Grateful77

(Also, I’m teasing about the question marks. I appreciate you checking in on me :))

So many question marks 😉

The third pathology was supposed to take several weeks, and the consensus was the lesion shouldn’t stay on that long (I’d had a shave biopsy) and should be excised with conservative “in situ” margins.
The second pathology came from a very reputable melanoma center, and he was 90% confident it was in situ, so I was comfortable moving forward with that suggestion.

The “agreement” now on total depth is Maximum 0.8. (b/c no residual invasive melanoma in WLE).
The first pathology staged me as 1b, the second in situ, and the third 1a.

It’s all ok– I’m obviously not thrilled about needing a second excision, but these things happen. Doctors are only human, and we make the best decision we can with the information we have.
I think if we’d known the third pathology would come in less than a week after the WLE, we all would have made different decisions.
But here we are.

Ed & Ellie,

Just wanted to circle back here–
I had a WLE with 0.5 cm margins last week– pathology came back with clear margins and no evidence of invasive melanoma. (Obviously good news).

In the meantime, however, Northwestern agreed with the original invasive melanoma diagnosis so I need to go back for another WLE. Wishing this information had come sooner and/or we’d taken 1 cm margins in the first instance. But I’m glad to have some clarity about the diagnosis.

Thanks again for your guidance.

Just by way of update, my slides are being sent to Northwestern for FISH. I think the results of that will provide some clarity/comfort about “what lies beneath.”
We’re definitely looking at Melanoma in Situ, but there’s disagreement among the pathologists about the deep margins (Pathology 1 said invasive melanoma, Pathology 2 said MELTUMP likely benign).

Just for context the lesion itself was amelanotic and didn’t present at all like melanoma. I had two derms decline to biopsy it, but I insisted on biopsy when my spidey sense kept tingling.
And I’m so glad I did.

Thanks again to Ed & Ellie for weighing in here. I’ll let you know how it turns out.

Ellie- I really appreciate you taking the time to reply– and the article you posted is so helpful. Thank you!

I’m an organ transplant recipient, and that complicates matters a bit because I’m ineligible for immunotherapy and because my body doesn’t “fight” cancer the way it’s supposed to. The drugs I take for my transplant likely caused this melanoma in the first place.

Bottom line: I’d hate to forgo the SLNB based on the in situ diagnosis only to find out later that the melanoma WAS invasive. I’m very lucky to live in DC near many strong melanoma centers, and I guess there’s no harm in having another team look at the slides. I’ll keep you posted on how it goes.

Also, I’ve been “creeping” around this board ever since my diagnosis. I’m so inspired by the stories here and by this sense of community. Thanks especially to all of you who take time to comfort the newly diagnosed. I’m keeping you all close in my heart and wishing you many healthy days.

Ellie– I appreciate your reply. If I asked for a third opinion, it would definitely be from another melanoma specialist in the region (not from a generalist).
Also, I *did* ask the melanoma specialists about the results. They told be biopsy results change in 1 in 5 cases when their dermapathologists review them. He did not/could not opine as to how often they’re downgraded rather than upgraded. I guess I was just hoping someone on this forum may have had a similar experience and sought more than two opinions on original biopsy slides.