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      Participant

        It's good to be fully informed. The good news is that the melanoma has been completely excised (peripheral and deep margins uninvolved). The not so good news is the depth (deep enough to require a SLNB), ulceration (not seen as a good indicator), mitotic rate (reasonably high, meaning actively growing). Of all these, though, the main thing is Breslow depth. 2.8mm is intermediate thickness so comes with a slight risk of spread to lymph nodes. I wish you all the best in your journey. The main thing is that the little sucker is gone for now and likely for good!

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        Participant

          I am sorry you are going through this. My best guess is that original shave biopsy of a suspected melanoma (never accept this – always demand a proper excisional biopsy in future) has made it nigh on impossible to ever guess the real depth of your melanoma. because hte shave biopsy bisected the base. What residual found on the WLE is impossible to 'match' with the original stupid shave excision so I would take the first path report as leading, but unfortunately with 'at least' 1.2mm. Either way, treatement is the same… perhaps a further exicision is needed and probalby a SLNB.

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            OK, the first thing is to understand that treatment for melanoma has really advanced so its one of the first cancers that is becoming very treatable, even at stage 4.

             

            The second thing is to understand that the nodular subtype is a bit nastier than others because it is kind of like a carrot – a bump on top but with a tendency to grow deeper. This is kind of shown in the clark level, the vertical growth found, and the Breslow thickness. The Breslow is most important, and yours is past that 0.75mm or 1mm point where you wouldn't need an SLNB because the odds of spread are so low. There is a chance – a small chance – your lymph nodes will be affected. Its still a fairly thin melanoma.

             

            The third thing is mitotic rate has been dropped from the diagnostic criteria for melanoma AFAIK. It was considered important, now not so much. The fact that there is no ulceration is good news.

             

            I think you have good odds of a clear SLNB, but no-ne can guess. The main thing is that it is found and treated as nodular is considered faster and more aggressive than other types:

             

            https://www.dermnetnz.org/topics/nodular-melanoma/

             

            In short, it's not great to be diagnosed with this particular type of melanoma, but hopefully the wide level excision/SLNB is the enough to get you in the clear.

             

             

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              In Australia this would be an everyday thing, a wide level excision only, no SLNB. Kind of… uneventful. Put your mind at ease, go on living and enjoying life, only now with the inconvenience of an annual skin check for a) any new melanoma b) a recurrence at the original site, both of which are very unlikely and now that you will be getting regular checks, would be caught early anyways. Nutrients – just try to stay reasonably healthy, not just for melanoma but for everything! No need to go on a wheat juice fast or anything weird.

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                Tex you have done a great job – it's enough info, not too much, not too little, with heaps of pics and an easy way to contact you. This is going to really help people who find themselves in the same situation.

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                  I'm so sorry to hear that, Elizabeth. He fought the good fight. RIP Ezio.

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                    I'll second you OP, because the board is so often hacked with spam, and that raises questions about the safety of our personal info (profiles etc). Such a low thing to do, hack a forum for people battling disease.

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                      I really don't know, but If I had to guess, I'd say the shaved because it's 'ground zero' so to speak, but that said the reason I won't accept shaves is they often dissect the base of the melanoma or leave cells behind around the edges, and that's bad because then you can never ascertain true depth. To me the WLE is a blunt instrument that says either clear or not clear, but no longer offers what you most need to know which is true depth of the melanoma – the most important prognostic indicator. Why do you ask? Did your WLE show up something more ominous than the original shave? I

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                        As far as melanoma goes, this is the jackpot: in situ has no metastatic potential/no means of spreading, and the big danger with melanoma is not what is excised but what has already spread through blood and lymph. As far as skin cancer goes, melanoma is certainly NOT the jackpot because of its potential to metastasise, so that's a bummer to have it at all, but if you do have it then in situ is the best kind of all. Once you have the wide level excision done, you should just have regular skin checks and NEVER accept a shave biopsy for a suspected melanoma because they can be incomplete (like yours, with residual  melanoma left behind. Always get a proper excisional biopsy for suspected melanoma. But how bad does it sound? Not. Bad. At. All. The only better scenario was for it to be one of the more benign types of skin cancer like BCC or SCC, or better still not skin cancer at all.

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                          I havent had this but read up on it recently. Its very common and removal is done by an opthalmologist or plastic surgeon. you.might have a bad week or two but the face has an excellent blood supply and heals quickly and well. if it does turn pit to be a bcc you might use cream iquimod or something instead of excison.
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                            Thanks for the update, not the news I wanted to hear from you, I was hoping that the whole thing was a misunderstanding. Next best thing is to find and excise that sucker… glad that is done now. I think you will be enshrined in some medical journal somewhere 'Highly unusual presentation of…'. Just such an extraordinary case. Hope you are on the way to the all-clear.

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                              It's not quite that simple. The path report shows an in situ melanoma, wiht an iinvasive melanoma component with a Breslow depth .57mm. Thiis is now what is leading, it is most likely a stage 1A melanoma, it is definitely no longer 'just' an in situ. That said, it is the next best thing: a shallow, non-ulcerated, completely excised stage 1 melanoma. It is highly unlikely that the wide level excision (1cm border all around the existing excision) will show up anything other than healthy skin, but OP has had a stage 1 melanoma. OP, the WLE is likely all you will need, and either six monthly or yearly skin checks depending how vigilant your dermatologist is. 

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                                Grrrr I am angry at your derm!  I cannot believe that YOU told HER the gold standard (excisional biopsy) but SHE railroaded YOU into an (incomplete) shave. Luckily she preserved depth, but missed the edges which is a concern but of course less of a concern than bisecting the base. It really is borderline for SLNB, in Australia you would not qualify as there is no concerning features (ulceration, mitosis).  Just a straight WLE and you are on your way. I still want to slap that derm though… I don't think age is very interesting or has any prognostic value. For me it would be yes to the WLE, no to the SLNB oh and did I mention… your derm is arrogant beyond words.  Sorry but that just makes me livid.

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                                  I would have thought that mitosis 1/mm would make you a stage 1b. As for SLNB, in Australia it's 1mm or 0.75mm if any concerning features, and you don't meet either criteria so no. It is a little close to the line so you could do it for peace of mind, but keep in mind SLNB is a staging tool only, not any kind of 'cure'. It's simply a more in-depth staging method than the usual wide level excision (WLE). In your shoes, I would not opt for an SLNB as your melanoma does not meet the fairly stringent criteria for one.

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                                    You're pretty switched on, and what you say is correct – however, it is just so NOT like any melanoma that I've ever seen… the main thing is, you have the thing found, biopsied, on your way to complete removal. It's relatively thin and doesn't seem aggressive (no mitosis). Added to that, you are switched on and thinking well and doing your homework. All in all it's a pretty good… just odd… picture. Keep us updated – I just genuinely find this to be so odd!

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