Location: Melanoma

Discussion: Malignant Melanoma Biopsy & Confusion

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Anonymous		 Malignant Melanoma Biopsy & Confusion
May 6 2006, 11:50 AM EDT
Here is what the biopsy report says, the proceeding has comments...

Diagnosis

Mid Back-Malignant Melenoma, Approx 3.0 CM in
thickness W/gross measurements greater than 1 CM with
histologic measurement

Note

This represents a quite large pedunculated malignant
melanoma in wich there is evidence of histologic
satellite metastasis. The lesion is classified as a
Clarks's level IV as the reticular dermis is involved.
There is evidence of ulceration as well.
45x35x35 MM R/O Malignant Melenoma

Gross Description
Brown, Gray and tan polypoid rubbery tissue mass which
measures 45x35x35 mm. There is an attached portion of
stalk which measures 15x15x3. The epideral surface of
the polypoid tissue is extensively brown, gray,
ulcerated and macerated. All resection margins have
been inked blue. Serial softened sections through the
specimen reveal extensive areas of brown/gray softened
tissue separated by zones of gray/white rubbery
tissue. The largest area of brown softened tissue
measures approximately 3.0 CM from the epidurmal
surface to w/in 0.5 cm of the stalk reaction margin.
Representative sections are submitted as follows: 1-
base of attached stalk submitted en face, II-VIII
representative sections.

Microscopic Description
There is a broad asymmetrical poorly circumscribed
melanocytic neoplasm with numeruos atypical
melancocytes present sheets throughout the dermis. The
lesion had a polypoid morphology which extended far
above the base of the skin, there are several small
nodular aggregates that are distinct from the main
bulk of the neoplasm that represent histologic
satellitosis.

Based on this biopsy report, what are the chances that this condition is limited to the affected mole and the risk was removed with the mole. My Dermatologist insists that this condition is "life threatening, while the Doc at the VA shows no sign of urgency.

Please advise

Mike 6  out of 6 found this valuable. Do you?    
Louise
Louise		 RE: Malignant Melanoma Biopsy & Confusion
May 7 2006, 12:10 PM EDT
Mike, I am not a doctor or pathologist, so I can't really advise. What I can say, however, is that the classification of Clark's level IV indicates that there is invasion of the deep dermis, which is more significant than if the mole was only on the surface of the skin.

You need to ask why your dermatologist feels this is life-threatening -- he may be worried that there is metastasis to other organs, or that not all the cancer was removed, or he could be worried about the grade of the cancer -- and why the doctor at the VA is not concerned. If you can get a third or fourth opinion, this will also help. Ask about your treatment options and if further surgery is necessary. Also ask about how you should be monitered now, and if there are any diagnostic tests which can be performed to see if this cancer has metastasized to other parts of the body.

Good luck with everything Mike, and please update if you are able. I am curious about why you've been given two very different prognoses.

Louise, wikiCancer mdoerator 1  out of 1 found this valuable. Do you?    

Anonymous		 RE: Malignant Melanoma Biopsy & Confusion
May 7 2006, 3:22 PM EDT
"Mike, I am not a doctor or pathologist, so I can't really advise. What I can say, however, is that the classification of Clark's level IV indicates that there is invasion of the deep dermis, which is more significant than if the mole was only on the surface of the skin.

You need to ask why your dermatologist feels this is life-threatening -- he may be worried that there is metastasis to other organs, or that not all the cancer was removed, or he could be worried about the grade of the cancer -- and why the doctor at the VA is not concerned. If you can get a third or fourth opinion, this will also help. Ask about your treatment options and if further surgery is necessary. Also ask about how you should be monitered now, and if there are any diagnostic tests which can be performed to see if this cancer has metastasized to other parts of the body.

Good luck with everything Mike, and please update if you are able. I am curious about why you've been given two very different prognoses.

Louise, wikiCancer mdoerator"
Thanks for the response Louise

Good things come to those who wait...this metaphor must have been conceived at the VA.

In no way do I mean to bash the VA. They do provide a great service; unfortunately, it just takes a long wait to get into the cycle of care.

I do favor the opinion of the dermatologist over the observation of the PA at the VA (specialist vs. general knowledge). I finally got a call to confirm an appointment with the surgical oncologist for this Wednesday, so I hope to have direction from this appointment. I suppose I am holding to hope that the cancer was removed the first time. Clark level IV is no laughing matter, but all things are possible.

Thanks again for your response!

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Louise
Louise		 RE: Malignant Melanoma Biopsy & Confusion
May 8 2006, 1:55 PM EDT
"Thanks for the response Louise

Good things come to those who wait...this metaphor must have been conceived at the VA.

In no way do I mean to bash the VA. They do provide a great service; unfortunately, it just takes a long wait to get into the cycle of care.

I do favor the opinion of the dermatologist over the observation of the PA at the VA (specialist vs. general knowledge). I finally got a call to confirm an appointment with the surgical oncologist for this Wednesday, so I hope to have direction from this appointment. I suppose I am holding to hope that the cancer was removed the first time. Clark level IV is no laughing matter, but all things are possible.

Thanks again for your response!

Mike"
Certainly I would want to err on the side of caution in this matter. It's better to be wary than overconfident. Best of luck, and I hope the VA pushes you through quickly. 1  out of 1 found this valuable. Do you?    

Anonymous		 RE: Malignant Melanoma Biopsy & Confusion
May 18 2006, 11:36 PM EDT
"Certainly I would want to err on the side of caution in this matter. It's better to be wary than overconfident. Best of luck, and I hope the VA pushes you through quickly."
UPdate

Im in a mess whith the process. I had my appointment with the VA and it was uneventful. They were great at scheduling CT & PET scans in 1 week spans.

Getting parinoid, I went on a journey to seek a second opinion. A local melanoma specialist indicated that protocal states that surgery is a must and should be done yesterday. The scans results notwithstanding. The scans will help determine the extent of damage control; however, the urgency having the known area removed is "Damn important"

Interesting opinion that supports Dr. Dermatologists direction.

I relayed this information to the VA Surgeon who dissagreeded. His opinion was that if mets were appatent in the scans, the course of action was to decline any surgery and begin chemo.

Oh brother! Now what! Local specialist: 2 VA: 1...

Any comments? What is protocol in the situation?

Mike Do you find this valuable?    

Anonymous		 RE: Malignant Melanoma Biopsy & Confusion
May 27 2006, 9:06 PM EDT
"UPdate

Im in a mess whith the process. I had my appointment with the VA and it was uneventful. They were great at scheduling CT & PET scans in 1 week spans.

Getting parinoid, I went on a journey to seek a second opinion. A local melanoma specialist indicated that protocal states that surgery is a must and should be done yesterday. The scans results notwithstanding. The scans will help determine the extent of damage control; however, the urgency having the known area removed is "Damn important"

Interesting opinion that supports Dr. Dermatologists direction.

I relayed this information to the VA Surgeon who dissagreeded. His opinion was that if mets were appatent in the scans, the course of action was to decline any surgery and begin chemo.

Oh brother! Now what! Local specialist: 2 VA: 1...

Any comments? What is protocol in the situation?

Mike"
Mike, I have had 2 stage 0 melanomas removed in the last 1 year. All that I know is the plastic surgeon I go to is very conservative and states this is very important to keep following every 4 months or sooner if any moles change..He then tells me that if I ever have one that is a stage one or more I would be having a full body scan and removal and biopsy of the nearest lymph nodes.

I personaly would not go back to the VA and go where someone knows what they are doing. I have done a lot of research on melanoma and have discussed concerns with my Dr. and the Dr. I work for. My advise would be to contact M.D. Anderson and get their opinion. I pray everything works well for you.
P.S. I believe you can get a consult on line with M.D. Anderson, or at least tell them your story and get their opinion on what to do.

Best of luck,
Sarah 1  out of 1 found this valuable. Do you?    

Anonymous		 RE: Malignant Melanoma Biopsy & Confusion
May 28 2006, 9:44 PM EDT
"Mike, I have had 2 stage 0 melanomas removed in the last 1 year. All that I know is the plastic surgeon I go to is very conservative and states this is very important to keep following every 4 months or sooner if any moles change..He then tells me that if I ever have one that is a stage one or more I would be having a full body scan and removal and biopsy of the nearest lymph nodes.

I personaly would not go back to the VA and go where someone knows what they are doing. I have done a lot of research on melanoma and have discussed concerns with my Dr. and the Dr. I work for. My advise would be to contact M.D. Anderson and get their opinion. I pray everything works well for you.
P.S. I believe you can get a consult on line with M.D. Anderson, or at least tell them your story and get their opinion on what to do.

Best of luck,
Sarah"
Well, I finally had surgery... I had a large excision of the general area, a lump removed, and the lymp node from under my left arm pit removed. The scans (PET/CT) show tyroid involvement also. So, we'll have to wait and see what will happen next. One boo-boo at a time.

I decided againt the VA for several reasons and had the surgery done by a melanoma specialist. 2  out of 2 found this valuable. Do you?    

Anonymous		 RE: Malignant Melanoma Biopsy & Confusion
Feb 15 2008, 2:56 AM EST
Mike, I agree and wouldnt go to the VA,, Id choose a specialist... you get but 1 life....
Is there any sight that has more MM survivors who keep in touch? 1  out of 1 found this valuable. Do you?    
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