› Forums › General Melanoma Community › Difference between satellite, in-transit and new primary melanoma?
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CHD.
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- June 15, 2014 at 8:19 pm
Hi! New here. Have been following this site for awhile and I need help. I have been dealing with vulvar melanoma, and what I'm wondering is if anyone here could explain the difference between satellite, in-transit and new primary melanoma in terms of local regional recurrence? How are they different? Do any, or all of them, mean that you have had a local recurrence/metastasis of melanoma? Does this affect your overall prognosis for the worst?
I had a right radical vulvectomy last May. Then in October a left-side vulvectomy to try to even things out, I was so uncomfortable, but during that surgery melanoma in situ was found. The problem was, it wasn't evident on my skin and totally unexpected so the specimen sent to pathology wasn't oriented, and we didn't know where it had been, just that it was there somewhere and went all the way out to the margins. I have had vulvar biopsies and just had a third hemivulvectomy trying to find the MIS, which also failed to locate it. 🙁
But what I'm wondering is, the original melanoma was on the right, removed by surgery with clear, 2 cm margins all the way around. The MIS was found 5 months later on the left, totally separated from the one that had been on the right. So would that be considered an in-transit melanoma, a satellite lesion, or a new primary developing?
I know I should probably wait until I see my oncologist in July to ask this, but it is driving me crazy, wondering if I have had a local regional recurrence and if that changes my prognosis to worse than it already was.
Any thoughts would be appreciated!
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- June 16, 2014 at 2:12 am
This is NOT an exact science, but in general a satellite would be located within 2cm of the original lesion. In-transit would be further away than that headed in the direction of the nearest lymph node basin. A new primary is a total independent occurrence of melanoma. Satellites and in-transits are usually labeled as "metastatic disease". Basically, that means they are traveling through the lymph vessels. So in the very simplest form, satellites and in-transits grow UP from the lymph vessels toward the surface. A new primary grows from the surface down toward the lymph and blood vessels.
I am only guessing without any real path reports to look at, but if "in situ" is listed, it is either a remnant of the first primary not removed with the vulvectomies (a little strange since it is on the other side…. but vulvar melanoma is a rare one and I could certainly be wrong about that) or this in situ is a separate primary.
We can only speculate here, you really need to get your doctor's opinion. He has reviewed the pathology and is in a much better position to satisfy your curiousity.
Janner
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- June 16, 2014 at 2:12 am
This is NOT an exact science, but in general a satellite would be located within 2cm of the original lesion. In-transit would be further away than that headed in the direction of the nearest lymph node basin. A new primary is a total independent occurrence of melanoma. Satellites and in-transits are usually labeled as "metastatic disease". Basically, that means they are traveling through the lymph vessels. So in the very simplest form, satellites and in-transits grow UP from the lymph vessels toward the surface. A new primary grows from the surface down toward the lymph and blood vessels.
I am only guessing without any real path reports to look at, but if "in situ" is listed, it is either a remnant of the first primary not removed with the vulvectomies (a little strange since it is on the other side…. but vulvar melanoma is a rare one and I could certainly be wrong about that) or this in situ is a separate primary.
We can only speculate here, you really need to get your doctor's opinion. He has reviewed the pathology and is in a much better position to satisfy your curiousity.
Janner
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- June 16, 2014 at 3:53 am
Janner,
Thank you so much! The part about how metastatic melanoma would grow upward from the lymph vessels toward the surface makes perfect sense. As does your explanation of in transit versus satellite.
It is definitely in situ on the path report. And it is definitely not part of the original melanoma – well, at least it seems unlikely since the original melanoma had 2 cm clear margins all the way around. This makes me think it is most likely to be a second primary then. Which would be a big relief, if I understand it all correctly, as most of the research I've read says a second primary is only as dangerous as it is deep, and this is just in situ. I'll definitely ask about that in July.
Anyway, what a relief that would be. It will now be MUCH easier to get from here to July when I see the oncologist.
Cheri
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- June 16, 2014 at 3:53 am
Janner,
Thank you so much! The part about how metastatic melanoma would grow upward from the lymph vessels toward the surface makes perfect sense. As does your explanation of in transit versus satellite.
It is definitely in situ on the path report. And it is definitely not part of the original melanoma – well, at least it seems unlikely since the original melanoma had 2 cm clear margins all the way around. This makes me think it is most likely to be a second primary then. Which would be a big relief, if I understand it all correctly, as most of the research I've read says a second primary is only as dangerous as it is deep, and this is just in situ. I'll definitely ask about that in July.
Anyway, what a relief that would be. It will now be MUCH easier to get from here to July when I see the oncologist.
Cheri
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- June 16, 2014 at 12:20 pm
Janner, sorry to hijact the thread but I have a quick ? for you.
In your experience. Do prmary or satellites on the skin resemble the original primay found? For instance, my primary was Nodular, 1/4 inch above the skin. I typically just look for a repeat of this. Can they show in a different form than the original?
Again, opoligies to the OP.
Colleen
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- June 16, 2014 at 12:20 pm
Janner, sorry to hijact the thread but I have a quick ? for you.
In your experience. Do prmary or satellites on the skin resemble the original primay found? For instance, my primary was Nodular, 1/4 inch above the skin. I typically just look for a repeat of this. Can they show in a different form than the original?
Again, opoligies to the OP.
Colleen
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- June 16, 2014 at 1:30 pm
Yes, they can look different. In transits can often be like little peas UNDER the skin or show up as dark spots. Different people, different melanoma, different looks. I think what you should be looking for is "new and different from anything else". You can't know exactly what to look for, so you look for something that doesn't match what's normally on you!
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- June 16, 2014 at 1:30 pm
Yes, they can look different. In transits can often be like little peas UNDER the skin or show up as dark spots. Different people, different melanoma, different looks. I think what you should be looking for is "new and different from anything else". You can't know exactly what to look for, so you look for something that doesn't match what's normally on you!
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- June 16, 2014 at 1:30 pm
Yes, they can look different. In transits can often be like little peas UNDER the skin or show up as dark spots. Different people, different melanoma, different looks. I think what you should be looking for is "new and different from anything else". You can't know exactly what to look for, so you look for something that doesn't match what's normally on you!
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- June 16, 2014 at 12:20 pm
Janner, sorry to hijact the thread but I have a quick ? for you.
In your experience. Do prmary or satellites on the skin resemble the original primay found? For instance, my primary was Nodular, 1/4 inch above the skin. I typically just look for a repeat of this. Can they show in a different form than the original?
Again, opoligies to the OP.
Colleen
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- June 16, 2014 at 3:53 am
Janner,
Thank you so much! The part about how metastatic melanoma would grow upward from the lymph vessels toward the surface makes perfect sense. As does your explanation of in transit versus satellite.
It is definitely in situ on the path report. And it is definitely not part of the original melanoma – well, at least it seems unlikely since the original melanoma had 2 cm clear margins all the way around. This makes me think it is most likely to be a second primary then. Which would be a big relief, if I understand it all correctly, as most of the research I've read says a second primary is only as dangerous as it is deep, and this is just in situ. I'll definitely ask about that in July.
Anyway, what a relief that would be. It will now be MUCH easier to get from here to July when I see the oncologist.
Cheri
-
- June 16, 2014 at 2:12 am
This is NOT an exact science, but in general a satellite would be located within 2cm of the original lesion. In-transit would be further away than that headed in the direction of the nearest lymph node basin. A new primary is a total independent occurrence of melanoma. Satellites and in-transits are usually labeled as "metastatic disease". Basically, that means they are traveling through the lymph vessels. So in the very simplest form, satellites and in-transits grow UP from the lymph vessels toward the surface. A new primary grows from the surface down toward the lymph and blood vessels.
I am only guessing without any real path reports to look at, but if "in situ" is listed, it is either a remnant of the first primary not removed with the vulvectomies (a little strange since it is on the other side…. but vulvar melanoma is a rare one and I could certainly be wrong about that) or this in situ is a separate primary.
We can only speculate here, you really need to get your doctor's opinion. He has reviewed the pathology and is in a much better position to satisfy your curiousity.
Janner
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- June 16, 2014 at 4:07 pm
Colleen, that was an interesting question actually. It never occurred to me that melanoma could recur in a different form.
I'm wondering if the inner vulvar skin is thinner or more vascular closer to the surface than skin elsewhere on the body. Is there the same size epidermal layer on inner vulvar skin as there is on normal outer labial skin, for example?
Because if the skin is more vascular, or more vascular closer to the surface, it would take a much thinner melanoma to reach into the vascular layers. And I am told melanoma also travels through the blood.
Janner, do you know? I know it's all just speculation.
I have been researching the histology of inner labia all morning and the layers of skin but no luck finding an answer to this. I guess that's what happens when you have a rare form of cancer, it can be a nightmare trying to find answers between doctor visits.
But I wonder if the skin IS thinner and more vascular, it would be possible to form in-transit or satellite lesions by traveling through the blood to another part of the inner labia, equally vascular.
If so, though, would it be something other than in situ when it appears?
A thousand questions, I know!
Cheri
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- June 16, 2014 at 4:07 pm
Colleen, that was an interesting question actually. It never occurred to me that melanoma could recur in a different form.
I'm wondering if the inner vulvar skin is thinner or more vascular closer to the surface than skin elsewhere on the body. Is there the same size epidermal layer on inner vulvar skin as there is on normal outer labial skin, for example?
Because if the skin is more vascular, or more vascular closer to the surface, it would take a much thinner melanoma to reach into the vascular layers. And I am told melanoma also travels through the blood.
Janner, do you know? I know it's all just speculation.
I have been researching the histology of inner labia all morning and the layers of skin but no luck finding an answer to this. I guess that's what happens when you have a rare form of cancer, it can be a nightmare trying to find answers between doctor visits.
But I wonder if the skin IS thinner and more vascular, it would be possible to form in-transit or satellite lesions by traveling through the blood to another part of the inner labia, equally vascular.
If so, though, would it be something other than in situ when it appears?
A thousand questions, I know!
Cheri
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- June 16, 2014 at 6:28 pm
One clarification: Satellite and in-transits are only seen via LYMPH vessel spread. Blood vessels (i.e. more vascular) would not likely promote either satellites or intransits – you would most likely have organ mets then. So with thinner skin or more access to the blood vessels, your risk of moving to stage IV would probably be higher. Again, I do not know the in-depth anatomy of that area so can't comment if you would be higher risk of either. Just pointing out that lymph vessels are more likely to carry "local" disease. In situ is confined to the epidermis which has ZERO access to lymph and blood vessels. Those are located in deeper skin layers.
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- June 16, 2014 at 6:28 pm
One clarification: Satellite and in-transits are only seen via LYMPH vessel spread. Blood vessels (i.e. more vascular) would not likely promote either satellites or intransits – you would most likely have organ mets then. So with thinner skin or more access to the blood vessels, your risk of moving to stage IV would probably be higher. Again, I do not know the in-depth anatomy of that area so can't comment if you would be higher risk of either. Just pointing out that lymph vessels are more likely to carry "local" disease. In situ is confined to the epidermis which has ZERO access to lymph and blood vessels. Those are located in deeper skin layers.
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- June 16, 2014 at 6:28 pm
One clarification: Satellite and in-transits are only seen via LYMPH vessel spread. Blood vessels (i.e. more vascular) would not likely promote either satellites or intransits – you would most likely have organ mets then. So with thinner skin or more access to the blood vessels, your risk of moving to stage IV would probably be higher. Again, I do not know the in-depth anatomy of that area so can't comment if you would be higher risk of either. Just pointing out that lymph vessels are more likely to carry "local" disease. In situ is confined to the epidermis which has ZERO access to lymph and blood vessels. Those are located in deeper skin layers.
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- June 16, 2014 at 8:08 pm
Ok, that makes sense, that in-transits and satellites are melanoma that has spread via lymph vessels, so in situ would then be highly unlikely to be one, and that they are more likely to carry local disease. Also, that blood vessel spread would be more likely to spead distantly. So if the vulvar skin is thinner or more vascular, it could be a poor prognostic sign in terms of advancing to stage IV disease. But only based on the depth of my primary, of course, as the in situ is up above all the blood and lymph vessels. That all makes sense.
Getting back then to considering the in situ may have been the beginning stages of another primary, I was reading up on that, too, and the consensus seems to be that it is not unheard of to have more than one primary in a person prone to melanoma, though it is not all that common either (8% chance of it, I think is what I read).
It is hard to imagine that I would form 2 separate melanomas in roughly the same part of my anatomy, just on opposite sides of the midline, for lack of a better way to describe it, because it is such a rare place for melanoma to form in the first place! But, on the other hand, I suppose if your body is inclined, genetically or otherwise, to form one rare type of mucosal melanoma, it could just as easily form more than one. Maybe, if anything, it is MORE likely to happen with a mucosal type of melanoma that is so clearly not sun-related.
Anyway, thanks again!
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- June 16, 2014 at 8:08 pm
Ok, that makes sense, that in-transits and satellites are melanoma that has spread via lymph vessels, so in situ would then be highly unlikely to be one, and that they are more likely to carry local disease. Also, that blood vessel spread would be more likely to spead distantly. So if the vulvar skin is thinner or more vascular, it could be a poor prognostic sign in terms of advancing to stage IV disease. But only based on the depth of my primary, of course, as the in situ is up above all the blood and lymph vessels. That all makes sense.
Getting back then to considering the in situ may have been the beginning stages of another primary, I was reading up on that, too, and the consensus seems to be that it is not unheard of to have more than one primary in a person prone to melanoma, though it is not all that common either (8% chance of it, I think is what I read).
It is hard to imagine that I would form 2 separate melanomas in roughly the same part of my anatomy, just on opposite sides of the midline, for lack of a better way to describe it, because it is such a rare place for melanoma to form in the first place! But, on the other hand, I suppose if your body is inclined, genetically or otherwise, to form one rare type of mucosal melanoma, it could just as easily form more than one. Maybe, if anything, it is MORE likely to happen with a mucosal type of melanoma that is so clearly not sun-related.
Anyway, thanks again!
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- June 16, 2014 at 8:08 pm
Ok, that makes sense, that in-transits and satellites are melanoma that has spread via lymph vessels, so in situ would then be highly unlikely to be one, and that they are more likely to carry local disease. Also, that blood vessel spread would be more likely to spead distantly. So if the vulvar skin is thinner or more vascular, it could be a poor prognostic sign in terms of advancing to stage IV disease. But only based on the depth of my primary, of course, as the in situ is up above all the blood and lymph vessels. That all makes sense.
Getting back then to considering the in situ may have been the beginning stages of another primary, I was reading up on that, too, and the consensus seems to be that it is not unheard of to have more than one primary in a person prone to melanoma, though it is not all that common either (8% chance of it, I think is what I read).
It is hard to imagine that I would form 2 separate melanomas in roughly the same part of my anatomy, just on opposite sides of the midline, for lack of a better way to describe it, because it is such a rare place for melanoma to form in the first place! But, on the other hand, I suppose if your body is inclined, genetically or otherwise, to form one rare type of mucosal melanoma, it could just as easily form more than one. Maybe, if anything, it is MORE likely to happen with a mucosal type of melanoma that is so clearly not sun-related.
Anyway, thanks again!
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- June 16, 2014 at 9:18 pm
My thoughts exactly which is why I mentioned the possibility of the original primary not being completely removed. It is worth asking your doctor because I can't come up with what I consider a good explanation either. '
BTW, I've had 3 primaries but mine were all over – one on each leg and one on my back.
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- June 16, 2014 at 9:18 pm
My thoughts exactly which is why I mentioned the possibility of the original primary not being completely removed. It is worth asking your doctor because I can't come up with what I consider a good explanation either. '
BTW, I've had 3 primaries but mine were all over – one on each leg and one on my back.
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- June 16, 2014 at 9:18 pm
My thoughts exactly which is why I mentioned the possibility of the original primary not being completely removed. It is worth asking your doctor because I can't come up with what I consider a good explanation either. '
BTW, I've had 3 primaries but mine were all over – one on each leg and one on my back.
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- June 16, 2014 at 4:07 pm
Colleen, that was an interesting question actually. It never occurred to me that melanoma could recur in a different form.
I'm wondering if the inner vulvar skin is thinner or more vascular closer to the surface than skin elsewhere on the body. Is there the same size epidermal layer on inner vulvar skin as there is on normal outer labial skin, for example?
Because if the skin is more vascular, or more vascular closer to the surface, it would take a much thinner melanoma to reach into the vascular layers. And I am told melanoma also travels through the blood.
Janner, do you know? I know it's all just speculation.
I have been researching the histology of inner labia all morning and the layers of skin but no luck finding an answer to this. I guess that's what happens when you have a rare form of cancer, it can be a nightmare trying to find answers between doctor visits.
But I wonder if the skin IS thinner and more vascular, it would be possible to form in-transit or satellite lesions by traveling through the blood to another part of the inner labia, equally vascular.
If so, though, would it be something other than in situ when it appears?
A thousand questions, I know!
Cheri
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- June 17, 2014 at 6:37 pm
So, I just got back from a derm appt and asked him exactly the same thing.
Janner, he basically said exactly what you said. He said that in-transit and satellites are cells that have "escaped the barn" so to speak and are on the way to other places. They travel through the lymphatic system. My in situ by definition is limited to the epidermis where the lymph nodes don't reach; if I had a metastasis, he would expect it to be moving from the deeper levels to the surface. He said he thinks it is most probable that I had a new primary growing there.
I also said that it seemed so odd that I could form not one, but two rare cancers in the same area (inner vulva), just on opposite sides, but that maybe this wasn't so surprising if it is something that is genetically linked. And he said as a matter of fact, it would make sense that, with a genetic component, the tissue on both sides of midline, left and right, could be similarly vulnerable to whatever it is that causes a vulvar melanoma to form. Made perfect sense.
I am so relieved. Everything I have read, and my derm confirmed, would indicate that a new primary bodes much better than a metastasis. Feel like I have dodged a bullet there. What a relief for now. I guess, in a strange sort of way, it is good that there is no inner vulva left on my body at all, as that does seem to be especially vulnerable to creating melanomas on me. Never thought I would ever see that as a good thing.
Janner, thank you for all your help! It sounds like you were exactly right.
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- June 17, 2014 at 6:37 pm
So, I just got back from a derm appt and asked him exactly the same thing.
Janner, he basically said exactly what you said. He said that in-transit and satellites are cells that have "escaped the barn" so to speak and are on the way to other places. They travel through the lymphatic system. My in situ by definition is limited to the epidermis where the lymph nodes don't reach; if I had a metastasis, he would expect it to be moving from the deeper levels to the surface. He said he thinks it is most probable that I had a new primary growing there.
I also said that it seemed so odd that I could form not one, but two rare cancers in the same area (inner vulva), just on opposite sides, but that maybe this wasn't so surprising if it is something that is genetically linked. And he said as a matter of fact, it would make sense that, with a genetic component, the tissue on both sides of midline, left and right, could be similarly vulnerable to whatever it is that causes a vulvar melanoma to form. Made perfect sense.
I am so relieved. Everything I have read, and my derm confirmed, would indicate that a new primary bodes much better than a metastasis. Feel like I have dodged a bullet there. What a relief for now. I guess, in a strange sort of way, it is good that there is no inner vulva left on my body at all, as that does seem to be especially vulnerable to creating melanomas on me. Never thought I would ever see that as a good thing.
Janner, thank you for all your help! It sounds like you were exactly right.
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- June 17, 2014 at 6:37 pm
So, I just got back from a derm appt and asked him exactly the same thing.
Janner, he basically said exactly what you said. He said that in-transit and satellites are cells that have "escaped the barn" so to speak and are on the way to other places. They travel through the lymphatic system. My in situ by definition is limited to the epidermis where the lymph nodes don't reach; if I had a metastasis, he would expect it to be moving from the deeper levels to the surface. He said he thinks it is most probable that I had a new primary growing there.
I also said that it seemed so odd that I could form not one, but two rare cancers in the same area (inner vulva), just on opposite sides, but that maybe this wasn't so surprising if it is something that is genetically linked. And he said as a matter of fact, it would make sense that, with a genetic component, the tissue on both sides of midline, left and right, could be similarly vulnerable to whatever it is that causes a vulvar melanoma to form. Made perfect sense.
I am so relieved. Everything I have read, and my derm confirmed, would indicate that a new primary bodes much better than a metastasis. Feel like I have dodged a bullet there. What a relief for now. I guess, in a strange sort of way, it is good that there is no inner vulva left on my body at all, as that does seem to be especially vulnerable to creating melanomas on me. Never thought I would ever see that as a good thing.
Janner, thank you for all your help! It sounds like you were exactly right.
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- August 7, 2014 at 2:12 pm
Just wanted to add an update:
I saw a melanoma specialist for the first time this week and his opinion is that what I had was actually part of the same primary, even though it was on the opposite side, because all of the mucosal tissue in that region is very close together. My impression is this is something unique to vulvar melanoma because of the way the anatomy there is all sort of crowded together. Also characteristic of vulvar melanoma is an unusually high tendency (even for melanoma) to recur locally, something else I didn't know.
Again, thank you for the feedback and insight. Regardless of what the in situ actually was, I learned a great deal from this thread!
Cheri
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- August 7, 2014 at 2:12 pm
Just wanted to add an update:
I saw a melanoma specialist for the first time this week and his opinion is that what I had was actually part of the same primary, even though it was on the opposite side, because all of the mucosal tissue in that region is very close together. My impression is this is something unique to vulvar melanoma because of the way the anatomy there is all sort of crowded together. Also characteristic of vulvar melanoma is an unusually high tendency (even for melanoma) to recur locally, something else I didn't know.
Again, thank you for the feedback and insight. Regardless of what the in situ actually was, I learned a great deal from this thread!
Cheri
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- August 7, 2014 at 2:12 pm
Just wanted to add an update:
I saw a melanoma specialist for the first time this week and his opinion is that what I had was actually part of the same primary, even though it was on the opposite side, because all of the mucosal tissue in that region is very close together. My impression is this is something unique to vulvar melanoma because of the way the anatomy there is all sort of crowded together. Also characteristic of vulvar melanoma is an unusually high tendency (even for melanoma) to recur locally, something else I didn't know.
Again, thank you for the feedback and insight. Regardless of what the in situ actually was, I learned a great deal from this thread!
Cheri
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