How do I read / understand cancer stage with these…

› Forums › General Melanoma Community › How do I read / understand cancer stage with these…

  • Post
    • April 24, 2016 at 5:15 am
    Emma_Melbourne
    Participant

      I am in Australia, and just diagnosed, and I wasn't given staging which fits the model that Americans are using.

       

      Can someone tell me what stage you regard this as in the USA please?? (I know it's below the epidermal and into the dermal layer.)

       

      Here's the info I have on my Synoptic report:

      Malignant melanoma, superficial spreading subtype

      Site: Right forearm

      Clark level: 2

      Breslow thickness: 0.25 mm

      Ulceration: absent

      Cell type: Epithelial

      Mitotic index: Nil

      Lymphovascular invation: Not seen

      Neurotropsim / desmoplasia / satellites: Not seen

      Features of regression: Present

      Associated naevus (type): Displastic junctional naevus

       

      Microscopy:

      There are atyypical melanocytes at the dermo-epidural junction and small numbers of atypical melanocytes in the papillary dermis. The junctional melanocytes show nested and confulent growth and pagetoid spread. The dermal component is surrounded by a dense lymphcytic inflammatory infiltrate.

       

      Thanks in advance for any help you can give me.

    Viewing 2 reply threads
    • Replies
        • April 24, 2016 at 9:00 pm
        stars
        Participant

          Emma, this must be a huge shock for you. That said, it's basically good news in the melanoma world. A very thin (0.25mm) melanoma with no mitosis and no ulceration puts you at 1A with basically almost 100% cure rate. I think the official rate would be something like 98% chance of 10 year survival. It's basically curable with a wide level excision. The only better outcome would be in situ – confined to the epidermis. The next best thing is your diagnosis – 1A – very thin but moving into the dermis, but without aggressive features like ulceration and mitosis. Have your WLE if you haven't already had it, go for your 6 monthly skin check and you are all good. I

          • April 24, 2016 at 9:00 pm
          stars
          Participant

            Emma, this must be a huge shock for you. That said, it's basically good news in the melanoma world. A very thin (0.25mm) melanoma with no mitosis and no ulceration puts you at 1A with basically almost 100% cure rate. I think the official rate would be something like 98% chance of 10 year survival. It's basically curable with a wide level excision. The only better outcome would be in situ – confined to the epidermis. The next best thing is your diagnosis – 1A – very thin but moving into the dermis, but without aggressive features like ulceration and mitosis. Have your WLE if you haven't already had it, go for your 6 monthly skin check and you are all good. I

            • April 24, 2016 at 9:00 pm
            stars
            Participant

              Emma, this must be a huge shock for you. That said, it's basically good news in the melanoma world. A very thin (0.25mm) melanoma with no mitosis and no ulceration puts you at 1A with basically almost 100% cure rate. I think the official rate would be something like 98% chance of 10 year survival. It's basically curable with a wide level excision. The only better outcome would be in situ – confined to the epidermis. The next best thing is your diagnosis – 1A – very thin but moving into the dermis, but without aggressive features like ulceration and mitosis. Have your WLE if you haven't already had it, go for your 6 monthly skin check and you are all good. I

                • April 25, 2016 at 10:56 am
                Emma_Melbourne
                Participant

                  Hi Anonymous,

                   

                  Thanks for your comment..

                   

                  I have an 8 week old baby, so it was a huge shock. The doctor gave me 92% for 5 year survival. And called it Stage 2 on Australian melanoma staging system. 

                  I'll try and find out more information at my appointment in 2 weeks time.

                   

                  Best,

                   

                  Emma

                   

                  • April 25, 2016 at 11:28 am
                  JC
                  Participant

                    Please note that Clark level 2 and stage 2 are different things.  But are often confused.

                    • April 25, 2016 at 11:28 am
                    JC
                    Participant

                      Please note that Clark level 2 and stage 2 are different things.  But are often confused.

                      • April 25, 2016 at 11:28 am
                      JC
                      Participant

                        Please note that Clark level 2 and stage 2 are different things.  But are often confused.

                        • April 26, 2016 at 10:08 am
                        stars
                        Participant

                          I think your doctor is wrong or you have misheard/misunderstood. It's pretty certain that you have a stage 1 melanoma which has reached Clark level 2 of skin invasion. That's perfectly normal – stage 1 is always clark level 2 or more. Clark 1 means confined to epidermis and be a melanoma in situ, aka a stage 0 melanoma. Clear as mud!

                          But you are stage 1, and better still, as you have no mitosis and no ulceration, you are stage 1A. It just doesn't get much better than this, frankly. THe only better thing is melanoma in situe (clark level 1, only in epidermis) or no melanoma at all. You had a thin melanoma with no aggressive features. AJCC had a lifespan tool that I'm pretty sure would give you 98% chance of being alive in 10 years… excellent odds. It's not online at the moment, probably because survival stats for melanoma are getting better by the day so these old odds don't reflect new realities. I used another silly calculator (see link below), plugged in your age as 35 ( a wild guess, you're probably younger), plugged in the other info you gave and got the following: 1.7% expected 15-year cancer death rate, this cancer shortens the life of a 35 year old woman by 0.8 years. If you are 25 years old, it drops to 1.5% over 15 years. Now this tool is not really a legit one, but the result actually sounds about right to me- you have a very, very low chance of ever having any trouble from this melanoma.

                           

                          You do need to be watchful of new melanomas, thus the 6 monthly skin checks – if you do have any more, you'll catch them early. Please stop worrying about your diagnosis, the melanoma is found and gone, you can enjoy your baby and just be vigilant with the skin checks. There's every chance you'll never have to grapple with melanoma again. I wish you all the best,

                          Stars

                          PS here's the calculator I used:

                          http://www.lifemath.net/cancer/melanoma/condsurv/index.php

                          • April 26, 2016 at 10:08 am
                          stars
                          Participant

                            I think your doctor is wrong or you have misheard/misunderstood. It's pretty certain that you have a stage 1 melanoma which has reached Clark level 2 of skin invasion. That's perfectly normal – stage 1 is always clark level 2 or more. Clark 1 means confined to epidermis and be a melanoma in situ, aka a stage 0 melanoma. Clear as mud!

                            But you are stage 1, and better still, as you have no mitosis and no ulceration, you are stage 1A. It just doesn't get much better than this, frankly. THe only better thing is melanoma in situe (clark level 1, only in epidermis) or no melanoma at all. You had a thin melanoma with no aggressive features. AJCC had a lifespan tool that I'm pretty sure would give you 98% chance of being alive in 10 years… excellent odds. It's not online at the moment, probably because survival stats for melanoma are getting better by the day so these old odds don't reflect new realities. I used another silly calculator (see link below), plugged in your age as 35 ( a wild guess, you're probably younger), plugged in the other info you gave and got the following: 1.7% expected 15-year cancer death rate, this cancer shortens the life of a 35 year old woman by 0.8 years. If you are 25 years old, it drops to 1.5% over 15 years. Now this tool is not really a legit one, but the result actually sounds about right to me- you have a very, very low chance of ever having any trouble from this melanoma.

                             

                            You do need to be watchful of new melanomas, thus the 6 monthly skin checks – if you do have any more, you'll catch them early. Please stop worrying about your diagnosis, the melanoma is found and gone, you can enjoy your baby and just be vigilant with the skin checks. There's every chance you'll never have to grapple with melanoma again. I wish you all the best,

                            Stars

                            PS here's the calculator I used:

                            http://www.lifemath.net/cancer/melanoma/condsurv/index.php

                            • April 26, 2016 at 10:12 am
                            stars
                            Participant

                              Forgot to say: there is no separate Australian system, we also use the American system so you are 100% going to be stage 1, please don't sweat this – if you really want to do the math yourself, check out:

                              https://cancerstaging.org/references-tools/quickreferences/documents/melanomasmall.pdf

                              Or, you can just take my word for it: I am sure you are a T1ANOMO, aka a patient with stage 1A melanoma.

                              Stars

                              • April 26, 2016 at 10:12 am
                              stars
                              Participant

                                Forgot to say: there is no separate Australian system, we also use the American system so you are 100% going to be stage 1, please don't sweat this – if you really want to do the math yourself, check out:

                                https://cancerstaging.org/references-tools/quickreferences/documents/melanomasmall.pdf

                                Or, you can just take my word for it: I am sure you are a T1ANOMO, aka a patient with stage 1A melanoma.

                                Stars

                                • April 29, 2016 at 11:38 pm
                                Emma_Melbourne
                                Participant

                                  Thanks for your reply.

                                  My pathology report notes that there is evidence of regression. 

                                  And that the derman component is surrounded by a dense lymphcytic inflammatory inflitrate.

                                  If I understand correctly, this regression means they don't know how thick the melanoma initially was, which makes staging more difficult.

                                  I have an appointment on Wednesday afternoon, so will ask them then and see if I can get more answers.

                                  • May 3, 2016 at 9:55 am
                                  stars
                                  Participant

                                    Welcome to what I call the information overload phase of melanoma. It's a funny mental trick: you're in full fight or flight mode, so you start to read up on things thinking that more info is better, and before you know it your mind has found one more thing to worry about (in this case, regression). I think we all do this, I remember having this exact fear myself. Really, in terms of melanoma, the biggies are: Breslow depth (yours is thin), ulceration (you don't have it), mitosis. Everything else is kind of interesting but not that important – you'll find one study saying regression is bad, another saying it's good. What it means is that your body has started an immune response against the melanoma. Around half of melanomas will have regression. Not unusual and no need for alarm bells to ring. My understanding is that overall, regression makes little difference to prognosis. You have been staged, there is no difficulty in staging. Your prognosis is excellent. Please, let me save you lots of worrying here. I've been where you are, more info does not help, take your prognosis at face value as a great prognosis.

                                    • May 3, 2016 at 9:55 am
                                    stars
                                    Participant

                                      Welcome to what I call the information overload phase of melanoma. It's a funny mental trick: you're in full fight or flight mode, so you start to read up on things thinking that more info is better, and before you know it your mind has found one more thing to worry about (in this case, regression). I think we all do this, I remember having this exact fear myself. Really, in terms of melanoma, the biggies are: Breslow depth (yours is thin), ulceration (you don't have it), mitosis. Everything else is kind of interesting but not that important – you'll find one study saying regression is bad, another saying it's good. What it means is that your body has started an immune response against the melanoma. Around half of melanomas will have regression. Not unusual and no need for alarm bells to ring. My understanding is that overall, regression makes little difference to prognosis. You have been staged, there is no difficulty in staging. Your prognosis is excellent. Please, let me save you lots of worrying here. I've been where you are, more info does not help, take your prognosis at face value as a great prognosis.

                                      • May 3, 2016 at 9:55 am
                                      stars
                                      Participant

                                        Welcome to what I call the information overload phase of melanoma. It's a funny mental trick: you're in full fight or flight mode, so you start to read up on things thinking that more info is better, and before you know it your mind has found one more thing to worry about (in this case, regression). I think we all do this, I remember having this exact fear myself. Really, in terms of melanoma, the biggies are: Breslow depth (yours is thin), ulceration (you don't have it), mitosis. Everything else is kind of interesting but not that important – you'll find one study saying regression is bad, another saying it's good. What it means is that your body has started an immune response against the melanoma. Around half of melanomas will have regression. Not unusual and no need for alarm bells to ring. My understanding is that overall, regression makes little difference to prognosis. You have been staged, there is no difficulty in staging. Your prognosis is excellent. Please, let me save you lots of worrying here. I've been where you are, more info does not help, take your prognosis at face value as a great prognosis.

                                        • April 29, 2016 at 11:38 pm
                                        Emma_Melbourne
                                        Participant

                                          Thanks for your reply.

                                          My pathology report notes that there is evidence of regression. 

                                          And that the derman component is surrounded by a dense lymphcytic inflammatory inflitrate.

                                          If I understand correctly, this regression means they don't know how thick the melanoma initially was, which makes staging more difficult.

                                          I have an appointment on Wednesday afternoon, so will ask them then and see if I can get more answers.

                                          • April 29, 2016 at 11:38 pm
                                          Emma_Melbourne
                                          Participant

                                            Thanks for your reply.

                                            My pathology report notes that there is evidence of regression. 

                                            And that the derman component is surrounded by a dense lymphcytic inflammatory inflitrate.

                                            If I understand correctly, this regression means they don't know how thick the melanoma initially was, which makes staging more difficult.

                                            I have an appointment on Wednesday afternoon, so will ask them then and see if I can get more answers.

                                            • April 26, 2016 at 10:12 am
                                            stars
                                            Participant

                                              Forgot to say: there is no separate Australian system, we also use the American system so you are 100% going to be stage 1, please don't sweat this – if you really want to do the math yourself, check out:

                                              https://cancerstaging.org/references-tools/quickreferences/documents/melanomasmall.pdf

                                              Or, you can just take my word for it: I am sure you are a T1ANOMO, aka a patient with stage 1A melanoma.

                                              Stars

                                              • April 26, 2016 at 10:08 am
                                              stars
                                              Participant

                                                I think your doctor is wrong or you have misheard/misunderstood. It's pretty certain that you have a stage 1 melanoma which has reached Clark level 2 of skin invasion. That's perfectly normal – stage 1 is always clark level 2 or more. Clark 1 means confined to epidermis and be a melanoma in situ, aka a stage 0 melanoma. Clear as mud!

                                                But you are stage 1, and better still, as you have no mitosis and no ulceration, you are stage 1A. It just doesn't get much better than this, frankly. THe only better thing is melanoma in situe (clark level 1, only in epidermis) or no melanoma at all. You had a thin melanoma with no aggressive features. AJCC had a lifespan tool that I'm pretty sure would give you 98% chance of being alive in 10 years… excellent odds. It's not online at the moment, probably because survival stats for melanoma are getting better by the day so these old odds don't reflect new realities. I used another silly calculator (see link below), plugged in your age as 35 ( a wild guess, you're probably younger), plugged in the other info you gave and got the following: 1.7% expected 15-year cancer death rate, this cancer shortens the life of a 35 year old woman by 0.8 years. If you are 25 years old, it drops to 1.5% over 15 years. Now this tool is not really a legit one, but the result actually sounds about right to me- you have a very, very low chance of ever having any trouble from this melanoma.

                                                 

                                                You do need to be watchful of new melanomas, thus the 6 monthly skin checks – if you do have any more, you'll catch them early. Please stop worrying about your diagnosis, the melanoma is found and gone, you can enjoy your baby and just be vigilant with the skin checks. There's every chance you'll never have to grapple with melanoma again. I wish you all the best,

                                                Stars

                                                PS here's the calculator I used:

                                                http://www.lifemath.net/cancer/melanoma/condsurv/index.php

                                                • April 25, 2016 at 10:56 am
                                                Emma_Melbourne
                                                Participant

                                                  Hi Anonymous,

                                                   

                                                  Thanks for your comment..

                                                   

                                                  I have an 8 week old baby, so it was a huge shock. The doctor gave me 92% for 5 year survival. And called it Stage 2 on Australian melanoma staging system. 

                                                  I'll try and find out more information at my appointment in 2 weeks time.

                                                   

                                                  Best,

                                                   

                                                  Emma

                                                   

                                                  • April 25, 2016 at 10:56 am
                                                  Emma_Melbourne
                                                  Participant

                                                    Hi Anonymous,

                                                     

                                                    Thanks for your comment..

                                                     

                                                    I have an 8 week old baby, so it was a huge shock. The doctor gave me 92% for 5 year survival. And called it Stage 2 on Australian melanoma staging system. 

                                                    I'll try and find out more information at my appointment in 2 weeks time.

                                                     

                                                    Best,

                                                     

                                                    Emma

                                                     

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