› Forums › General Melanoma Community › Almost have melanoma? Have consultation with oncology next week…
- This topic has 39 replies, 4 voices, and was last updated 14 years, 2 months ago by
Shawna1972.
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- February 16, 2012 at 3:41 pm
Wow, what a last few weeks I have had. I would appreciate any feedback or answers that you can provide.
I went to the dermatologist a few weeks ago to have, what I thought, a mole removed for cosmetic reasons – as it was on my face. Had it for about a year. Dermatologist said 'I'm not so sure that's a mole, I suspect that possibly could be basal cell – but we'll send it to the lab to see'. I was less nervous about basal cell, I thought ok, if it's basal cell – she just took it out.
Wow, what a last few weeks I have had. I would appreciate any feedback or answers that you can provide.
I went to the dermatologist a few weeks ago to have, what I thought, a mole removed for cosmetic reasons – as it was on my face. Had it for about a year. Dermatologist said 'I'm not so sure that's a mole, I suspect that possibly could be basal cell – but we'll send it to the lab to see'. I was less nervous about basal cell, I thought ok, if it's basal cell – she just took it out.
Two weeks later, I got the call to come in and discuss. Derm advised lab had a hard time figuring out what to call it. From what I gather, the punch biopsy showed 'potential' for malignant melanoma. The margins were not clear, so I know there will be another excision. Do I expect bloodwork, xrays, scans? Also, the report advises a low mitotic rate of less than 1%, hopefully that's a good thing? Two Dr.'s were consulted by lab, one had the conservative approach opinion of another excision and watch – the other more radical, involving lymph nodes.
I contacted my primary care Dr. who has referred me to a hematologist/oncologist for an initial consultation next week. Any advice on what to expect at an initial consultation? Also, would an elevated blood calcium level that was found last fall, have anything to do with this?
The research on the internet is freaking me out. At this point, I have no stage, no real concrete of a diagnosis for melanoma – just 'potential'.
Any help or insight would be greatly appreciated!
- Replies
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- February 16, 2012 at 3:49 pm
Hi ! I absolutely understand how you feel. I am in similiar situation . Was diagnosed month ago ,still not sure about breslow thikness ( in another lab for second opinion). Still did not have my Wide exition.
Try do not search a lot in internet – it what I was doing for first couple of weeks. It is a lot of scary information in where.
Everyone's case is individual .
I suppose it will be good thing to do some tests ,it is what I am waiting to do – wide exition and blood,possible x-ray.
As far as I understand low mitotic rate is a good factor.
Try to stay positive , it is always hope
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- February 16, 2012 at 3:49 pm
Hi ! I absolutely understand how you feel. I am in similiar situation . Was diagnosed month ago ,still not sure about breslow thikness ( in another lab for second opinion). Still did not have my Wide exition.
Try do not search a lot in internet – it what I was doing for first couple of weeks. It is a lot of scary information in where.
Everyone's case is individual .
I suppose it will be good thing to do some tests ,it is what I am waiting to do – wide exition and blood,possible x-ray.
As far as I understand low mitotic rate is a good factor.
Try to stay positive , it is always hope
-
- February 16, 2012 at 3:52 pm
I am trying very hard, believe me – both of staying positive and staying away from internet searches. Thanks so much for your response, it makes me feel a little better to know that I'm not alone in this situation!
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- February 16, 2012 at 3:52 pm
I am trying very hard, believe me – both of staying positive and staying away from internet searches. Thanks so much for your response, it makes me feel a little better to know that I'm not alone in this situation!
-
- February 16, 2012 at 4:05 pm
You are deffinately not alone.
I don't know a lot about my stage and situation as well – I even don't know my mitotic rate
My first pathology of melanoma was done abroad ,while on holiday
They did not privode me with specific information, so now they sent my melanoma to UK for second opinion ,and time is going , and still don't know anything
Melanoma pages in internet was only thinh=g I was reading in internet for first couple of weeks ,I scared myself till high temperature and horrible headaches because of stress
I pray God every day to get help faster and hopefully everything will not be as bad
Try do not read in internet ,we are individuals
We need to stay positive and try to change something in our lives – probably this diagnosys is a warning bell to everyone – try to think about positive things , love yourself and people around ,love God. This positive attitude will deffinately help us !!!!
Wish you all the best
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- February 16, 2012 at 4:05 pm
You are deffinately not alone.
I don't know a lot about my stage and situation as well – I even don't know my mitotic rate
My first pathology of melanoma was done abroad ,while on holiday
They did not privode me with specific information, so now they sent my melanoma to UK for second opinion ,and time is going , and still don't know anything
Melanoma pages in internet was only thinh=g I was reading in internet for first couple of weeks ,I scared myself till high temperature and horrible headaches because of stress
I pray God every day to get help faster and hopefully everything will not be as bad
Try do not read in internet ,we are individuals
We need to stay positive and try to change something in our lives – probably this diagnosys is a warning bell to everyone – try to think about positive things , love yourself and people around ,love God. This positive attitude will deffinately help us !!!!
Wish you all the best
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- February 16, 2012 at 4:12 pm
And all my best to you as well! I will be thinking about and praying for you too. Take care!
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- February 16, 2012 at 4:12 pm
And all my best to you as well! I will be thinking about and praying for you too. Take care!
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- February 16, 2012 at 4:12 pm
And all my best to you as well! I will be thinking about and praying for you too. Take care!
-
- February 16, 2012 at 4:05 pm
You are deffinately not alone.
I don't know a lot about my stage and situation as well – I even don't know my mitotic rate
My first pathology of melanoma was done abroad ,while on holiday
They did not privode me with specific information, so now they sent my melanoma to UK for second opinion ,and time is going , and still don't know anything
Melanoma pages in internet was only thinh=g I was reading in internet for first couple of weeks ,I scared myself till high temperature and horrible headaches because of stress
I pray God every day to get help faster and hopefully everything will not be as bad
Try do not read in internet ,we are individuals
We need to stay positive and try to change something in our lives – probably this diagnosys is a warning bell to everyone – try to think about positive things , love yourself and people around ,love God. This positive attitude will deffinately help us !!!!
Wish you all the best
-
- February 16, 2012 at 3:52 pm
I am trying very hard, believe me – both of staying positive and staying away from internet searches. Thanks so much for your response, it makes me feel a little better to know that I'm not alone in this situation!
-
- February 16, 2012 at 3:49 pm
Hi ! I absolutely understand how you feel. I am in similiar situation . Was diagnosed month ago ,still not sure about breslow thikness ( in another lab for second opinion). Still did not have my Wide exition.
Try do not search a lot in internet – it what I was doing for first couple of weeks. It is a lot of scary information in where.
Everyone's case is individual .
I suppose it will be good thing to do some tests ,it is what I am waiting to do – wide exition and blood,possible x-ray.
As far as I understand low mitotic rate is a good factor.
Try to stay positive , it is always hope
-
- February 16, 2012 at 4:15 pm
Do yourself a favor and meet with a melanoma specialist.
Your specimen should be read by a dermopathologist. They specialize in skin/pathology.
Melanoma is a very unique cancer and should be treated as such. A regular oncologist won't be as versed in it.
Information is not a bad thing. It will lead you to lots and lots of questions. Be sure to write down questions as they come up. Keep a notebook. Have someone go to appointments with you so they can ask the questions you forget and write everything down.
Just my two cents!
Best wishes.
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- February 16, 2012 at 4:15 pm
Do yourself a favor and meet with a melanoma specialist.
Your specimen should be read by a dermopathologist. They specialize in skin/pathology.
Melanoma is a very unique cancer and should be treated as such. A regular oncologist won't be as versed in it.
Information is not a bad thing. It will lead you to lots and lots of questions. Be sure to write down questions as they come up. Keep a notebook. Have someone go to appointments with you so they can ask the questions you forget and write everything down.
Just my two cents!
Best wishes.
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- February 16, 2012 at 4:23 pm
As far as I am aware, this Dr that I am scheduled with is a specialist in melanoma and sarcoma at the University of Iowa Hospitals & Clinics and is an associate professor, so hopefully he will be the right Dr. for me!
Thanks so much!
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- February 16, 2012 at 4:23 pm
As far as I am aware, this Dr that I am scheduled with is a specialist in melanoma and sarcoma at the University of Iowa Hospitals & Clinics and is an associate professor, so hopefully he will be the right Dr. for me!
Thanks so much!
-
- February 16, 2012 at 4:23 pm
As far as I am aware, this Dr that I am scheduled with is a specialist in melanoma and sarcoma at the University of Iowa Hospitals & Clinics and is an associate professor, so hopefully he will be the right Dr. for me!
Thanks so much!
-
- February 16, 2012 at 4:15 pm
Do yourself a favor and meet with a melanoma specialist.
Your specimen should be read by a dermopathologist. They specialize in skin/pathology.
Melanoma is a very unique cancer and should be treated as such. A regular oncologist won't be as versed in it.
Information is not a bad thing. It will lead you to lots and lots of questions. Be sure to write down questions as they come up. Keep a notebook. Have someone go to appointments with you so they can ask the questions you forget and write everything down.
Just my two cents!
Best wishes.
-
- February 16, 2012 at 5:21 pm
WAIT WAIT WAIT. "Potential for melanoma"? Is this lesion melanoma or is this lesion "dysplastic" or "atypical"? Do you have a copy of the pathology report?
An atypical mole has the potential to turn into melanoma BUT RARELY DOES. So if this lesion is atypical, it IS NOT cancer. Atypical lesions are usually specified as mild, moderate or severe. Severely atypical lesions usually require 5mm margins and they are treated the same as melanoma in situ. Moderately or mildly atypical lesions usually require at least clear margins.
Now, if the pathology is unclear – that is, the pathologist is unsure of the diagnosis – instead of seeing an oncologist, I'd send your slides to have them read by another dermatopathologist. Get a second opinion on the slides and THEN decide if you need to see an oncologist. At all times, get a copy of the pathology reports for your own records.
As for any additional things (bloodwork and scans), I'd say that is highly unlikely at this point. Those are not going to be helpful, but a clear and understandable pathology report is KEY!
Best wishes,
Janner
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- February 16, 2012 at 5:21 pm
WAIT WAIT WAIT. "Potential for melanoma"? Is this lesion melanoma or is this lesion "dysplastic" or "atypical"? Do you have a copy of the pathology report?
An atypical mole has the potential to turn into melanoma BUT RARELY DOES. So if this lesion is atypical, it IS NOT cancer. Atypical lesions are usually specified as mild, moderate or severe. Severely atypical lesions usually require 5mm margins and they are treated the same as melanoma in situ. Moderately or mildly atypical lesions usually require at least clear margins.
Now, if the pathology is unclear – that is, the pathologist is unsure of the diagnosis – instead of seeing an oncologist, I'd send your slides to have them read by another dermatopathologist. Get a second opinion on the slides and THEN decide if you need to see an oncologist. At all times, get a copy of the pathology reports for your own records.
As for any additional things (bloodwork and scans), I'd say that is highly unlikely at this point. Those are not going to be helpful, but a clear and understandable pathology report is KEY!
Best wishes,
Janner
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- February 16, 2012 at 6:20 pm
Janner,
I do have a copy of the lab report, though not with me at the moment. I do not recall any wording saying 'dysplatic' or 'atypical', but I will review again tonight.
Thank you for all your input and information!
Shawna
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- February 16, 2012 at 6:20 pm
Janner,
I do have a copy of the lab report, though not with me at the moment. I do not recall any wording saying 'dysplatic' or 'atypical', but I will review again tonight.
Thank you for all your input and information!
Shawna
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- February 16, 2012 at 8:38 pm
Sorry, I missed the fact that you had two docs opinions on the original report. If you post your pathology report, it might help. We obviously can't interpret things like your doctors will, but at least we'd have a basis for discussion. I'd also want to know that the pathologists who read the slides are dermatopathologists who see a lot of melanoma. If there's a difference of opinion on the diagnosis, find an expert. Is the oncologist you are scheduled to see a melanoma specialist?
Janner
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- February 16, 2012 at 8:38 pm
Sorry, I missed the fact that you had two docs opinions on the original report. If you post your pathology report, it might help. We obviously can't interpret things like your doctors will, but at least we'd have a basis for discussion. I'd also want to know that the pathologists who read the slides are dermatopathologists who see a lot of melanoma. If there's a difference of opinion on the diagnosis, find an expert. Is the oncologist you are scheduled to see a melanoma specialist?
Janner
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- February 16, 2012 at 8:38 pm
Sorry, I missed the fact that you had two docs opinions on the original report. If you post your pathology report, it might help. We obviously can't interpret things like your doctors will, but at least we'd have a basis for discussion. I'd also want to know that the pathologists who read the slides are dermatopathologists who see a lot of melanoma. If there's a difference of opinion on the diagnosis, find an expert. Is the oncologist you are scheduled to see a melanoma specialist?
Janner
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- February 16, 2012 at 9:08 pm
I will post the pathology report tomorrow if it will help get anymore information to the surface here. The Dr. I am scheduled to see is an associate professor at the University of Iowa Hospital & Clinics – specializing in melanoma and sarcoma, so hopefully he will be the appropriate Dr. to tackle this.
Thanks for all your help! I hope you will be on tomorrow to take a look at the path report, you have been a great deal of help and some relief to me in trying to figure out this puzzle…
-
- February 16, 2012 at 9:08 pm
I will post the pathology report tomorrow if it will help get anymore information to the surface here. The Dr. I am scheduled to see is an associate professor at the University of Iowa Hospital & Clinics – specializing in melanoma and sarcoma, so hopefully he will be the appropriate Dr. to tackle this.
Thanks for all your help! I hope you will be on tomorrow to take a look at the path report, you have been a great deal of help and some relief to me in trying to figure out this puzzle…
-
- February 16, 2012 at 9:08 pm
I will post the pathology report tomorrow if it will help get anymore information to the surface here. The Dr. I am scheduled to see is an associate professor at the University of Iowa Hospital & Clinics – specializing in melanoma and sarcoma, so hopefully he will be the appropriate Dr. to tackle this.
Thanks for all your help! I hope you will be on tomorrow to take a look at the path report, you have been a great deal of help and some relief to me in trying to figure out this puzzle…
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- February 17, 2012 at 2:10 pm
Sorry, not able to scan path report but I will type in here:
CLINICAL IMPRESSION/HISTORY
5mm pink papule. DDx: Neoplasm of uncertain behavior vs. dysplastic nevus vs. basal cell carcinoma. Possible BCC vs. nevus. 238.2
FINAL MICROSCOPIC DIAGNOSIS
Right central mylar cheek, Punch biopsy: ATYPICAL DERMOEPIDERMAL MELANOCYTIC PROLIFERATION; THE LESION EXTENDS TO BOTH LATERAL MARGICS AND TO THE DEEP MARGIN OF THE SPECIMEN.
Comment: Multiple additional levels are performed in our laboratory. Sections show an atypical compound melanocytic proliferation with pleomorphic spindle and epithelioid cell with large irregular nuclei and prominent nucleoli without maturation. Spindle and epithelioid cell melanocytic neoplasms are notoriously difficult to classify in postpubertal populations. Although special stains (Ki67/MART-1) reveals a low dermal mitotic index (<1%) and in areas the dermal melanocytes has a fascicular growth pattern reminiscent of deep penetrating nevus, two dermal mitoses are identified in the mid dermis and the degree of cytological atypia is very worrisome for malignant melanoma. Overall, perhaps such a lesion in best considered to have uncertain malignant potential. A complete excision is recommended. Given the unusual features, this case was forwarded to Dr. Scott Granter at the Brigham and Women's Hospital for an expert consultation. This case was also reviewed by Dr. Elsa Velazquez who is in concurrence with the above interpretation.
***Let me know what you get out of this report. Thanks so much! If melanoma, stage would be advanced due to it being at least 5mm???
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- February 17, 2012 at 2:10 pm
Sorry, not able to scan path report but I will type in here:
CLINICAL IMPRESSION/HISTORY
5mm pink papule. DDx: Neoplasm of uncertain behavior vs. dysplastic nevus vs. basal cell carcinoma. Possible BCC vs. nevus. 238.2
FINAL MICROSCOPIC DIAGNOSIS
Right central mylar cheek, Punch biopsy: ATYPICAL DERMOEPIDERMAL MELANOCYTIC PROLIFERATION; THE LESION EXTENDS TO BOTH LATERAL MARGICS AND TO THE DEEP MARGIN OF THE SPECIMEN.
Comment: Multiple additional levels are performed in our laboratory. Sections show an atypical compound melanocytic proliferation with pleomorphic spindle and epithelioid cell with large irregular nuclei and prominent nucleoli without maturation. Spindle and epithelioid cell melanocytic neoplasms are notoriously difficult to classify in postpubertal populations. Although special stains (Ki67/MART-1) reveals a low dermal mitotic index (<1%) and in areas the dermal melanocytes has a fascicular growth pattern reminiscent of deep penetrating nevus, two dermal mitoses are identified in the mid dermis and the degree of cytological atypia is very worrisome for malignant melanoma. Overall, perhaps such a lesion in best considered to have uncertain malignant potential. A complete excision is recommended. Given the unusual features, this case was forwarded to Dr. Scott Granter at the Brigham and Women's Hospital for an expert consultation. This case was also reviewed by Dr. Elsa Velazquez who is in concurrence with the above interpretation.
***Let me know what you get out of this report. Thanks so much! If melanoma, stage would be advanced due to it being at least 5mm???
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- February 17, 2012 at 3:17 pm
5mm is not the depth, but the width of the lesion. The clinical impression is what the doctor is seeing when he is doing the biopsy. He sees a pink 5mm lesion that he thinks is possibly a BCC or dysplastic nevus. The depth is not listed and the diagnosis of melanoma is not given either – only an "atypical lesion". Severely atypical lesions have the potential to become melanoma (but don't have to). It appears that in the final diagnosis, they are NOT declaring this is malignant – only atypical (ATYPICAL DERMOEPIDERMAL MELANOCYTIC PROLIFERATION). However, they do recommend getting complete margins and probably a little extra. You will have to get clarification, but nowhere does this say it IS melanoma. (And for insurance purposes, that is important. If you can keep "melanoma" out of your insurance history, you will be much better off). You want to get your margins and discuss this with the doctor. Severely atypical lesions are often treated as early melanomas but aren't given that diagnosis. This is what I read. I'm not an expert. You need to discuss this with one as this does appear to be one of those in a gray area.
Best wishes,
Janner
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- February 17, 2012 at 3:17 pm
5mm is not the depth, but the width of the lesion. The clinical impression is what the doctor is seeing when he is doing the biopsy. He sees a pink 5mm lesion that he thinks is possibly a BCC or dysplastic nevus. The depth is not listed and the diagnosis of melanoma is not given either – only an "atypical lesion". Severely atypical lesions have the potential to become melanoma (but don't have to). It appears that in the final diagnosis, they are NOT declaring this is malignant – only atypical (ATYPICAL DERMOEPIDERMAL MELANOCYTIC PROLIFERATION). However, they do recommend getting complete margins and probably a little extra. You will have to get clarification, but nowhere does this say it IS melanoma. (And for insurance purposes, that is important. If you can keep "melanoma" out of your insurance history, you will be much better off). You want to get your margins and discuss this with the doctor. Severely atypical lesions are often treated as early melanomas but aren't given that diagnosis. This is what I read. I'm not an expert. You need to discuss this with one as this does appear to be one of those in a gray area.
Best wishes,
Janner
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- February 17, 2012 at 3:22 pm
Thank you for your view on this, it does help to have someone at least say something other than dr's who say nothing except 'we're referring you to oncology'. It gives me a little more explanation to what the 'greek' says. Thanks again…my appt can't get here fast enough!
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- February 17, 2012 at 3:22 pm
Thank you for your view on this, it does help to have someone at least say something other than dr's who say nothing except 'we're referring you to oncology'. It gives me a little more explanation to what the 'greek' says. Thanks again…my appt can't get here fast enough!
-
- February 17, 2012 at 3:22 pm
Thank you for your view on this, it does help to have someone at least say something other than dr's who say nothing except 'we're referring you to oncology'. It gives me a little more explanation to what the 'greek' says. Thanks again…my appt can't get here fast enough!
-
- February 17, 2012 at 3:17 pm
5mm is not the depth, but the width of the lesion. The clinical impression is what the doctor is seeing when he is doing the biopsy. He sees a pink 5mm lesion that he thinks is possibly a BCC or dysplastic nevus. The depth is not listed and the diagnosis of melanoma is not given either – only an "atypical lesion". Severely atypical lesions have the potential to become melanoma (but don't have to). It appears that in the final diagnosis, they are NOT declaring this is malignant – only atypical (ATYPICAL DERMOEPIDERMAL MELANOCYTIC PROLIFERATION). However, they do recommend getting complete margins and probably a little extra. You will have to get clarification, but nowhere does this say it IS melanoma. (And for insurance purposes, that is important. If you can keep "melanoma" out of your insurance history, you will be much better off). You want to get your margins and discuss this with the doctor. Severely atypical lesions are often treated as early melanomas but aren't given that diagnosis. This is what I read. I'm not an expert. You need to discuss this with one as this does appear to be one of those in a gray area.
Best wishes,
Janner
-
- February 17, 2012 at 2:10 pm
Sorry, not able to scan path report but I will type in here:
CLINICAL IMPRESSION/HISTORY
5mm pink papule. DDx: Neoplasm of uncertain behavior vs. dysplastic nevus vs. basal cell carcinoma. Possible BCC vs. nevus. 238.2
FINAL MICROSCOPIC DIAGNOSIS
Right central mylar cheek, Punch biopsy: ATYPICAL DERMOEPIDERMAL MELANOCYTIC PROLIFERATION; THE LESION EXTENDS TO BOTH LATERAL MARGICS AND TO THE DEEP MARGIN OF THE SPECIMEN.
Comment: Multiple additional levels are performed in our laboratory. Sections show an atypical compound melanocytic proliferation with pleomorphic spindle and epithelioid cell with large irregular nuclei and prominent nucleoli without maturation. Spindle and epithelioid cell melanocytic neoplasms are notoriously difficult to classify in postpubertal populations. Although special stains (Ki67/MART-1) reveals a low dermal mitotic index (<1%) and in areas the dermal melanocytes has a fascicular growth pattern reminiscent of deep penetrating nevus, two dermal mitoses are identified in the mid dermis and the degree of cytological atypia is very worrisome for malignant melanoma. Overall, perhaps such a lesion in best considered to have uncertain malignant potential. A complete excision is recommended. Given the unusual features, this case was forwarded to Dr. Scott Granter at the Brigham and Women's Hospital for an expert consultation. This case was also reviewed by Dr. Elsa Velazquez who is in concurrence with the above interpretation.
***Let me know what you get out of this report. Thanks so much! If melanoma, stage would be advanced due to it being at least 5mm???
-
- February 16, 2012 at 6:20 pm
Janner,
I do have a copy of the lab report, though not with me at the moment. I do not recall any wording saying 'dysplatic' or 'atypical', but I will review again tonight.
Thank you for all your input and information!
Shawna
-
- February 16, 2012 at 5:21 pm
WAIT WAIT WAIT. "Potential for melanoma"? Is this lesion melanoma or is this lesion "dysplastic" or "atypical"? Do you have a copy of the pathology report?
An atypical mole has the potential to turn into melanoma BUT RARELY DOES. So if this lesion is atypical, it IS NOT cancer. Atypical lesions are usually specified as mild, moderate or severe. Severely atypical lesions usually require 5mm margins and they are treated the same as melanoma in situ. Moderately or mildly atypical lesions usually require at least clear margins.
Now, if the pathology is unclear – that is, the pathologist is unsure of the diagnosis – instead of seeing an oncologist, I'd send your slides to have them read by another dermatopathologist. Get a second opinion on the slides and THEN decide if you need to see an oncologist. At all times, get a copy of the pathology reports for your own records.
As for any additional things (bloodwork and scans), I'd say that is highly unlikely at this point. Those are not going to be helpful, but a clear and understandable pathology report is KEY!
Best wishes,
Janner
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Tagged: cutaneous melanoma
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