@mtcowhand
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- August 4, 2017 at 2:01 am
Hello Papillion,
I am guessing a bit about what might be going on with your case based on my own recent research (I was diagnosed Stage 2b a few months ago), but my understanding is that in January 2018 a number of new guidelines are being adopted by a number of cancer organisations that deal with the complex relationship between diagnosis, prognosis and treatment. For melanoma specifically, I believe Clark level is essentially being disregarded as a significant prognostic factor for lesions that have a Breslow depth greater than 0.8 mm, but still being considered for lesions shallower than that. As you seem to recognize, your Clark level is unusual given the depth of your lesion, but it is not unheard of either, and I am thinking your dermatologist is recommending the SLNB because of this and also in concordance with the 2018 guidelines. While this may worry you, the other prognostic factors you mention (no ulceration, low mitotic rate, clear margins) are very good, so I think your doctor is being cautious here in a good way. With melanoma nothing is sacred and we all recognize the intial terror of diagnosis, but at the same time there is huge progress being made in figuring out the best medical avenues for treating it. Hope this helps and best wishes.
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- July 12, 2017 at 6:14 pm
Hi…this is my first post to this forum, but having been recently diagnosed (Stage 2b, desmoplastic melanoma), I came across a fair amount of info on Spitz nevi in my initial research on DM. There was a time when Spitz nevi were sometimes misdiagnosed for melanoma and melanoma for Spitz nevi. This does not happen as frequently now due to vastly improved diagnostics, but given your family's history, a lovely but possibly challenged dermatologist, and the infinitesimal probability that the path lab messed up, I would definitely seek another opinion. You should leave nothing to chance with this disease. You should ask your dermatologist for the path report and the originla tissue sample/slides (which she will either have or can obtain from the path lab) and go from there. I hope the nevi is reconfirmed for you if you go the second opinion route.
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- August 4, 2017 at 7:00 pm
Hi…link is below for a summary article, and there are links within this article that you can follow as well. Besides new mel staging guidelines, I understand the AJCC is also planning to update survival data and possibly present some of the first robust data on conditional survival like the Australians are doing…lots of good news in the new trends, I understand. Best to you.
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- July 22, 2017 at 12:12 am
Hi Jason, I am also new here, just went through what you are going through about 3 months ago. Your path reports as you describe them indicate that the shave biopsies did not get the entire lesion, meaning there is additional tumor left in at least one and possibly both primary sites. This is why they are recommending additional surgery, a wide local incision (WLE) and sentinel lymphnode biopsy (SLB), because without this information they cannot really stage your lesion's actual depth or the cancer's spread if present, which then determines future treatments. It is imperative that you find a surgeon(s) with experience in the melanoma business to do the WLE and SLB, and that further pathology reports are requested to provide better guidance on treatment. Dermatologists generally do not do this, as this can be pretty serious surgery under full anesthesia.
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- July 19, 2017 at 5:54 pm
Hi again, Janner, just a quick note. You mentioned a cutaneous oncologist in your previous response, which is a specialization I did not know existed. Anyway, your comment allowed me to narrow my searches a bit more and I stumbled across a Mayo Clinic partnership that led back to the Billings Clinic here in Montana, meaning that by going there I will have access to Mayo expertise as well. That is probably the solution for me, so again thanks for your comments, not sure I would have discovered this without them.
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- July 18, 2017 at 12:29 am
Thank you, Janner, I actually contacted Huntsman when I was first diagnosed, getting the remarkable answer that I was not really "sick enough" at Stage 2b to warrant too much attention too soon relative to the later stages that do need more help. I can understand that, but if that perspective in any way actually reflects how Huntsman approaches medicine in general, I would not want to go there anyway. And, yes, Seattle is on my radar, as are a few other possibilities.
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- July 13, 2017 at 7:34 pm
Hellos Paul, Larry and Nicky….kind thanks for your informative responses, really appreciate it, and, Paul, for your offer to contact you if I have other questions. I get the feeling that the radiation option in treating DM is kind of situational, dependent on many factors encompassing both lesion and patient individual characteristics. I have my first visit with an oncologist tomorrow, so your responses are timely and very helpful. Thanks again.
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