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natasha.
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- November 23, 2012 at 2:10 pm
Hi,
I'm new here – my wife is 38 weeks pregnant with our first child, and about 2 weeks ago was diagnosed with a melanoma lesion on her upper arm. The details of the pathology report are as follows:
Breslow depth – 1.1mm
Clarks level 4
Non-ulcerated
Mitotic rate – none identified
Spitzoid type, unaffected margins
Hi,
I'm new here – my wife is 38 weeks pregnant with our first child, and about 2 weeks ago was diagnosed with a melanoma lesion on her upper arm. The details of the pathology report are as follows:
Breslow depth – 1.1mm
Clarks level 4
Non-ulcerated
Mitotic rate – none identified
Spitzoid type, unaffected margins
She recently had a wide local exicision performed, and the results came back as all margins clear. She is scheduled to have a SNB done in about two weeks after the baby is born. Apparantely, the docs do not want to do it before due to the radioactive dye used. The other thing that confuses me is how the clarks level correlates to the breslow depth. Isn't the breslow depth, and level of invasion basically the same thing? I guess I'm confused because in the grand scheme of things, the depth doesn't seem extremely deep, but the clarks level would indicate that it is…..
Also – is mitotic rate of "none identified" mean that it is zero, or that they didn't check for that?
Can anyone tell me how worried we should realistically be about this? The doctor said "not to worry" and that she is at low risk for it having spread to her lymph nodes. He also added that some doctors might not ever do the SNB for her situation, but that most would simply as a "standard of care". I'm reading a lot of conflicting info – and it seems like every story I read concerning a breslow depth of over 1mm – has spread to the nodes. She has no swollen nodes or anything, but not sure if this matters or not…..thanks!
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- November 23, 2012 at 3:00 pm
Sorry you've joined us. Did the path report mention regression at all? Spitzoid I think is a different/unique type, Janner can probably add more about it.
It's confusing, isn't it? On the one hand you will hear this is a low risk lesion, you caught it on the early side, etc. . . but on the other hand you will also hear of stories where supposed "low risk" lesions years later ended up causing more problems. I don't say this to scare you, I say it because I'd want to know the truth about what this means. I was diagnosed a year and a half ago with a similar early stage lesion, and over the last year and a half I've read and researched and learned a lot. What I'd say it this is definitely a life-changing diagnosis, it's scary, and there is some % of these early "low risk" lesions that can go on to be more trouble later. So, it means we have to be vigilant and pay attention to our bodies and hope it works out in our favor. But, it is a big deal – I think sometimes it can tend to be underestimated or downplayed, but it is a major thing. I wouldn't freak out. The lesion is low risk., but it is bombshell news.
I'm not a doctor, but this is what I understand, others can correct me if I'm wrong: SNB should be done prior to the WLE to have real value. The WLE removes a lot of tissue. It may alter the drainage paths to the sentinel node. The "sentinel node" they find after the WLE might not be the same one they would have found before the WLE. The SNB and WLE are typically done in the same setting with the SNB first, followed by the WLE.
A negative sentinel node biopsy certainly is a good result and may give someone peace of mind. But, even that is not a guarantee – sometimes the cells have not traveled yet to the lymph nodes (or to different nodes), or sometimes they can travel in the blood, not in the nodes.
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- November 23, 2012 at 3:00 pm
Sorry you've joined us. Did the path report mention regression at all? Spitzoid I think is a different/unique type, Janner can probably add more about it.
It's confusing, isn't it? On the one hand you will hear this is a low risk lesion, you caught it on the early side, etc. . . but on the other hand you will also hear of stories where supposed "low risk" lesions years later ended up causing more problems. I don't say this to scare you, I say it because I'd want to know the truth about what this means. I was diagnosed a year and a half ago with a similar early stage lesion, and over the last year and a half I've read and researched and learned a lot. What I'd say it this is definitely a life-changing diagnosis, it's scary, and there is some % of these early "low risk" lesions that can go on to be more trouble later. So, it means we have to be vigilant and pay attention to our bodies and hope it works out in our favor. But, it is a big deal – I think sometimes it can tend to be underestimated or downplayed, but it is a major thing. I wouldn't freak out. The lesion is low risk., but it is bombshell news.
I'm not a doctor, but this is what I understand, others can correct me if I'm wrong: SNB should be done prior to the WLE to have real value. The WLE removes a lot of tissue. It may alter the drainage paths to the sentinel node. The "sentinel node" they find after the WLE might not be the same one they would have found before the WLE. The SNB and WLE are typically done in the same setting with the SNB first, followed by the WLE.
A negative sentinel node biopsy certainly is a good result and may give someone peace of mind. But, even that is not a guarantee – sometimes the cells have not traveled yet to the lymph nodes (or to different nodes), or sometimes they can travel in the blood, not in the nodes.
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- November 23, 2012 at 3:35 pm
Thanks – I didn't notice anything about regression. Would regression be considered good or bad? I can take a closer look at the path report and update….
We wanted to get the SNB done prior to the WLE, but it was impossible due to the timing and the baby. I think the doctors figured that the reward outweighed the risk of harming the baby with the radioactive dye.
You are right about the severity being downplayed. I think most people think that since it typically manifests itself a t first as "external", it can just be cut out and you are good to go. Thanks for the feedback!
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- November 23, 2012 at 3:35 pm
Thanks – I didn't notice anything about regression. Would regression be considered good or bad? I can take a closer look at the path report and update….
We wanted to get the SNB done prior to the WLE, but it was impossible due to the timing and the baby. I think the doctors figured that the reward outweighed the risk of harming the baby with the radioactive dye.
You are right about the severity being downplayed. I think most people think that since it typically manifests itself a t first as "external", it can just be cut out and you are good to go. Thanks for the feedback!
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- November 23, 2012 at 4:37 pm
Regression: An attribute that may be either absent or present in the radial growth phase (which is adjacent to the vertical growth phase). Regression is evidence of destruction (probably by immune factors) of some of the melanoma cells in the radial growth phase. Immunologically mediated regression of this sort is a weakly negative factor.It's something you don't want to see in the same sentence with "prominent" or "extensive" on a pathology report. Up until about ten years ago, extensive regression was thought to be a very ominous sign that indicates a lesion with greater potential for metastasis.For some reason, the issue is ignored by a lot of people who should be interested. It wasn't even taken into consideration when the 2009 staging criteria were being decided. No one really even agrees on how to measure it. I do know of one respectable study on the matter that has taken place in the last couple of years, but it only included lesions with a vertical growth phase. The conclusion was that lymphovascular invasion was more prevalent in lesions showing "complete regression" of the radial growth phase.
Some melanomas are completely erased by regression. Those are nearly guaranteed to metastasize.
This is the best study on regression I've seen. only vertical growth phase lesions are included." In complete regression melanoma cells are absent in the overlying epidermis; whereas in partial regression they are present in the epidermis.9 RGP regression is common, particularly in thin lesions. The incidence of regression in melanomas of all thicknesses has been estimated at about 10–35%, and as up to 58% in melanomas with thicknesses of <0.75 mm.3,18"
"RGP regression has been shown to be associated with an adverse clinical outcome, both in lesions without and with an adjacent VGP.9 The presence of complete regression in the RGP of lesions with VGP was associated with poorer survival in a prognostic model published by Clark et al.4 The extent of regression in thin melanomas also has been associated with poorer prognosis."
only extensive regression has shown to be prognostically significant, not focal regression -
- November 23, 2012 at 4:37 pm
Regression: An attribute that may be either absent or present in the radial growth phase (which is adjacent to the vertical growth phase). Regression is evidence of destruction (probably by immune factors) of some of the melanoma cells in the radial growth phase. Immunologically mediated regression of this sort is a weakly negative factor.It's something you don't want to see in the same sentence with "prominent" or "extensive" on a pathology report. Up until about ten years ago, extensive regression was thought to be a very ominous sign that indicates a lesion with greater potential for metastasis.For some reason, the issue is ignored by a lot of people who should be interested. It wasn't even taken into consideration when the 2009 staging criteria were being decided. No one really even agrees on how to measure it. I do know of one respectable study on the matter that has taken place in the last couple of years, but it only included lesions with a vertical growth phase. The conclusion was that lymphovascular invasion was more prevalent in lesions showing "complete regression" of the radial growth phase.
Some melanomas are completely erased by regression. Those are nearly guaranteed to metastasize.
This is the best study on regression I've seen. only vertical growth phase lesions are included." In complete regression melanoma cells are absent in the overlying epidermis; whereas in partial regression they are present in the epidermis.9 RGP regression is common, particularly in thin lesions. The incidence of regression in melanomas of all thicknesses has been estimated at about 10–35%, and as up to 58% in melanomas with thicknesses of <0.75 mm.3,18"
"RGP regression has been shown to be associated with an adverse clinical outcome, both in lesions without and with an adjacent VGP.9 The presence of complete regression in the RGP of lesions with VGP was associated with poorer survival in a prognostic model published by Clark et al.4 The extent of regression in thin melanomas also has been associated with poorer prognosis."
only extensive regression has shown to be prognostically significant, not focal regression -
- November 23, 2012 at 4:37 pm
Regression: An attribute that may be either absent or present in the radial growth phase (which is adjacent to the vertical growth phase). Regression is evidence of destruction (probably by immune factors) of some of the melanoma cells in the radial growth phase. Immunologically mediated regression of this sort is a weakly negative factor.It's something you don't want to see in the same sentence with "prominent" or "extensive" on a pathology report. Up until about ten years ago, extensive regression was thought to be a very ominous sign that indicates a lesion with greater potential for metastasis.For some reason, the issue is ignored by a lot of people who should be interested. It wasn't even taken into consideration when the 2009 staging criteria were being decided. No one really even agrees on how to measure it. I do know of one respectable study on the matter that has taken place in the last couple of years, but it only included lesions with a vertical growth phase. The conclusion was that lymphovascular invasion was more prevalent in lesions showing "complete regression" of the radial growth phase.
Some melanomas are completely erased by regression. Those are nearly guaranteed to metastasize.
This is the best study on regression I've seen. only vertical growth phase lesions are included." In complete regression melanoma cells are absent in the overlying epidermis; whereas in partial regression they are present in the epidermis.9 RGP regression is common, particularly in thin lesions. The incidence of regression in melanomas of all thicknesses has been estimated at about 10–35%, and as up to 58% in melanomas with thicknesses of <0.75 mm.3,18"
"RGP regression has been shown to be associated with an adverse clinical outcome, both in lesions without and with an adjacent VGP.9 The presence of complete regression in the RGP of lesions with VGP was associated with poorer survival in a prognostic model published by Clark et al.4 The extent of regression in thin melanomas also has been associated with poorer prognosis."
only extensive regression has shown to be prognostically significant, not focal regression -
- November 23, 2012 at 6:44 pm
Wow! What an emotional roller coaster you and your wife have been on! The wonderful event of the new baby and then the scary event of melanoma! Whew! If it's any consolation, I am sure that a month from now– once you have had time to get your heads around both events– your emotions will settle down and life will be more managable.
I think your doctors were probably right not to use a radioactive tracer in a pregnant woman. If, based on the path report, they thought that a SLN was really important, they could have just used a blue dye without radioactivity. Or even induced labor and then done the SNL/WLE. I've heard of that being done. But apparently, they didn't think the SLN was really necessary in your wife's case. I hope you are reassured by that.
However, doing the SNL after the WLE doesn't make sense to me. The lymph vessels going from the lesion to the nearest lymph nodes will have been completely disrupted by the WLE. It's possible that the doctors want to remove a lot of lymph nodes from the whole region around the lesion, but that's not a "sentinal node biopsy", it's a lymphectomy. You should probably get clarification about what they are proposing to do.
The real problems with melanoma happen when someone is diagnosed at Stage III or Stage IV from "out of the blue". That won't happen with your wife. Statistically, she will have no further trouble with melanoma. But even if any new tumors should develop at some future time, if she has regular dermatology check-ups and periodic CT or PET scans she will find them right away. Yes, early stage melanoma is worrisome but it's not a death sentence. Just have to resign yourselves to remaining vigilant.
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- November 23, 2012 at 6:44 pm
Wow! What an emotional roller coaster you and your wife have been on! The wonderful event of the new baby and then the scary event of melanoma! Whew! If it's any consolation, I am sure that a month from now– once you have had time to get your heads around both events– your emotions will settle down and life will be more managable.
I think your doctors were probably right not to use a radioactive tracer in a pregnant woman. If, based on the path report, they thought that a SLN was really important, they could have just used a blue dye without radioactivity. Or even induced labor and then done the SNL/WLE. I've heard of that being done. But apparently, they didn't think the SLN was really necessary in your wife's case. I hope you are reassured by that.
However, doing the SNL after the WLE doesn't make sense to me. The lymph vessels going from the lesion to the nearest lymph nodes will have been completely disrupted by the WLE. It's possible that the doctors want to remove a lot of lymph nodes from the whole region around the lesion, but that's not a "sentinal node biopsy", it's a lymphectomy. You should probably get clarification about what they are proposing to do.
The real problems with melanoma happen when someone is diagnosed at Stage III or Stage IV from "out of the blue". That won't happen with your wife. Statistically, she will have no further trouble with melanoma. But even if any new tumors should develop at some future time, if she has regular dermatology check-ups and periodic CT or PET scans she will find them right away. Yes, early stage melanoma is worrisome but it's not a death sentence. Just have to resign yourselves to remaining vigilant.
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- November 23, 2012 at 7:36 pm
Thanks for the informative response. From everything I've read on various sites – it seems like the common theme is that the SNB shouldn't be done after the WLE (although I have no experience/knowledge in this area, the rationale why not makes 100% sense to me).
Once the melanoma was diagnosed, the WLE was scheduled/happened so fast that we barely had any time to get 2nd opinions or clarification on the SNB being done afterwards. After reading these sites however – we did pose this question to the surgeon. Apparentely, they "didn't think it would be an issue", about the pathway disruption, and still are planning to do the SNB after my wife delivers. My take on it is……..yes, they may or may not get the "correct" node, but I suppose the fact that they'll be checking one of them is better than nothing right? And – they "might" get the correct one anyways.
I guess we should have gotten some 2nd opinions here. Unfortunately now however, since the WLE has been done and we can't change that, is there ANY secondary scans, blood tests, or biopsies that could help ensure that there is nothing in her lymph nodes?
Thanks again!
-
- November 23, 2012 at 7:36 pm
Thanks for the informative response. From everything I've read on various sites – it seems like the common theme is that the SNB shouldn't be done after the WLE (although I have no experience/knowledge in this area, the rationale why not makes 100% sense to me).
Once the melanoma was diagnosed, the WLE was scheduled/happened so fast that we barely had any time to get 2nd opinions or clarification on the SNB being done afterwards. After reading these sites however – we did pose this question to the surgeon. Apparentely, they "didn't think it would be an issue", about the pathway disruption, and still are planning to do the SNB after my wife delivers. My take on it is……..yes, they may or may not get the "correct" node, but I suppose the fact that they'll be checking one of them is better than nothing right? And – they "might" get the correct one anyways.
I guess we should have gotten some 2nd opinions here. Unfortunately now however, since the WLE has been done and we can't change that, is there ANY secondary scans, blood tests, or biopsies that could help ensure that there is nothing in her lymph nodes?
Thanks again!
-
- November 23, 2012 at 7:53 pm
Let me clarify my last post. What the surgeon said specifically was – she "could" have done the SNB during the pregnancy, but would rather not have due to the risk. At the time, my wife was 35 weeks pregnant…..and did not want to be induced. Additionally, she was diagnosed, and within 2 days the WLE was done – so needless to say we didn't argue too much about it or have much time to research this extensively.
When we posed the question of the drainage path being disrupted, she advised that it wouldn't be an issue because of the location of the lesion. With it being on my wifes upper arm…….she was confident that it was going to drain to the armpit area, so she wouldn't have a problem finding the correct lymph node.
Being that it's the upper arm – I could imagine it could drain to either the armpit, or neck areas, so I hope she is correct in her assumption. Unfortunately what's done is done in terms of the WLE………so I suppose biopsying any nodes at this point is better than none.
Thanks!
-
- November 23, 2012 at 7:53 pm
Let me clarify my last post. What the surgeon said specifically was – she "could" have done the SNB during the pregnancy, but would rather not have due to the risk. At the time, my wife was 35 weeks pregnant…..and did not want to be induced. Additionally, she was diagnosed, and within 2 days the WLE was done – so needless to say we didn't argue too much about it or have much time to research this extensively.
When we posed the question of the drainage path being disrupted, she advised that it wouldn't be an issue because of the location of the lesion. With it being on my wifes upper arm…….she was confident that it was going to drain to the armpit area, so she wouldn't have a problem finding the correct lymph node.
Being that it's the upper arm – I could imagine it could drain to either the armpit, or neck areas, so I hope she is correct in her assumption. Unfortunately what's done is done in terms of the WLE………so I suppose biopsying any nodes at this point is better than none.
Thanks!
-
- November 23, 2012 at 9:14 pm
I think your best bet would be to go to your nearest melanoma Center of Excellent and get a second opinion about the lymph node analysis. Once there, you will be able to get a lot more information about what to expect in the future, too.
My concern is about the after effects of a lymphectomy. A SNB is a small surgery where they only remove a few (4 of 5?) lymph nodes for testing. If one or more of those nodes are positive, they often go in again and do a much more extensive surgery to remove many more nodes (20 or 30?). Recovery from this lymphectomy is much more painful. Sometimes you need physical therapy to recover the complete use of your arm, and you could be plagued with lymphedema (swelling) for the rest of your life. This could make it very hard to care for a new baby or a toddler. Of course, if a node is positive on SNB, the after effects of lymphectomy are worth it. But to have a lymphectomy with no evidence of disease? I would get a second opinion first.
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- November 23, 2012 at 9:14 pm
I think your best bet would be to go to your nearest melanoma Center of Excellent and get a second opinion about the lymph node analysis. Once there, you will be able to get a lot more information about what to expect in the future, too.
My concern is about the after effects of a lymphectomy. A SNB is a small surgery where they only remove a few (4 of 5?) lymph nodes for testing. If one or more of those nodes are positive, they often go in again and do a much more extensive surgery to remove many more nodes (20 or 30?). Recovery from this lymphectomy is much more painful. Sometimes you need physical therapy to recover the complete use of your arm, and you could be plagued with lymphedema (swelling) for the rest of your life. This could make it very hard to care for a new baby or a toddler. Of course, if a node is positive on SNB, the after effects of lymphectomy are worth it. But to have a lymphectomy with no evidence of disease? I would get a second opinion first.
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- November 23, 2012 at 9:14 pm
I think your best bet would be to go to your nearest melanoma Center of Excellent and get a second opinion about the lymph node analysis. Once there, you will be able to get a lot more information about what to expect in the future, too.
My concern is about the after effects of a lymphectomy. A SNB is a small surgery where they only remove a few (4 of 5?) lymph nodes for testing. If one or more of those nodes are positive, they often go in again and do a much more extensive surgery to remove many more nodes (20 or 30?). Recovery from this lymphectomy is much more painful. Sometimes you need physical therapy to recover the complete use of your arm, and you could be plagued with lymphedema (swelling) for the rest of your life. This could make it very hard to care for a new baby or a toddler. Of course, if a node is positive on SNB, the after effects of lymphectomy are worth it. But to have a lymphectomy with no evidence of disease? I would get a second opinion first.
-
- November 23, 2012 at 7:53 pm
Let me clarify my last post. What the surgeon said specifically was – she "could" have done the SNB during the pregnancy, but would rather not have due to the risk. At the time, my wife was 35 weeks pregnant…..and did not want to be induced. Additionally, she was diagnosed, and within 2 days the WLE was done – so needless to say we didn't argue too much about it or have much time to research this extensively.
When we posed the question of the drainage path being disrupted, she advised that it wouldn't be an issue because of the location of the lesion. With it being on my wifes upper arm…….she was confident that it was going to drain to the armpit area, so she wouldn't have a problem finding the correct lymph node.
Being that it's the upper arm – I could imagine it could drain to either the armpit, or neck areas, so I hope she is correct in her assumption. Unfortunately what's done is done in terms of the WLE………so I suppose biopsying any nodes at this point is better than none.
Thanks!
-
- November 23, 2012 at 7:36 pm
Thanks for the informative response. From everything I've read on various sites – it seems like the common theme is that the SNB shouldn't be done after the WLE (although I have no experience/knowledge in this area, the rationale why not makes 100% sense to me).
Once the melanoma was diagnosed, the WLE was scheduled/happened so fast that we barely had any time to get 2nd opinions or clarification on the SNB being done afterwards. After reading these sites however – we did pose this question to the surgeon. Apparentely, they "didn't think it would be an issue", about the pathway disruption, and still are planning to do the SNB after my wife delivers. My take on it is……..yes, they may or may not get the "correct" node, but I suppose the fact that they'll be checking one of them is better than nothing right? And – they "might" get the correct one anyways.
I guess we should have gotten some 2nd opinions here. Unfortunately now however, since the WLE has been done and we can't change that, is there ANY secondary scans, blood tests, or biopsies that could help ensure that there is nothing in her lymph nodes?
Thanks again!
-
- November 24, 2012 at 3:12 am
If you think that metastatic disease has no cure, regardless, you should read more of the posts on this forum. There are a lot of people here who have been stage IV for many years– sometimes more than a decade. That may not be a cure, but it's pretty darn close.
And, yes, catching metastases early does have a big impact. There are people here who have one or two mets– perhaps in the liver or lung or groin– which can often be removed surgically or by SRS. Contrast that with my brother who got a stage IV diagnosis "out of the blue". The day he was diagnosed he already had 5 brain mets, countless lung mets, several along the intestines and one in the pancreas. No surgery or SRS for him!
Does surgically removing a single met "cure" the cancer? Maybe yes, maybe no. But surgically removing one or two mets does have a much better prognosis than does a widely disseminated cancer that can not be treated surgically. So I would say, yes, close monitoring and catching it early is a very good thing.
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- November 24, 2012 at 3:12 am
If you think that metastatic disease has no cure, regardless, you should read more of the posts on this forum. There are a lot of people here who have been stage IV for many years– sometimes more than a decade. That may not be a cure, but it's pretty darn close.
And, yes, catching metastases early does have a big impact. There are people here who have one or two mets– perhaps in the liver or lung or groin– which can often be removed surgically or by SRS. Contrast that with my brother who got a stage IV diagnosis "out of the blue". The day he was diagnosed he already had 5 brain mets, countless lung mets, several along the intestines and one in the pancreas. No surgery or SRS for him!
Does surgically removing a single met "cure" the cancer? Maybe yes, maybe no. But surgically removing one or two mets does have a much better prognosis than does a widely disseminated cancer that can not be treated surgically. So I would say, yes, close monitoring and catching it early is a very good thing.
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- November 24, 2012 at 3:12 am
If you think that metastatic disease has no cure, regardless, you should read more of the posts on this forum. There are a lot of people here who have been stage IV for many years– sometimes more than a decade. That may not be a cure, but it's pretty darn close.
And, yes, catching metastases early does have a big impact. There are people here who have one or two mets– perhaps in the liver or lung or groin– which can often be removed surgically or by SRS. Contrast that with my brother who got a stage IV diagnosis "out of the blue". The day he was diagnosed he already had 5 brain mets, countless lung mets, several along the intestines and one in the pancreas. No surgery or SRS for him!
Does surgically removing a single met "cure" the cancer? Maybe yes, maybe no. But surgically removing one or two mets does have a much better prognosis than does a widely disseminated cancer that can not be treated surgically. So I would say, yes, close monitoring and catching it early is a very good thing.
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- November 24, 2012 at 1:37 pm
By this logic, almost nobody diagnosed at an earlier stage should progress to a later stage of a bad outcome. . because they should be getting scanned, and catching anything early and taking care of it. But there are countless examples of early stage diagnosed people who go on to develop advanced disease with bad outcomes. I like your positivity and optimism, but I think it may be a bit unrealistic and misleading
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- November 24, 2012 at 1:37 pm
By this logic, almost nobody diagnosed at an earlier stage should progress to a later stage of a bad outcome. . because they should be getting scanned, and catching anything early and taking care of it. But there are countless examples of early stage diagnosed people who go on to develop advanced disease with bad outcomes. I like your positivity and optimism, but I think it may be a bit unrealistic and misleading
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- November 24, 2012 at 1:37 pm
By this logic, almost nobody diagnosed at an earlier stage should progress to a later stage of a bad outcome. . because they should be getting scanned, and catching anything early and taking care of it. But there are countless examples of early stage diagnosed people who go on to develop advanced disease with bad outcomes. I like your positivity and optimism, but I think it may be a bit unrealistic and misleading
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- November 24, 2012 at 2:11 pm
Countless examples? That isn't very scientific. Yes, there are people with early stage melanoma that progress. There are statistics BY STAGE for the percentages. This isn't countless. I think early stagers who visit these boards think almost everyone progresses — because few early stagers stick around to give perspective to this site. There is no reason not to be optomistic when diagnosed at an early stage. Living your life thinking you will be one who will progress is no way to live. Give melanoma the respect it deserve, but LIVE LIFE! Early stagers should be optomistic, but vigilant. There are no guarantees with life in general.
At the moment, I pay little attention to survival statistics, however. In the last two years, there have been breakthrough treatments for advanced stage melanoma and other treatments in clinical trials showing great promise. Any survival statistics are by definition, out of date because they don't reflect treatment options available today.
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- November 24, 2012 at 2:11 pm
Countless examples? That isn't very scientific. Yes, there are people with early stage melanoma that progress. There are statistics BY STAGE for the percentages. This isn't countless. I think early stagers who visit these boards think almost everyone progresses — because few early stagers stick around to give perspective to this site. There is no reason not to be optomistic when diagnosed at an early stage. Living your life thinking you will be one who will progress is no way to live. Give melanoma the respect it deserve, but LIVE LIFE! Early stagers should be optomistic, but vigilant. There are no guarantees with life in general.
At the moment, I pay little attention to survival statistics, however. In the last two years, there have been breakthrough treatments for advanced stage melanoma and other treatments in clinical trials showing great promise. Any survival statistics are by definition, out of date because they don't reflect treatment options available today.
-
- November 24, 2012 at 2:11 pm
Countless examples? That isn't very scientific. Yes, there are people with early stage melanoma that progress. There are statistics BY STAGE for the percentages. This isn't countless. I think early stagers who visit these boards think almost everyone progresses — because few early stagers stick around to give perspective to this site. There is no reason not to be optomistic when diagnosed at an early stage. Living your life thinking you will be one who will progress is no way to live. Give melanoma the respect it deserve, but LIVE LIFE! Early stagers should be optomistic, but vigilant. There are no guarantees with life in general.
At the moment, I pay little attention to survival statistics, however. In the last two years, there have been breakthrough treatments for advanced stage melanoma and other treatments in clinical trials showing great promise. Any survival statistics are by definition, out of date because they don't reflect treatment options available today.
-
- November 23, 2012 at 6:44 pm
Wow! What an emotional roller coaster you and your wife have been on! The wonderful event of the new baby and then the scary event of melanoma! Whew! If it's any consolation, I am sure that a month from now– once you have had time to get your heads around both events– your emotions will settle down and life will be more managable.
I think your doctors were probably right not to use a radioactive tracer in a pregnant woman. If, based on the path report, they thought that a SLN was really important, they could have just used a blue dye without radioactivity. Or even induced labor and then done the SNL/WLE. I've heard of that being done. But apparently, they didn't think the SLN was really necessary in your wife's case. I hope you are reassured by that.
However, doing the SNL after the WLE doesn't make sense to me. The lymph vessels going from the lesion to the nearest lymph nodes will have been completely disrupted by the WLE. It's possible that the doctors want to remove a lot of lymph nodes from the whole region around the lesion, but that's not a "sentinal node biopsy", it's a lymphectomy. You should probably get clarification about what they are proposing to do.
The real problems with melanoma happen when someone is diagnosed at Stage III or Stage IV from "out of the blue". That won't happen with your wife. Statistically, she will have no further trouble with melanoma. But even if any new tumors should develop at some future time, if she has regular dermatology check-ups and periodic CT or PET scans she will find them right away. Yes, early stage melanoma is worrisome but it's not a death sentence. Just have to resign yourselves to remaining vigilant.
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- November 23, 2012 at 3:35 pm
Thanks – I didn't notice anything about regression. Would regression be considered good or bad? I can take a closer look at the path report and update….
We wanted to get the SNB done prior to the WLE, but it was impossible due to the timing and the baby. I think the doctors figured that the reward outweighed the risk of harming the baby with the radioactive dye.
You are right about the severity being downplayed. I think most people think that since it typically manifests itself a t first as "external", it can just be cut out and you are good to go. Thanks for the feedback!
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- November 23, 2012 at 3:00 pm
Sorry you've joined us. Did the path report mention regression at all? Spitzoid I think is a different/unique type, Janner can probably add more about it.
It's confusing, isn't it? On the one hand you will hear this is a low risk lesion, you caught it on the early side, etc. . . but on the other hand you will also hear of stories where supposed "low risk" lesions years later ended up causing more problems. I don't say this to scare you, I say it because I'd want to know the truth about what this means. I was diagnosed a year and a half ago with a similar early stage lesion, and over the last year and a half I've read and researched and learned a lot. What I'd say it this is definitely a life-changing diagnosis, it's scary, and there is some % of these early "low risk" lesions that can go on to be more trouble later. So, it means we have to be vigilant and pay attention to our bodies and hope it works out in our favor. But, it is a big deal – I think sometimes it can tend to be underestimated or downplayed, but it is a major thing. I wouldn't freak out. The lesion is low risk., but it is bombshell news.
I'm not a doctor, but this is what I understand, others can correct me if I'm wrong: SNB should be done prior to the WLE to have real value. The WLE removes a lot of tissue. It may alter the drainage paths to the sentinel node. The "sentinel node" they find after the WLE might not be the same one they would have found before the WLE. The SNB and WLE are typically done in the same setting with the SNB first, followed by the WLE.
A negative sentinel node biopsy certainly is a good result and may give someone peace of mind. But, even that is not a guarantee – sometimes the cells have not traveled yet to the lymph nodes (or to different nodes), or sometimes they can travel in the blood, not in the nodes.
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- November 23, 2012 at 3:24 pm
Mitotic rate of "none identified" should be essentially the same as zero. Sometimes they might say "none identified" or <1 to cover themselves in case they miss a mitotic figure and someone on a 2nd opinion finds one.
Breslow is the most important factor (depth). Clarks level is not used as much any more. But basically you can have the melanoma on a different part of the body with thicker or thinner skin, etc. . so that the same depth in one place might be Clark III while in another place could be Clark IV. But, depth is the #1 factor to pay attention to, not so much Clark.
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- November 23, 2012 at 3:24 pm
Mitotic rate of "none identified" should be essentially the same as zero. Sometimes they might say "none identified" or <1 to cover themselves in case they miss a mitotic figure and someone on a 2nd opinion finds one.
Breslow is the most important factor (depth). Clarks level is not used as much any more. But basically you can have the melanoma on a different part of the body with thicker or thinner skin, etc. . so that the same depth in one place might be Clark III while in another place could be Clark IV. But, depth is the #1 factor to pay attention to, not so much Clark.
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- November 23, 2012 at 3:24 pm
Mitotic rate of "none identified" should be essentially the same as zero. Sometimes they might say "none identified" or <1 to cover themselves in case they miss a mitotic figure and someone on a 2nd opinion finds one.
Breslow is the most important factor (depth). Clarks level is not used as much any more. But basically you can have the melanoma on a different part of the body with thicker or thinner skin, etc. . so that the same depth in one place might be Clark III while in another place could be Clark IV. But, depth is the #1 factor to pay attention to, not so much Clark.
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- November 25, 2012 at 6:50 pm
Hi,
I am so sorry you guys are going through this. I first spotted my mole while pregnant as well. Unlike your wife I waited until 4 months after I delivered to have it checked out. Stupid I know but at the time I really did not think about it. It was 1.0 mm and clarks level 4 partial regression and no mitoses. This put me at a stage 2. They did the WLE and the SNB at the same time for me. All came back clear which was great news! Now I am seeing an oncologist and he is recommending I go on Interferon treatments for a year. This week I will be seeing a Melanoma specialist to get a second opinion. I am also scheduled for a PET scan this week. I am praying for good news.
On a side note it seems that pregnancy and Melanoma have some link…
I know how scary this is. My baby is 6 month old now and it seems so unfair. Please keep us posted on how she is doing and when your child is born.
Amanda
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- November 25, 2012 at 6:50 pm
Hi,
I am so sorry you guys are going through this. I first spotted my mole while pregnant as well. Unlike your wife I waited until 4 months after I delivered to have it checked out. Stupid I know but at the time I really did not think about it. It was 1.0 mm and clarks level 4 partial regression and no mitoses. This put me at a stage 2. They did the WLE and the SNB at the same time for me. All came back clear which was great news! Now I am seeing an oncologist and he is recommending I go on Interferon treatments for a year. This week I will be seeing a Melanoma specialist to get a second opinion. I am also scheduled for a PET scan this week. I am praying for good news.
On a side note it seems that pregnancy and Melanoma have some link…
I know how scary this is. My baby is 6 month old now and it seems so unfair. Please keep us posted on how she is doing and when your child is born.
Amanda
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- November 25, 2012 at 6:50 pm
Hi,
I am so sorry you guys are going through this. I first spotted my mole while pregnant as well. Unlike your wife I waited until 4 months after I delivered to have it checked out. Stupid I know but at the time I really did not think about it. It was 1.0 mm and clarks level 4 partial regression and no mitoses. This put me at a stage 2. They did the WLE and the SNB at the same time for me. All came back clear which was great news! Now I am seeing an oncologist and he is recommending I go on Interferon treatments for a year. This week I will be seeing a Melanoma specialist to get a second opinion. I am also scheduled for a PET scan this week. I am praying for good news.
On a side note it seems that pregnancy and Melanoma have some link…
I know how scary this is. My baby is 6 month old now and it seems so unfair. Please keep us posted on how she is doing and when your child is born.
Amanda
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- November 25, 2012 at 6:51 pm
Hi,
I am so sorry you guys are going through this. I first spotted my mole while pregnant as well. Unlike your wife I waited until 4 months after I delivered to have it checked out. Stupid I know but at the time I really did not think about it. It was 1.0 mm and clarks level 4 partial regression and no mitoses. This put me at a stage 2. They did the WLE and the SNB at the same time for me. All came back clear which was great news! Now I am seeing an oncologist and he is recommending I go on Interferon treatments for a year. This week I will be seeing a Melanoma specialist to get a second opinion. I am also scheduled for a PET scan this week. I am praying for good news.
On a side note it seems that pregnancy and Melanoma have some link…
I know how scary this is. My baby is 6 month old now and it seems so unfair. Please keep us posted on how she is doing and when your child is born.
Amanda
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- December 2, 2012 at 11:03 pm
Pregnancy and melanoma havvve a link .
Doctors still don't want to recognize it. But a lot of women can proof it. I had melanoma during IVF – I had pregnancy hormones injected and got pregnant – it is not reccomended to become pregnant during next 5 years for me now.
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- December 2, 2012 at 11:03 pm
Pregnancy and melanoma havvve a link .
Doctors still don't want to recognize it. But a lot of women can proof it. I had melanoma during IVF – I had pregnancy hormones injected and got pregnant – it is not reccomended to become pregnant during next 5 years for me now.
-
- December 2, 2012 at 11:03 pm
Pregnancy and melanoma havvve a link .
Doctors still don't want to recognize it. But a lot of women can proof it. I had melanoma during IVF – I had pregnancy hormones injected and got pregnant – it is not reccomended to become pregnant during next 5 years for me now.
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- November 25, 2012 at 6:51 pm
Hi,
I am so sorry you guys are going through this. I first spotted my mole while pregnant as well. Unlike your wife I waited until 4 months after I delivered to have it checked out. Stupid I know but at the time I really did not think about it. It was 1.0 mm and clarks level 4 partial regression and no mitoses. This put me at a stage 2. They did the WLE and the SNB at the same time for me. All came back clear which was great news! Now I am seeing an oncologist and he is recommending I go on Interferon treatments for a year. This week I will be seeing a Melanoma specialist to get a second opinion. I am also scheduled for a PET scan this week. I am praying for good news.
On a side note it seems that pregnancy and Melanoma have some link…
I know how scary this is. My baby is 6 month old now and it seems so unfair. Please keep us posted on how she is doing and when your child is born.
Amanda
-
- November 25, 2012 at 6:51 pm
Hi,
I am so sorry you guys are going through this. I first spotted my mole while pregnant as well. Unlike your wife I waited until 4 months after I delivered to have it checked out. Stupid I know but at the time I really did not think about it. It was 1.0 mm and clarks level 4 partial regression and no mitoses. This put me at a stage 2. They did the WLE and the SNB at the same time for me. All came back clear which was great news! Now I am seeing an oncologist and he is recommending I go on Interferon treatments for a year. This week I will be seeing a Melanoma specialist to get a second opinion. I am also scheduled for a PET scan this week. I am praying for good news.
On a side note it seems that pregnancy and Melanoma have some link…
I know how scary this is. My baby is 6 month old now and it seems so unfair. Please keep us posted on how she is doing and when your child is born.
Amanda
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