Staging Question

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  • Post
    • July 19, 2015 at 6:45 am
    Squash
    Participant

      Originally stage 2b two years ago.

      Recently melanoma found in scar tissue at excision site.

      PET scan done and came back no recurrent disease, no nodal involvment , no distant disease.

      Now does that mean I have moved to stage 3 or am i still stage 2b?

      And does that make my prognosis worse?

      To complicate matters the scar tissue is very thick and near nerves and blood vessels so I am wondering if they can get it all anyway when they do the excision. And if they cant what would be the usual procedure to get the remaining unresectable disease.

       

       

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    • Replies
        • July 19, 2015 at 6:26 pm
        CHD
        Participant

          You are still stage 2b.  Having a local recurrence, which is a recurrence of melanoma within the nearest lymph basins that has not spread to the lymph nodes, does not change your stage.  I had a local recurrence and was told it did not affect my prognosis, though it concerned me too.  I am sometimes curious whether other people have been told the same thing I have!  I am not certain what the procedure is if there were remaining disease, though I wonder if radiation to the area might be offered, but that is just speculation. 

            • July 20, 2015 at 6:48 am
            stars
            Participant

              I think it depends on the pathology and where the recurrence occurs not only in terms of distance from original site, but in which layer of skin eg superficial or deeper.

              I found this link but cannot comment on whether it is really current info:

               

              http://www.nccn.org/patients/guidelines/melanoma/files/assets/basic-html/page68.html

              • July 20, 2015 at 6:48 am
              stars
              Participant

                I think it depends on the pathology and where the recurrence occurs not only in terms of distance from original site, but in which layer of skin eg superficial or deeper.

                I found this link but cannot comment on whether it is really current info:

                 

                http://www.nccn.org/patients/guidelines/melanoma/files/assets/basic-html/page68.html

                • July 20, 2015 at 6:48 am
                stars
                Participant

                  I think it depends on the pathology and where the recurrence occurs not only in terms of distance from original site, but in which layer of skin eg superficial or deeper.

                  I found this link but cannot comment on whether it is really current info:

                   

                  http://www.nccn.org/patients/guidelines/melanoma/files/assets/basic-html/page68.html

                  • July 20, 2015 at 2:10 pm
                  CHD
                  Participant

                    Just wanted to clarify that I based my response on this poster saying her recurrence was on her primary's scar and there was still no nodal involvement.  My understanding is that would keep her at stage IIb, but this is because my own doctor told me that my recurrence did not change my staging for that same reason (close to primary, within lymph node basins, still no lymph node involvement).  I had the impression the depth of the recurrence did not change anything; but you are possibly right here because my recurrence was NOT deeper than my primary.  Possibly that advice only applied to me, in which case I apologize if my post was misleading.  At any rate, I'm just another patient and definitely agree she/he should defer to the doctor's opinion.  : ) The last thing I would want to do is mis-lead anyone about something so important.

                    • July 20, 2015 at 2:10 pm
                    CHD
                    Participant

                      Just wanted to clarify that I based my response on this poster saying her recurrence was on her primary's scar and there was still no nodal involvement.  My understanding is that would keep her at stage IIb, but this is because my own doctor told me that my recurrence did not change my staging for that same reason (close to primary, within lymph node basins, still no lymph node involvement).  I had the impression the depth of the recurrence did not change anything; but you are possibly right here because my recurrence was NOT deeper than my primary.  Possibly that advice only applied to me, in which case I apologize if my post was misleading.  At any rate, I'm just another patient and definitely agree she/he should defer to the doctor's opinion.  : ) The last thing I would want to do is mis-lead anyone about something so important.

                      • July 20, 2015 at 2:10 pm
                      CHD
                      Participant

                        Just wanted to clarify that I based my response on this poster saying her recurrence was on her primary's scar and there was still no nodal involvement.  My understanding is that would keep her at stage IIb, but this is because my own doctor told me that my recurrence did not change my staging for that same reason (close to primary, within lymph node basins, still no lymph node involvement).  I had the impression the depth of the recurrence did not change anything; but you are possibly right here because my recurrence was NOT deeper than my primary.  Possibly that advice only applied to me, in which case I apologize if my post was misleading.  At any rate, I'm just another patient and definitely agree she/he should defer to the doctor's opinion.  : ) The last thing I would want to do is mis-lead anyone about something so important.

                      • July 19, 2015 at 6:26 pm
                      CHD
                      Participant

                        You are still stage 2b.  Having a local recurrence, which is a recurrence of melanoma within the nearest lymph basins that has not spread to the lymph nodes, does not change your stage.  I had a local recurrence and was told it did not affect my prognosis, though it concerned me too.  I am sometimes curious whether other people have been told the same thing I have!  I am not certain what the procedure is if there were remaining disease, though I wonder if radiation to the area might be offered, but that is just speculation. 

                        • July 19, 2015 at 6:26 pm
                        CHD
                        Participant

                          You are still stage 2b.  Having a local recurrence, which is a recurrence of melanoma within the nearest lymph basins that has not spread to the lymph nodes, does not change your stage.  I had a local recurrence and was told it did not affect my prognosis, though it concerned me too.  I am sometimes curious whether other people have been told the same thing I have!  I am not certain what the procedure is if there were remaining disease, though I wonder if radiation to the area might be offered, but that is just speculation. 

                          • July 19, 2015 at 9:01 pm
                          Janner
                          Participant

                            Easy question to ask but It's not really easy to answer.  If it is truly considered a "local" recurrence, staging is probably the same.  But if it is "in transit", that might upstage you.  I've seen some definitions say within 2cm is local and further out is in transit.  But places/docs seem to have different ideas on this so I think it is open to interpretation.  I'd ask your doc his opinion.

                            • July 19, 2015 at 9:01 pm
                            Janner
                            Participant

                              Easy question to ask but It's not really easy to answer.  If it is truly considered a "local" recurrence, staging is probably the same.  But if it is "in transit", that might upstage you.  I've seen some definitions say within 2cm is local and further out is in transit.  But places/docs seem to have different ideas on this so I think it is open to interpretation.  I'd ask your doc his opinion.

                                • July 20, 2015 at 2:46 am
                                Squash
                                Participant

                                  Well the confusing thing is the PET scan  says no recurrent disease so I take that to mean it is not a recurrence but nonetheless there is melanoma in the scar tissue.

                                  • July 20, 2015 at 2:46 am
                                  Squash
                                  Participant

                                    Well the confusing thing is the PET scan  says no recurrent disease so I take that to mean it is not a recurrence but nonetheless there is melanoma in the scar tissue.

                                    • July 20, 2015 at 3:42 am
                                    Janner
                                    Participant

                                      PET scans have a minimum resolution of about 5mm.  So unless the recurrence is larger than that, it's unlikely to be shown.  That's one reason why PET scans aren't reliable to find new primaries either.  Obviously, a biopsy where tissue is analyzed at a cellular level is much preferable to a PET scan in this situation.

                                      • July 20, 2015 at 3:42 am
                                      Janner
                                      Participant

                                        PET scans have a minimum resolution of about 5mm.  So unless the recurrence is larger than that, it's unlikely to be shown.  That's one reason why PET scans aren't reliable to find new primaries either.  Obviously, a biopsy where tissue is analyzed at a cellular level is much preferable to a PET scan in this situation.

                                        • July 20, 2015 at 3:42 am
                                        Janner
                                        Participant

                                          PET scans have a minimum resolution of about 5mm.  So unless the recurrence is larger than that, it's unlikely to be shown.  That's one reason why PET scans aren't reliable to find new primaries either.  Obviously, a biopsy where tissue is analyzed at a cellular level is much preferable to a PET scan in this situation.

                                          • July 20, 2015 at 2:46 am
                                          Squash
                                          Participant

                                            Well the confusing thing is the PET scan  says no recurrent disease so I take that to mean it is not a recurrence but nonetheless there is melanoma in the scar tissue.

                                          • July 19, 2015 at 9:01 pm
                                          Janner
                                          Participant

                                            Easy question to ask but It's not really easy to answer.  If it is truly considered a "local" recurrence, staging is probably the same.  But if it is "in transit", that might upstage you.  I've seen some definitions say within 2cm is local and further out is in transit.  But places/docs seem to have different ideas on this so I think it is open to interpretation.  I'd ask your doc his opinion.

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