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Newly Diagnosed - Help w/Biopsy Results

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Newly Diagnosed - Help w/Biopsy Results

Posted By
kcomUT
11/9/2020 11:17am
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Replies: 10

Hello, everyone. I just received a call from my dermatologist informing me of my Melanoma diagnosis. I'm 34 years old and male.

I was able to find this website while waiting for my results and I was hoping to post my biopsy results here hoping to draw upon the collective experience of the group.

Here is the complete biopsy:

START OF REPORT

Breslow Depth: 0.9 mm
Ulceration: Not Present
Vascular Invasion: Not Present
Perineurial Invasion: Not Present
Mitoses: Greater than 1 per mm squared (6 per mm squared)
Type: Superficial spreading
Microsatellitosis: Not Present
Lymphocytes: Present, abundant
Preexisting lesion: Not Identified
Tumor regression: Not Present
Growth Phase: Vertical and Radial
Peripheral Margins: Lesions extends to the peripheral margins of the biopsy
Deep Margins: Free of tumor by 0.1 mm
Tumor stage: pT1bNxDx

Comments: Atypical melanocytes are present both as solitary units, and as nests, at and above the junction in a pagetoid patter as well as tracking down adnexal structures. Additionally, atypical melanocytes are present in nests that vary in size, shape, and spacing, which extend into the dermis to a Breslow depth of 0.9 mm. Pigment is distributed unevenly.

END OF REPORT

I was hoping that someone here can help me make sense of some of the information here.I do know that depth is a key indicator. However my dermatologist also told me that he was concerned about the Mitosis rate being 6 per mm, which is high. My plan is to get a sentinel lymph node biopsy (SLNB) as soon as I can to see if the cancer has spread.

I realize that only the SYNB can confirm if the cancer has spread, but I wondering what the chances are that happened based upon my pathology report. Any counsel or wisdom that the group could provide would be greatly appreciated. Thanks in advance.

Hi there,
Sounds like 1b for now. Have the SLNB done and you will know more.
I was Depth 1.9 Mm and 1b for just 5 month. The SLNB were negative. Everything else sounded the same as yours. Just 1mm different which is a big deal in melanoma world. Although It sounds like this is pretty bad cancer which spreads.
After 5 months after suggestion of my Dermatologist I did PET scan to find out it spread to lymph nodes and put me in 3C
Knowing now how this beast works I would suggest to do a PET scan in 6 months If you are clear now and then maybe in 6 months again so you will not get to advance to stage 4 without even noticing. If you are clear after a year I would breath and go from there with skin checks and listening to your body very closely.

Thank you for the quick response. So, are you saying that after your PET scan it revealed that your cancer had actually spread and that put you into stage IIIC? Does that mean that the SLNB may not be 100% conclusive? How are you doing right now? I hope that everything is going well.

When they do tracing of lymph nodes in SLNB surgery they inject tracing material and this it goes to closest lymph nodes. In my case they had indentified closest lymph nodes and removed one. It was negative.
They said you are good to go and let us know if you have any problems.
I had a skin check 5 months after and my dermatologist was rather insistant on PET scan. I was confused why he suggests a scan when everything seemed to be ok.
I asked oncologist for a scan.
I had a scan I they found and then biopsied 2 lymph nodes close to the original site which were positive.
They said they either didnt see it/ identified on a SLNB surgery or cancer spread that fast. They were not sure.
If I didn’t have a scan I would have progressed to stage 4 without even blinking my eye.

Wow. Have thankful you must have been to have caught that. I assume that you are all clear now? I hope so. Thanks for sharing your experience. I wish you continued good health.

I had a surgery to remove those 2 lymph nodes and 2 more to make sure The recovery was not fun. I had a drain for 5 weeks. Didn’t take a shower for 5 weeks. Could not walk much. The surgical site It’s in my groin looks pretty deformed. They move sartorius muscle, this is how it called, and it seems that that muscle had been attached or healed up weird. Not sure who is doing the surgery the students or the doctors. I m pretty unhappy with results, haven’t gotten laid since the surgery because of being too self conscious about that leg. It looks weird, feels weird.
Will have to do revision if I will survive the cancer if not I dont really care how It looks in a casket.
I m getting Keyruda now. Will be getting it for a year if everything looks good and no side effects. Fingers crossed.
What I learned from this you have to be proactive or it maybe too late.

i am 3c with 4Ln removed, NED after 6 months of opvido. andof course i leave immo in 2 months.

i asked my docs this exact question: what scans are the most likely to reveal further spread. I had a CT for the NED pronouncement but it only really identifies a tumor where as PET shows melanotic cells activity. I get it, its all about money and Standard of Care and that seems to be his response. CT scans every 6 months to look for a mass. if PET reveal activity at an earlier stage, it would seem that would be the proper medicine.

i would be interested in other's thinking. does CT get the job done, or is PET much better.

i am 3c with 4Ln removed, NED after 6 months of opvido. andof course i leave immo in 2 months.

i asked my docs this exact question: what scans are the most likely to reveal further spread. I had a CT for the NED pronouncement but it only really identifies a tumor where as PET shows melanotic cells activity. I get it, its all about money and Standard of Care and that seems to be his response. CT scans every 6 months to look for a mass. if PET reveal activity at an earlier stage, it would seem that would be the proper medicine.

i would be interested in other's thinking. does CT get the job done, or is PET much better.

The standard progression for stage 1 or 2 is WLB and SNLB with six checks. There is usually a CT or CTs along the way. If you have some other sign of progression, a PET scan will be recommended but insurance will generally not pay to “check things”: About two years after my 2B melanoma I had a bad lung X-ray and I had a PET scan which presented as an optional or I could wait. They found nothing and it was determine it was temporary scarring from a bad cough.

I
About seven years later I did progress and so I’ve had many scans, mostly brain MRI and full body CT. But PET scans are rarely approved unless there is something new.

I think the most important thing to understand is that melanoma treatments are changing at a rapid pace right now.

“Skin checks not six checks”

I'm glad your lung was clear of any spreading. I hope you enjoy continued good health. I met with the doctor who will be doing my surgery. He echoed your sentiments about changes in melanoma treatment. He told me that we've come a long way and treatments have been greatly improved even in recent years.

Concerning my case when I met with the doctor I was a bit taken aback by his optimism. He said based on my pathology results (o.9 mm depth, no ulceration, deep margin free of tumor by 0.1 mm) that it's very unlikely the cancer has spread to nearby lymph nodes. However my mitotic rate being 6 had me a bit rattled. I'm sure like many on this forum I've found myself reading medical articles and trying to find studies that have been done the meet my criteria. One concern is that thin melanoma in the range of 0.8 mm - 1 mm and being relatively young actually may increase the chances of LN positivity. I found one study that put my odds around 70% of nothing spreading, but I know all cases and studies can be different. I should probably just do myself a big favor stop looking at anything online other than this forum. My body could be different from any other case out there.

My surgery is on 11/25 and I'm hoping to get the results a bit after that. I'll try and let the group know how it goes. I'm hoping it hasn't spread. Waiting is going to be hard but I'm taking comfort in knowing that the odds seem to be in my favor. Regardless of the results I'm trying to prep for any outcome. I have immense respect and admiration for everything going through a cancer battle. My love and good vibes are being sent to you all!