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Help requested to prep for surgical oncology consult (ulceration /mitosis/treatment options)

Help requested to prep for surgical oncology consult (ulceration /mitosis/treatment options)

Posted By
3/12/2019 6:37pm
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Replies: 5

Hi all:

This is my first post in this group.  I was diagnosed on 3/7/19 with invasive malignant melanoma, currently assessed at Stage II a/b. I only received my pathology report today (after harassing the Dr's office) and my consult with the surgical oncologist is tomorrow. I'm sure everyone on this board underastands the complete whirlwind of gettng a diagnosis and trying to take in and process a lot of information in a short time.  I want to be as prepare as possible so I can advocate for myself.  I haven't had a long time to study my pathology report, so I'm hoping someone who is farther along in the process can provide guidance.  The pathology reports are as follows:

Left Arm:  invasive malignant melanoma, ulcerated (focally present), Breslow depth 2.0 mm, Clark's level IV, extending to one lateral margin. Miotic rate:  1-2 per sq mm (approx). Lymphocapillary invasion, satelitosis, and perinerual invasion not identified.  Lymphocytic inflitrate:  non brisk. 

I understand what all of this means as far as understanding the terms, but am trying to put it all together as far as prognosis and treatment options.  From the research I've been able to do so far, it looks like ulceration  is "bad" and can be a risk factor for a higher rate of recurrance, and the miotic rate is also of concern.  I see some conflictign infomation on the miotic rate, with some sources sayign anything above 1 is concerning and there's no statistically important difference above 1, and other sources break it  down into low, medium, high miotic rate. 

Obviously, the results of the SLN biopsy may change things, but assuming it is clear and I remain in Stage II, should I still be looking at and considering treatment beyond wide excision and SLN biopsy?  It looks like Stage II is commonly addressed with only the biopsy and excision, but would the ulceration and miotic rate indicate the need for more? Should I request genomic testing?  

I will definitely listen to the doctor's advice, but also want to be prepared so I can have an informed conversation. Sorry I'm missing parts of the puzzle with these questios, but like I said, it's a lot to process in a few days. 



Here are two video's that are pretty good from Onclive from last summer talking about the stage you are at. The second link is to Onclive which is for oncologist in general (worth joining, free and no spam). The second link has a bar of #'s at the bottom choose # 5 for adjuvant video's.                                             

I am Stage 3B and I am being treated by a surgical oncologist and medical oncologist who specialize in melanoma.  I also got a second opinion.  I do not know if medical oncologists normally treat stage 2 but I would look into that.  If you can get a second opinion please do.  

The bottom line is find doctors who specialize in melanoma. This may involve travel. The best advice I received is you do not have to rush to treatment.  A few weeks to make an informed decision is ok. 

Best of luck to you. 



Hi Ashley, 

Sorry you are dealing with this.  Your plan to have a WLE (wide local excision) to attain necessary margins and SLNB sounds appropriate.  Hopefully, the SLNB will be negative and you will remain Stage II with the most likely "treatment" having been completed and a plan for observation and follow-up made.  However, as you seem interested and in case the node does contatin tumor (which would render you Stage III) you may find this primer I put together (mostly for Stage III/IV folks) interesting:  

A link at the bottome also contains a glossary of sorts that may be helpful.  I wish you my best.  Celeste

Thank you, Celeste.  I'm the kind of person who likes to have a lot of information and research things, so this is great information.  Hopefully, I don't need it, but I want to be prepared either way.