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- This topic has 12 replies, 3 voices, and was last updated 9 years, 3 months ago by
the scared wife.
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- November 27, 2016 at 2:15 pm
I've been lurking on here since 2013 when my husband was first diagnosed. The possibility that he has a recurrence has finally prompted me to post and my username says it all.
He originally had melanoma on his scalp. He had 1 positive lymph node. He had surgeries and was in a drug trial. He has been NED since late 2013.
He now has an area on his forehead. He had had it for probably 7 or 8 months and it was only skin coloured. The oncologist and the dermatologist both saw it when it was first noticed and thought it was an sk. Within the last month or so it has turned brown and looks like it is starting to ulcerate (not sure if right word – it does have a little bump in it similar to the many that were in his original area). We saw his oncologist last week and when we were saying it had turned colour she said that sk's can do that but when she looked at it she said that it was not an sk and he needed to get it biopsied. He is now booked to see the dermatologist on Tuesday.
I know I should know this, but what do they do to biopsy it? I ask because I'm not sure that things were done the right way at this point the first time so I need to know what is the proper way to determine if this is a recurrence. I want to be prepared for this appointment.
I'm sorry if this doesn't make sense. I'm just very worried…..
Thanks
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- November 27, 2016 at 8:42 pm
Hi,
The preferred form of biopsy is usually an incisional biopsy where they cut out the whole of the lesion. This makes it easier to properly assess the size and depth of the lesion if it were to be melanoma. The skin sample is then sent to the pathologist for staining testing and examination.
The difficulty here is that the lesion is on your husbands forehead where the skin may not be so deep as on the thigh and it might be more difficult to close the incision as sometimes skin grafts can be needed on the face. The surgeon/ dermatologist will inspect and decide what is best partially based on your history and a visual inspection. Sometime they opt for a punch biopsy but this makes the staging less accurate if you can't measure depth and size. A punch biopsy tkesa core of skin from the suspect area of the lesion.
It might be an idea to take photos of the lesion so you have a record of it if you go to other docs later.
There are some treatments that could be injected into the lesion etc but first things first- if it looks like melanoma and can be cut out easily – that seem to be the thing to do… but if tricky then maybe the smaller biopsy and on the basis of results decide what to do next.
Best of luck
Deb
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- November 28, 2016 at 1:12 am
How big is it? Punch biopsy is my preference – especially on the face. Punches get a full skin thickness so are good in staging, but they be close on the edges. Some derms like to do shave biopsies and shave biopsies are the ones that can lose staging information if they don't go deep enough. The last thing you want to do is bisect a lesion. The thing is, let's say this is melanoma. (Hopefully not, but let's go there for now). It is possible that it is a new occurrence of melanoma unrelated to the other – a new primary. So the first thing you want determined is if this is a suspected in-transit / sub-q / recurrence versus is this a new primary. New primaries are dealt with independenly of current staging – that is they would biopsy and do a WLE and possibly a SNB if it were to drain to a different area than his first primary. If this were a type of recurrence, you'd probably be doing more evaluation.
Typically, a pathology doc can determine if this is a metastasis versus a new primary. In the most simplest terms, a new primary starts on the top of the skin and grows downward toward the blood and lymph vessels. In a recurrence, the melanoma got there from one of those vessels and may (or may not) grow upwards toward the top layer of skin. So the pathologist will look at growth patterns to see if this is a new primary versus met. In some cases, the pathologist cannot make a clear determination but that is quite rare. If this were to be a new primary, it wouldn't change staging. You are the staging of your worst primary. Since he is already stage III, this wouldn't change that.
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- November 29, 2016 at 11:20 am
Thank you Janner for the info. The area is about 1/4 of an inch across.
I'm praying that it is nothing but until we know for sure my mind has gone in soooo many directions. This appointment can't come soon enough but also it is coming too fast – if you know what I mean…
Again, thanks for the replies!
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- November 29, 2016 at 11:20 am
Thank you Janner for the info. The area is about 1/4 of an inch across.
I'm praying that it is nothing but until we know for sure my mind has gone in soooo many directions. This appointment can't come soon enough but also it is coming too fast – if you know what I mean…
Again, thanks for the replies!
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- November 29, 2016 at 11:20 am
Thank you Janner for the info. The area is about 1/4 of an inch across.
I'm praying that it is nothing but until we know for sure my mind has gone in soooo many directions. This appointment can't come soon enough but also it is coming too fast – if you know what I mean…
Again, thanks for the replies!
-
- November 28, 2016 at 1:12 am
How big is it? Punch biopsy is my preference – especially on the face. Punches get a full skin thickness so are good in staging, but they be close on the edges. Some derms like to do shave biopsies and shave biopsies are the ones that can lose staging information if they don't go deep enough. The last thing you want to do is bisect a lesion. The thing is, let's say this is melanoma. (Hopefully not, but let's go there for now). It is possible that it is a new occurrence of melanoma unrelated to the other – a new primary. So the first thing you want determined is if this is a suspected in-transit / sub-q / recurrence versus is this a new primary. New primaries are dealt with independenly of current staging – that is they would biopsy and do a WLE and possibly a SNB if it were to drain to a different area than his first primary. If this were a type of recurrence, you'd probably be doing more evaluation.
Typically, a pathology doc can determine if this is a metastasis versus a new primary. In the most simplest terms, a new primary starts on the top of the skin and grows downward toward the blood and lymph vessels. In a recurrence, the melanoma got there from one of those vessels and may (or may not) grow upwards toward the top layer of skin. So the pathologist will look at growth patterns to see if this is a new primary versus met. In some cases, the pathologist cannot make a clear determination but that is quite rare. If this were to be a new primary, it wouldn't change staging. You are the staging of your worst primary. Since he is already stage III, this wouldn't change that.
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- November 28, 2016 at 1:12 am
How big is it? Punch biopsy is my preference – especially on the face. Punches get a full skin thickness so are good in staging, but they be close on the edges. Some derms like to do shave biopsies and shave biopsies are the ones that can lose staging information if they don't go deep enough. The last thing you want to do is bisect a lesion. The thing is, let's say this is melanoma. (Hopefully not, but let's go there for now). It is possible that it is a new occurrence of melanoma unrelated to the other – a new primary. So the first thing you want determined is if this is a suspected in-transit / sub-q / recurrence versus is this a new primary. New primaries are dealt with independenly of current staging – that is they would biopsy and do a WLE and possibly a SNB if it were to drain to a different area than his first primary. If this were a type of recurrence, you'd probably be doing more evaluation.
Typically, a pathology doc can determine if this is a metastasis versus a new primary. In the most simplest terms, a new primary starts on the top of the skin and grows downward toward the blood and lymph vessels. In a recurrence, the melanoma got there from one of those vessels and may (or may not) grow upwards toward the top layer of skin. So the pathologist will look at growth patterns to see if this is a new primary versus met. In some cases, the pathologist cannot make a clear determination but that is quite rare. If this were to be a new primary, it wouldn't change staging. You are the staging of your worst primary. Since he is already stage III, this wouldn't change that.
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- November 29, 2016 at 11:06 am
Thank you so much for replying! Today is the day. Fingers crossed.
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- November 29, 2016 at 11:06 am
Thank you so much for replying! Today is the day. Fingers crossed.
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- November 29, 2016 at 11:06 am
Thank you so much for replying! Today is the day. Fingers crossed.
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- November 27, 2016 at 8:42 pm
Hi,
The preferred form of biopsy is usually an incisional biopsy where they cut out the whole of the lesion. This makes it easier to properly assess the size and depth of the lesion if it were to be melanoma. The skin sample is then sent to the pathologist for staining testing and examination.
The difficulty here is that the lesion is on your husbands forehead where the skin may not be so deep as on the thigh and it might be more difficult to close the incision as sometimes skin grafts can be needed on the face. The surgeon/ dermatologist will inspect and decide what is best partially based on your history and a visual inspection. Sometime they opt for a punch biopsy but this makes the staging less accurate if you can't measure depth and size. A punch biopsy tkesa core of skin from the suspect area of the lesion.
It might be an idea to take photos of the lesion so you have a record of it if you go to other docs later.
There are some treatments that could be injected into the lesion etc but first things first- if it looks like melanoma and can be cut out easily – that seem to be the thing to do… but if tricky then maybe the smaller biopsy and on the basis of results decide what to do next.
Best of luck
Deb
-
- November 27, 2016 at 8:42 pm
Hi,
The preferred form of biopsy is usually an incisional biopsy where they cut out the whole of the lesion. This makes it easier to properly assess the size and depth of the lesion if it were to be melanoma. The skin sample is then sent to the pathologist for staining testing and examination.
The difficulty here is that the lesion is on your husbands forehead where the skin may not be so deep as on the thigh and it might be more difficult to close the incision as sometimes skin grafts can be needed on the face. The surgeon/ dermatologist will inspect and decide what is best partially based on your history and a visual inspection. Sometime they opt for a punch biopsy but this makes the staging less accurate if you can't measure depth and size. A punch biopsy tkesa core of skin from the suspect area of the lesion.
It might be an idea to take photos of the lesion so you have a record of it if you go to other docs later.
There are some treatments that could be injected into the lesion etc but first things first- if it looks like melanoma and can be cut out easily – that seem to be the thing to do… but if tricky then maybe the smaller biopsy and on the basis of results decide what to do next.
Best of luck
Deb
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