› Forums › General Melanoma Community › Mitotic Rate
- This topic has 54 replies, 9 voices, and was last updated 13 years, 9 months ago by
JC.
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- May 19, 2012 at 12:07 pm
I'm confused by my mitotic rate. First 2 path reports did not identify any dermal mitoses. Next 2 reports (yes, 4 opinions all on the same biopsy slides, call me thorough) did identify one dermal mitotic figure and listed the rate as <1. So, is <1 the same as 0 or the same as 1? Does that move me from 1a to 1b? Does that put me into the higher risk category of thin melanomas for having <1 instead of 0? When I went back to the path that did not identify any dermal mitoses, they said, "there are thousands of cells on a slide and it is cert
I'm confused by my mitotic rate. First 2 path reports did not identify any dermal mitoses. Next 2 reports (yes, 4 opinions all on the same biopsy slides, call me thorough) did identify one dermal mitotic figure and listed the rate as <1. So, is <1 the same as 0 or the same as 1? Does that move me from 1a to 1b? Does that put me into the higher risk category of thin melanomas for having <1 instead of 0? When I went back to the path that did not identify any dermal mitoses, they said, "there are thousands of cells on a slide and it is certainly possible that a single mitosis is seen by one pathologist but not by another. Sometimes there are multiple sections and not every section is made available to the consulting pathologist." Doesn't make me very confident then in my WLE/SLNB path report of "clear" if things can be missed. Anyway, my question is when you read all these studies about different risk categories of thin melanomas based on mitotic rate, where does <1 fall? Is that 1? Is that considered 0? The path that identified the mitotic figure also said, "We did identify a mitotic figure in the invasive component of the lesion, therefore regarded the lesion in "vertical growth phase". The issue is further complicated by the presence of adjacent nests of nevus cells; namely it is very difficult to identify each melanocyte in the dermis whether it is a benign "nevus cell" or part of the melanoma, although p16 immunostain, together with the histologic features, was somewhat helpful in this context (highlighting the nevus cells). There is early invasion into the papillary dermis mingled with a residual nevus. Additional immunostains were performed to further characterize the lesion and show that the proliferation index of the melanomatous component is slightly increased (5%) as compared to the nevus component (1%). There is marked reduction of immunoreactivity of HMB-45 expression and no significant loss of p16 expression in the dermal component of the lesion. " I have no idea what most of this means or where it puts me w/ my mitotic rate. How can it be <1? Isn't it either 0 or 1 (or a whole number greater than 1)?
What I'm really trying to ask/get at is this:
I read a study by Gimotty and DuPont. Before, I could say since my melanoma was thin and 1a that I could look at the ninety-something % survival rates and feel ok. But, after reading their study, I would fall into the 31% 10-year metastasis rate, because my mitotic rate is greater than 0. I'm male, VGP present, mitotic rate greater than 0. So, even though tumor thickness is the most important prognostic factor and mine was thin (0.3mm), I still fall into the high-risk of thin invasive melanomas. This is why I'm trying as much as I can to really get at this mitotic rate and what it means for me and my risk. It seems to really put me in a different risk category once the mitotic rate is anything greater than 0, even if less than 1. Or, would I fall into the "patients with VGP lesions that had MR of 0 for whom the rate was 4% ". Is my mitotic rate of <1 considered to be greater than 0 or just 0??
This prospective cohort study included 884 patients who had thin invasive melanomas. A tree-structured analysis of 10-year metastasis was used to develop a new classification scheme. The overall 10-year metastasis rate was 6.5%. The prognostic tree defined four risk groups: high-risk: men with vertical growth phase (VGP) lesions that had mitotic rates (MRs) greater than 0, and for whom the 10-year metastasis rate was 31% (22% to 42%; n = 90); moderate-risk: women with VGP lesions that had MRs greater than 0 and for whom the rate was 13% (9% to 18%; n = 136); low-risk: patients with VGP lesions that had MR of 0 for whom the rate was 4% (2% to 7%; n = 247); and minimal-risk: patients with invasive lesions without VGP for whom the rate was 0.5% (0% to 1.2%; n = 411).
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- May 19, 2012 at 1:30 pm
There are people on here who are battling, presently, a deadly form of melanoma. Most of the people on this board have advanced disease. You are bogging the board with multiple questions, and you have a thin lesion. Would you mind combining your questions into one post, so as not to take the attention away from people who have much more serious concerns?
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- May 19, 2012 at 1:30 pm
There are people on here who are battling, presently, a deadly form of melanoma. Most of the people on this board have advanced disease. You are bogging the board with multiple questions, and you have a thin lesion. Would you mind combining your questions into one post, so as not to take the attention away from people who have much more serious concerns?
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- May 19, 2012 at 1:30 pm
There are people on here who are battling, presently, a deadly form of melanoma. Most of the people on this board have advanced disease. You are bogging the board with multiple questions, and you have a thin lesion. Would you mind combining your questions into one post, so as not to take the attention away from people who have much more serious concerns?
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- May 19, 2012 at 1:38 pm
With all due respect, I believe the purpose of sites like this is for anyone with any stage of the disease to be able to ask their questions and gather information, regardless of stage. All melanoma diagnoses are serious. If this is an issue, might I suggest categorizing the bulletin board then into different disease stages so folks with a particular stage can just post to that category then. It's disappointing that on a site like this that is dedicated to helping people research information and connect with others who might be able to help, that there would be discouragement to doing so. I'm not trying to bog down the board, I have actual legitimate questions I'd like to obtain information on.
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- May 19, 2012 at 1:38 pm
With all due respect, I believe the purpose of sites like this is for anyone with any stage of the disease to be able to ask their questions and gather information, regardless of stage. All melanoma diagnoses are serious. If this is an issue, might I suggest categorizing the bulletin board then into different disease stages so folks with a particular stage can just post to that category then. It's disappointing that on a site like this that is dedicated to helping people research information and connect with others who might be able to help, that there would be discouragement to doing so. I'm not trying to bog down the board, I have actual legitimate questions I'd like to obtain information on.
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- May 19, 2012 at 1:38 pm
With all due respect, I believe the purpose of sites like this is for anyone with any stage of the disease to be able to ask their questions and gather information, regardless of stage. All melanoma diagnoses are serious. If this is an issue, might I suggest categorizing the bulletin board then into different disease stages so folks with a particular stage can just post to that category then. It's disappointing that on a site like this that is dedicated to helping people research information and connect with others who might be able to help, that there would be discouragement to doing so. I'm not trying to bog down the board, I have actual legitimate questions I'd like to obtain information on.
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- May 19, 2012 at 9:47 pm
Sorry ,I think it is a little bit rude to reply this way to person who worry and want to learn and get more information.My lesion is Breslow 0.2 ,but I don't think I AM NOT ALLOWED to post here and I do post and reply.
We need to be kind to each other ,it will save us.
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- May 19, 2012 at 9:47 pm
Sorry ,I think it is a little bit rude to reply this way to person who worry and want to learn and get more information.My lesion is Breslow 0.2 ,but I don't think I AM NOT ALLOWED to post here and I do post and reply.
We need to be kind to each other ,it will save us.
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- May 19, 2012 at 9:47 pm
Sorry ,I think it is a little bit rude to reply this way to person who worry and want to learn and get more information.My lesion is Breslow 0.2 ,but I don't think I AM NOT ALLOWED to post here and I do post and reply.
We need to be kind to each other ,it will save us.
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- May 19, 2012 at 11:45 pm
I don't believe anyone has the right to tell another person that their concern is not serious! We are dealing with Melanoma here not a head cold. I have been following this board for 2 years and I am the daughter of the stage 4 melanoma patient who has multiple brain mets. I myself have had many moles removed, some severely atypical (I dont have melanoma) but the information on this board teaches me a lot should I ever end up battling this disease. Lovely souls like Janner and others on this board (not anonymous) have great insight into melanoma diagnosis and help ones like this and me to understand early diagnosis. Melanoma is melanoma, thin or thick, stage 1 or stage 4, we all battling to understand this horrid disease and gain information to help us make treatment decisions or just to put our mind at rest.
So please don't discourage someone from trying to reach out and understand this disease. I find your comment highly offensive.
Nahmi from Melbourne.
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- May 19, 2012 at 11:45 pm
I don't believe anyone has the right to tell another person that their concern is not serious! We are dealing with Melanoma here not a head cold. I have been following this board for 2 years and I am the daughter of the stage 4 melanoma patient who has multiple brain mets. I myself have had many moles removed, some severely atypical (I dont have melanoma) but the information on this board teaches me a lot should I ever end up battling this disease. Lovely souls like Janner and others on this board (not anonymous) have great insight into melanoma diagnosis and help ones like this and me to understand early diagnosis. Melanoma is melanoma, thin or thick, stage 1 or stage 4, we all battling to understand this horrid disease and gain information to help us make treatment decisions or just to put our mind at rest.
So please don't discourage someone from trying to reach out and understand this disease. I find your comment highly offensive.
Nahmi from Melbourne.
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- May 19, 2012 at 11:45 pm
I don't believe anyone has the right to tell another person that their concern is not serious! We are dealing with Melanoma here not a head cold. I have been following this board for 2 years and I am the daughter of the stage 4 melanoma patient who has multiple brain mets. I myself have had many moles removed, some severely atypical (I dont have melanoma) but the information on this board teaches me a lot should I ever end up battling this disease. Lovely souls like Janner and others on this board (not anonymous) have great insight into melanoma diagnosis and help ones like this and me to understand early diagnosis. Melanoma is melanoma, thin or thick, stage 1 or stage 4, we all battling to understand this horrid disease and gain information to help us make treatment decisions or just to put our mind at rest.
So please don't discourage someone from trying to reach out and understand this disease. I find your comment highly offensive.
Nahmi from Melbourne.
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- May 20, 2012 at 6:40 pm
Dear Anonymous 5/19/12 8:30 a.m.
No one "bogs" the board with questions. Every question is welcome. In regards to stages: where would this board be without Janner and she is a stage 1B. How is one persons concerns more important than another?
Having been around here for about 2 years I have noticed there are typically two groups: the new in-situ and stage 1 that a simply scared to death by the word cancer and those stage 4 warriors. They both deserve respect.
So please get over it. And please don't post as anonymous.
Mary
Stage 3
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- May 20, 2012 at 6:40 pm
Dear Anonymous 5/19/12 8:30 a.m.
No one "bogs" the board with questions. Every question is welcome. In regards to stages: where would this board be without Janner and she is a stage 1B. How is one persons concerns more important than another?
Having been around here for about 2 years I have noticed there are typically two groups: the new in-situ and stage 1 that a simply scared to death by the word cancer and those stage 4 warriors. They both deserve respect.
So please get over it. And please don't post as anonymous.
Mary
Stage 3
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- May 20, 2012 at 6:40 pm
Dear Anonymous 5/19/12 8:30 a.m.
No one "bogs" the board with questions. Every question is welcome. In regards to stages: where would this board be without Janner and she is a stage 1B. How is one persons concerns more important than another?
Having been around here for about 2 years I have noticed there are typically two groups: the new in-situ and stage 1 that a simply scared to death by the word cancer and those stage 4 warriors. They both deserve respect.
So please get over it. And please don't post as anonymous.
Mary
Stage 3
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- May 19, 2012 at 1:55 pm
How long ago was your diagnosis? Judging from your questions I would say with in the a year. I think you are still rattled by your diagnosis and are searching the web for any information on melanoma. We all go through a phase of doubting what the pathology reports say….what if theynmiss something, what if there really is vertical growth etc.
So my question to you is what would you do if they do find mitotic rate >1? Will that change your life? Will that change your treatment regiment?
I get the feeling you are looking for trouble where there is no trouble. Go live your life and be thankful you are not fighting for your life right now. You seem to be obsessing.-
- May 20, 2012 at 2:56 am
I am on a rant at the moment about these negative posts. Goodness me..who in their right mind would go looking for trouble unnessessarily? A diagnosis that could be Melanoma would be frightening for any newbie and if it were me I would naturally be concerned. The point here is that there are much nicer ways to tell someone that they shouldn't be overly concerned without belittling a person. If my dad had obsessed over his primary, he probably wouldn't be stage 4 now and dying. I have always felt that this board was a place for ALL concerns related to this disease. Please try to be more encouraging and don't assume that everyone has the same understanding of this disease, this a place to teach, encourage and support.
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- May 20, 2012 at 2:56 am
I am on a rant at the moment about these negative posts. Goodness me..who in their right mind would go looking for trouble unnessessarily? A diagnosis that could be Melanoma would be frightening for any newbie and if it were me I would naturally be concerned. The point here is that there are much nicer ways to tell someone that they shouldn't be overly concerned without belittling a person. If my dad had obsessed over his primary, he probably wouldn't be stage 4 now and dying. I have always felt that this board was a place for ALL concerns related to this disease. Please try to be more encouraging and don't assume that everyone has the same understanding of this disease, this a place to teach, encourage and support.
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- May 20, 2012 at 2:56 am
I am on a rant at the moment about these negative posts. Goodness me..who in their right mind would go looking for trouble unnessessarily? A diagnosis that could be Melanoma would be frightening for any newbie and if it were me I would naturally be concerned. The point here is that there are much nicer ways to tell someone that they shouldn't be overly concerned without belittling a person. If my dad had obsessed over his primary, he probably wouldn't be stage 4 now and dying. I have always felt that this board was a place for ALL concerns related to this disease. Please try to be more encouraging and don't assume that everyone has the same understanding of this disease, this a place to teach, encourage and support.
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- May 19, 2012 at 1:55 pm
How long ago was your diagnosis? Judging from your questions I would say with in the a year. I think you are still rattled by your diagnosis and are searching the web for any information on melanoma. We all go through a phase of doubting what the pathology reports say….what if theynmiss something, what if there really is vertical growth etc.
So my question to you is what would you do if they do find mitotic rate >1? Will that change your life? Will that change your treatment regiment?
I get the feeling you are looking for trouble where there is no trouble. Go live your life and be thankful you are not fighting for your life right now. You seem to be obsessing. -
- May 19, 2012 at 1:55 pm
How long ago was your diagnosis? Judging from your questions I would say with in the a year. I think you are still rattled by your diagnosis and are searching the web for any information on melanoma. We all go through a phase of doubting what the pathology reports say….what if theynmiss something, what if there really is vertical growth etc.
So my question to you is what would you do if they do find mitotic rate >1? Will that change your life? Will that change your treatment regiment?
I get the feeling you are looking for trouble where there is no trouble. Go live your life and be thankful you are not fighting for your life right now. You seem to be obsessing. -
- May 19, 2012 at 2:07 pm
The category for stage IA is "<1", not 0. So your "<1" lesion is still stage IA, not stage IB.
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- May 20, 2012 at 11:15 am
Thanks, Everyone, I appreciate the support. This is certainly not the place for bullying as we're all dealing with a devastating disease in one way or another. Anyway, I gather from the responses about my question that the one dermal mitotic figure identified is not something to dwell on or worry about or change my course of surveillance/treatment, etc… or increase my % of developing metastatic disease later.
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- May 20, 2012 at 11:15 am
Thanks, Everyone, I appreciate the support. This is certainly not the place for bullying as we're all dealing with a devastating disease in one way or another. Anyway, I gather from the responses about my question that the one dermal mitotic figure identified is not something to dwell on or worry about or change my course of surveillance/treatment, etc… or increase my % of developing metastatic disease later.
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- May 20, 2012 at 11:15 am
Thanks, Everyone, I appreciate the support. This is certainly not the place for bullying as we're all dealing with a devastating disease in one way or another. Anyway, I gather from the responses about my question that the one dermal mitotic figure identified is not something to dwell on or worry about or change my course of surveillance/treatment, etc… or increase my % of developing metastatic disease later.
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- May 20, 2012 at 6:46 pm
I cannot answer all your well researched information. I am a numbers person and I know statistic, so I also know that statistics have very little to do with one individuals outcome. What I can tell you is that I am stage 3a with a mitiotic rate of 16 (wow!). Good news is I am now past my 2 year anniversary with no evidence of cancer!
I hope that helps ease you mind a little!
Mary
Stage 3
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- May 20, 2012 at 6:46 pm
I cannot answer all your well researched information. I am a numbers person and I know statistic, so I also know that statistics have very little to do with one individuals outcome. What I can tell you is that I am stage 3a with a mitiotic rate of 16 (wow!). Good news is I am now past my 2 year anniversary with no evidence of cancer!
I hope that helps ease you mind a little!
Mary
Stage 3
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- May 20, 2012 at 6:46 pm
I cannot answer all your well researched information. I am a numbers person and I know statistic, so I also know that statistics have very little to do with one individuals outcome. What I can tell you is that I am stage 3a with a mitiotic rate of 16 (wow!). Good news is I am now past my 2 year anniversary with no evidence of cancer!
I hope that helps ease you mind a little!
Mary
Stage 3
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