Selle7

Diagnoses:

Dermal focus of malignant melanoma 

Tumour Thickness: 0.8mm

No Ulceration 

Mitosis: None Identified

Cell Type: Large Epitheloid

Compltely Excised in the plane of sections examined

Please see comment 

Diagnoses Comment:

Note is made of patients previous history of melanoma in the left neck/shoulder (thickness 1.9mm) with associated involvement of one sentinel node and negative completion lymphadenectomy. The current biopsy shows a small focus of malignant melanoma within the superficial dermis, abutting the dermal-epidermal junction. There is focal epidermotropism noted. The differential diagnosis includes a new primary lesion of modular melanoma versus focus of recurrent or in transit metastatic disease. Correlation with the biopsy site and relationship to previous excision may be helpful 

Diagnoses:

Dermal focus of malignant melanoma 

Tumour Thickness: 0.8mm

No Ulceration 

Mitosis: None Identified

Cell Type: Large Epitheloid

Compltely Excised in the plane of sections examined

Please see comment 

Diagnoses Comment:

Note is made of patients previous history of melanoma in the left neck/shoulder (thickness 1.9mm) with associated involvement of one sentinel node and negative completion lymphadenectomy. The current biopsy shows a small focus of malignant melanoma within the superficial dermis, abutting the dermal-epidermal junction. There is focal epidermotropism noted. The differential diagnosis includes a new primary lesion of modular melanoma versus focus of recurrent or in transit metastatic disease. Correlation with the biopsy site and relationship to previous excision may be helpful 

Hi Melanie,
My mom’s three tumours were all around 2.5cm, they have all been removed surgically at this point as on two different occasions, they started to bleed and had to be removed quickly. So now what we are left with is 3 tumour beds, and 1 “small spot”. It’s difficult to see on the CT scan and she is getting an MRI later this week to get a better look. Like you said, the MRI is the best to do that. In B.C. where we are, we don’t have Gamma Knife but a different type of stereotactic radiation that apparently isn’t as precise. The radiation oncologist claims that because of this, the amount of the brain he would have to radiate (3 cavities, 1 spot) would still amount to 70% of the brain and that he would be concerned about more tumours growing in the other 30% if we don’t do whole brain radiation.

He also mentioned that she needed to wait until she was off steroids to do immuno too.

Thank you so much for your detailed response. The bleeds were actually all separate events which made them want to remove all 3 surgically. Initially the plan was to do radiation on two.
Unfortunately because of the 3 craniotomy’s in 6 weeks, my mom isn’t in the best physical condition. She can barely sit up as she’s lost so much strength and the steroids are causing her a lot of stomach pain. I also think there’s an element of trauma involved that’s holding back her recovery.
The oncologist said she’s not in condition to the dual immuno right now, and I don’t know if I disagree. That being said, would it be wise to push for targeted therapy ASAP as it seems to be easier to take and more tolerable? Then try immuno when she’s had more time to recover?

Thank you for that article. It’s a great discussion of my moms situation as it discusses when Braf drugs could be used too. I just think especially in my moms case, where the 3 tumours have been surgically removed, there isn’t any justification to go so aggressive with the radiation. What good could it do?

Thank you for your input! That's along the lines of how my moms derm interpreted it. But also not confident. He just referred her to an oncologist. 

Thank you for your input! That's along the lines of how my moms derm interpreted it. But also not confident. He just referred her to an oncologist. 

Thank you for your input! That's along the lines of how my moms derm interpreted it. But also not confident. He just referred her to an oncologist. 

I couldn't figure out how to post the report so I copied it out for you. 

I couldn't figure out how to post the report so I copied it out for you. 

I couldn't figure out how to post the report so I copied it out for you.