Are all melanoma diagnosis’ referred to a surgical oncologist

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  • Post
    • August 24, 2017 at 6:42 am
    Kathryn Shoemaker
    Participant

      My husband was diagnosed with melanoma 2 days ago.  The dermatologist did an excision biopsy.  The Breslow depth is .24mm but that is all of the information my husband was given.  I've requested a copy of the pathological/histological report and I will find out the Clark level, mitosis factor et al.  The dermatologist referred him to a surgical oncologist.  Is this standard procedure for a very thin tumor or does this referral suggest something more serious was seen in the report but not shared with my husband?  His appointment with the oncologist is in 3 weeks.  That seems like a long time.  I won't be able to wait that long for staging information.  I'm preparing myself to understand the pathology report.  Can I be given the actual histological images the pathologist viewed?  Those are what I'm focusing on.  I have jumped head long into learning everything I can about the biology of this disease.  I'm not a wierd, bossy, control freak wife but my husband isn't big on in depth research of anything medical, especially a diagnosis that is scaring him badly.  I'm scared too but knowledge is power and I'm more frightened by not understanding.  Thanks. 

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        • August 24, 2017 at 11:34 am
        Nemesis
        Participant

          0.24 mm is an excellent depth all considering. I would not worry too much, it is almost unheard of to have any nodes involvement with such small melanoma.

           

          Mine was almost 1 mm and I had my surgery done by a plastic surgeon. I think that at this point, it isn't really that relevant who does it. I would try to calm down, he is very very likely to be ok.

           

          Good luck!

          • August 24, 2017 at 1:42 pm
          Janner
          Participant

            This mainly depends on the derm.  Some would do the wide excision themselves, others refer to a surgeon.  I have had all my excisions in an office setting and not with a surgical oncologist. Some with a derm and the others with a cutaneous oncologist.  The referral to someone else means nothing in terms of prognosis, only that this derm doesn't do wide excisions.  

            You can be given the path report but there are no images to look at.  The pathologists look directly at the stained slides and any crash course you read about will not give you the depth of knowledge to interpret those slides.  There is no need.  If you choose, send the slides to a pathologist of your choice for a second opinion.  However, understanding everything in a pathology report changes little when it comes to treatment or prognosis.  The important factors are called out on the path report and those same factors are used in staging.  Everything else is interesting to a point but hasn't been proven (at this time) to statistically impact prognosis/staging.  At .24mm, this is likely an extremely low risk lesion with little likelihood of spread.  Your husband is stage 1, most likely stage 1a.  It's an extremely good prognosis.  Knowing everything about this disease is admirable, but it is very likely your husband will never deal with melanoma again after this excision.  

              • August 24, 2017 at 6:34 pm
              Kathryn Shoemaker
              Participant

                Thank you. Your response is very reassuring. I'm feeling better about it all today and so is my husband.   I'm going to donate to this foundation and stay on the forum. 

                • August 24, 2017 at 7:22 pm
                casagrayson
                Participant

                  My only concern would be if the pathology report stated no clear margins at the depth.  That would indicate the entire melanoma was not removed.  That's probably not the case, however.  Have you asked for the pathology report to be uploaded to a patient portal, or have you asked to go by and get a hard copy?

                  • August 24, 2017 at 7:55 pm
                  Kathryn Shoemaker
                  Participant

                    He received the call while driving to the airport (due back next week). He also didn't list me on the HIPPA form (he has seen a doctor about 3 times in his entire 50 years and didn't know what it was). The derm won't release the path to me so we have to wait until he gets back.  I forced him to go and have his moles checked (he has a higher than average amount) because I noticed one that didn't look okay to me. I'm glad I did. I'll report back once we get the pathology. I'm so grateful for this forum/foundation. Thank you so much. 

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