside of the Spitz lineage, as defined in the 2018 WHO classification.
A p16 immunoperoxidase stain shows adequate expression of tumor suppressor gene product (nearly complete or complete absence of staining in a defined zone is worrisome for melanoma).
A PRAME immunostain is negative. Strong, uniform staining of the nuclei of the lesional melanocytes would have favored melanoma.
Cylindrical skin segment, 0.8 cm in diameter and 1.0 cm in thickness, with the margins inked, trisected and entirely submitted with fragments. BY/BY
Microscopic Description: There is a proliferation of melanocytes involving the epidermis and superficial dermis, with elongated rete ridges, increased numbers of single, cytologically bland melanocytes at their sides and bases, and melanocytes with variably abundant cytoplasm and variably enlarged and heterochromatic nuclei in the superficial dermis.
Okay. Here are my thoughts –
- May 29, 2022 at 11:11 am
From what the path report says – it looks as though the pathologists have looked at the things they need to and based on that, the diagnosis of melanoma is not indicated. That’s good! And if that is so, it is my understanding that a WLE with appropriate margins is all that is indicated.
BUT!!!!!!!!!!! This stuff is tough. Before I would have anything done – I would have my slides sent to another pathologist for them to read and render a second opinion. It is not hard. You can talk to your onc and pick the pathology department you want to send it to and the current lab will pack it up and send it off. (I had to do this way back in 2003 upon my first diagnosis when the two local pathologists were at odds – with one saying it absolutely was melanoma and the other saying it absolutely was not. So – we sent the slides to a pathologist who was renowned in his study of melanoma. He said, it was – and he was right! HA! Still, though I have yet to have the opportunity, if I am ever asked, “Have you been at Harvard?” I will say, “Why, yes! I have!”)
As you note, this is important stuff. The margins needed for and indications for SLNB are very different depending on what you are dealing with.
PS As for palpating lymph nodes – a very imprecise science. However, should they be enlarged because of anything (infection, cut, tumor, etc) in the lateral thigh – the ones that would enlarge (should ANY do so) would most likely be felt either in the groin or the popliteal space (behind your knee).
Hope that helps. C
Thank you, again, Celeste.
- May 29, 2022 at 8:59 pm
Still, though I have yet to have the opportunity, if I am ever asked, “Have you been at Harvard?” I will say, “Why, yes! I have!”)
In any case, I now feel armed with the right questions thanks to you. Onward!
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