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1sweetheart 09-01-2009 11:31 AM

New Melanoma Diagnosis

I have never posted anything on this message board before but I would appreciate any help that can be offered. My 38 year old husband had a punch biopsy done last Tuesday (8/25/09) for a suspicious mole on his left calf that had been changing and growing. The dermatologist called us yesterday and said the biopsy shows malignant melanoma. Per the dermatologist, this melanoma is a .70 and anything .75 or below is considered to be in the "safe" range. We have an appointment for a consultation with a surgical oncologist on Thursday (9/3/09) to discuss treatment.

My first question is about the "safe" range of .75 or below. What does this mean in regards to melanoma? My second question is regarding possible treatment options and what can we expect? I know there is no pat answer to this question but I was hoping someone could give me an idea. I have lost both of my parents to different types of cancer within the last nine years, with my mother being the most recent in February of this year. To be very blunt, I am in a near panicked state over this melanoma diagnosis. I have been on pins and needles since the day of the biopsy. I am finding myself unable to eat and didn't sleep more than an hour in total last night.

I apologize if this is long and rambling, but I am hoping against hope that someone can offer me some insight and/or words of comfort that might help me put this in perspective. I need to be strong for my husband now as he has always been for me, and I can't do it in the emotional state I am in. My husband doesn't seem terribly concerned about his diagnosis and tends to take things in stride. Many thanks in advance to you kind folks who will take the time to respond to me and hopefully help me find some peace of mind.

Chele60 09-01-2009 04:46 PM

Re: New Melanoma Diagnosis
Hello and welcome!

First, let me offer condolences on the loss of your parents. It's been so soon since you lost your mother, and I'm sorry to hear that.

Okay. Melanoma diagnosis. Right off, do me a favor, okay? Take a deep, deep breath, and slowly exhale. I know it seems like your world comes to a stop when you hear the words "malignant melanoma," but knowledge is power, and you and your husband are in a good place!

Just to let you know: I was diagnosed with malignant melanoma 2 years ago (February 23, 2007, to be exact), and I'm healthy and kicking and plan on being around for quite some time! My melanoma was on my left knee and was .70 mm in thickness, so I guess I have some things in common with you and your husband.

One thing you can be very thankful for is you two have caught this very early. (I'm not sure if you hounded your husband to have this checked out, or if he did it himself, but that is to be commended!) I know .70 sounds HUGE at this point, but it's actually quite thin. Also, your doctor did a punch biopsy, which is usually better than a shave biopsy, in that a punch goes a little deeper and chances are the melanoma has probably already been removed.

Your next move, as you stated, is to see a surgeon. The "safe zone" your doctor talked about means the difference between a sentinel node biopsy (SNB) and no SNB. Normally, that dividing line is 1.0 mm - it was 2 years ago, anyway. If the thickness of a melanoma is greater than that, the patient must undergo a SNB to determine if the lymph nodes are involved. With a depth of .70, your husband does not need to do this - the melanoma has not grown far enough into the epidermis to affect the lymph.

Your husband will have to have surgery. Some surgeons will have outpatient, others can do this in their office. I had mine outpatient, and that's what I would prefer. It's called "Wide Local Excision." What the surgeon will do is cut out quite a bit of skin tissue surrounding where the melanoma was located. Now, I'm sure you've seen where the melanoma/mole was located on your husband's calf, right? And I'm sure you've seen the stitches from the punch biopsy as well? Well the final cut from a wide excision will be approximately 3" to 4" long. Yeah, not very attractive, but necessary. The surgeon will take all that excess skin tissue - and it goes down deep as well - and send it to a lab. The pathologist will analyze it for any extraneous melanoma cells floating around. If the melanoma was completely removed, the surgeon will tell you he/she receive "clear margins." That means the margins surrounding the area where the melanoma was removed are clear of any additional melanoma cells. On the remote chance there are melanoma cells in the margins, the surgeon will need to go back in and a SNB will need to be done to see if the lymph nodes are involves. From what you say here, it sounds like the melanoma was probably removed with the biopsy. (I know mine was)

It will take a while for the wound to heal completely, because there is quite a bit of "meat" missing from the wound. It will be sensitive to hot/cold, and feel a bit "weird" at times. But before he knows it, he will feel as good as new.

Now, here comes the words of caution! Since he has had melanoma, his chances of developing another melanoma increase dramatically. From now on he will have to take all precautions while in the sun. This includes sunblock/sunscreen, wearing protective clothing, hats, limiting exposure. He's going to need to take care of his skin. For the next 5 years he will need to undergo regular skin checks with a dermatologist - usually once every 3 months for the first 2 or 3 years, and then twice a year for 3 or 2 years after that. For the rest of his life he will need to do annual skin checks. (As should everyone, really)

Also, if you have children, precaution should be taken. (Note: NOT panic!) Some say melanoma can be hereditary, others say that it can develop because habits develop in families. Either way, if children are involved, their skin should be checked on a regular basis and sun safety should be practced. Also, any immediate family members (parents and siblings) must be notified of this and cautioned to have skin checks and practice sun safety. They, too, are now at risk.

I know this is a LOT of information, and I know your head must be spinning, but really, the news you have is not all bad. In fact, as far as melanoma diagnoses go, it could be much worse. Please do try to relax, drink some camille tea, and try to get a good night's sleep! And if you have any questions or anything I can help you with, just let me know!

Good luck to you and your husband!

1sweetheart 09-02-2009 10:02 AM

Re: New Melanoma Diagnosis

Thank you so much for your kind words and for answering my questions so thoroughly. It truly helps to hear from someone who has been there, done that.

I have always been someone who imagines the worst possible outcome in almost any situation, and this one has been no different. You have helped me put this whole thing into the perspective it deserves and I guess we will just have to wait and find out what the surgeon says tomorrow. You are correct when you say the world seems to stop when you hear the words "malignant melanoma". To be honest with you, I wasn't too happy with the words "surgical oncologist" either!

Now I'm finding myself asking "what if", i.e. "what if the surgeon says the lab was wrong and the situation is really much worse" get the idea. I don't know much about how pathology works, but it's this type of thought lurking in the back of my mind. Not only do I see the glass as half empty, I also see that it has a crack in it!

I appreciate your advice about children, and have made an appointment with the dermatologist to have our 12 year old son checked out. He is fair skinned like my husband and me, and also has several moles. As for my husband's follow-up, the dermatologist told him that he will need to be seen every six months. He has not yet said for how many years. I am making it my personal mission to see that he makes and keeps those appointments.

Thank you once again for your well-written and thought out response. That, combined with a better night's sleep last night, has helped me feel a little more sane today and more prepared for what to expect tomorrow. I will definitely let you know how the appointment goes. Thanks again!

wasley81 09-04-2009 09:12 AM

Re: New Melanoma Diagnosis
thank you Chele60 you post has also put my mind at rest to has i have been diagnosed with pretty much the same thing early case of melanoma also on the back of my left calf.i'm only 27 years old and have never been burnt on my leg!
Its now been 4 weeks since it was removed and i have been deading the next visat to the docs to see if it had spread to areas around.
I know there is a small chance that it could have spread else where and i will always be worried it will.
You have made me feel better bu reading your kind words.
Thank you.

Chele60 09-04-2009 01:43 PM

Re: New Melanoma Diagnosis
Wasley81 ~

Ah, your welcome! Yes, this can be a very frightening time, but one thing I've learned is to simply stay calm and take one day (or doctor's appointment) at a time.

I sincerely hope your next visit to the doctor brings only good, good news!

1sweetheart 09-08-2009 04:39 AM

Re: New Melanoma Diagnosis

Here is an update on what happened at our appointment with the surgeon last Thursday:

The surgeon prefaced our discussion by saying that she only had the path reports from the dermatologist's lab and would be having her own lab review the slides to confirm the diagnosis. However, she said that based on the derm's path report, it looks like my husband is a Stage 1A, Breslow .7, Clarks Level II.

She said based on this report she feels good about my husband's outcome and believes surgery will be the only required treatment at this time. This surgeon does tend to treat more aggressively than some others where a SNB is concerned, and said that because my husband is young (38) he might want to consider it. My husband does not want the SNB unless the surgeon feels it is necessary once she receives the path report from her lab.

The surgeon explained how the surgery will be done (outpatient, under MAC anesthesia or "twilight sleep"). As you had told me in your first post, she discussed the incision, which will be about four inches long, and said because they have to go all the way down to the muscle, it will require about three weeks to recover. My husband has a job where he is on his feet quite a bit, so he will not be working much during this time. Surgery is scheduled for Oct. 6th. It could have been done sooner, but my husband is scheduled to go out of town for work during mid-September, and the surgeon did not want to do it before he goes. She said she feels comfortable waiting until the 6th, but said she would not have advised him to postpone for any great length of time (i.e. three months or more).

Once surgery is done my husband will continue to be re-examined by both the dermatologist and the surgeon on a rotating basis so that he will be seeing one or the other every three months. Per the surgeon, it is highly likely that my husband will have another melanoma at some point in his life, but because he will be examined so frequently it will likely be thinner when it is found.

Overall my husband and I felt pretty good about the consultation. He has never had many health problems and certainly no surgeries in the past, so this is all new to him. At this point he is just ready to get it done and get back to work, meanwhile, I am still finding things to "what if" about. I'm hoping that the surgeon's path report agrees with the original one and doesn't find anything more serious. Of course, if it comes back better than the original one, that is fine too!

The surgeon said she would call us when she has the new report, so I will continue to keep you updated. Thanks for listening!

Oleander53 09-08-2009 06:17 AM

Re: New Melanoma Diagnosis

That is good news...... I think I told you before my Dad had 6 melanomas. First one at 48 and his last at 93 almost 94.... they were all caught early and he never required anything but surgery. He was deligent about his skin checks.

I was told to take 2000 of Vit D for cancer prevention for my skin cancer. You might want to ask his Derm about it. MD Anderson has me taking it.

Good luck and thank God this was caught early. Let us know how he does.


Chele60 09-08-2009 10:43 AM

Re: New Melanoma Diagnosis
This is great news! Surgeons will normally have their own pathologists double-check the biopsy results to ensure what the results are.

As far as the SNB is concerned, you and your husband might want to do some research on that. I'm not sure if your surgeon discussed exactly how this procedure is done? If not: during the wide excision, the surgeon injects dye into the incision. It is monitored to see exactly which lymph nodes will "light up." Now, you stated your husband's melanoma is located on his left calf, so that would mean the nearest lymph nodes would probably be in his left groin area. The surgeon would then make an incision in that area and remove lymph nodes from there - how many is usually a decision made by the surgeon. Then everything is stitched back up. The incision for this, as with the melanoma removal, can be quite sizeable. I'm not at all trying to discourage you or your husband, and if the surgeon states the path report says it needs to be done, well he doesn't have a choice. But if this surgery is optional, please make certain you and your husband are fully comfortable and informed about your decision.

October 6 will be fine. It was about a month between my first consult with the surgeon and WLE, but yeah, they do not want people waiting much longer than that! You would be surprised how many people choose to wait and put this off for months! It's amazing to me.

I'm surprised the surgeon told your husband it would be highly likely he would have another melanoma in his lifetime. Huh. I know he is at greater risk, and I do know there are people who have had more than one primary, but they are not that common. It is true that now he will be looking and have others looking at him, more things will be caught - strange looking moles and such will be removed and biopsied. (Those are always way more scary to me than the original melanoma!)

As Oleander states, some in the medical community are highlighting the benefits of Vitamin D supplements for cancer prevention. It makes sense in a way, as those of us who have had skin cancer really do not get that much Vitamin D anyway, and perhaps our skin reacts differently to this vitamin. Who knows?

I'm so glad for you and your husband the news is so positive! That is the best news you could have hoped for in this position. I hope all goes well with your husband's surgery (the "twilight" is THE best!), and I hope you can come back and give us an update on how he's doing!

1sweetheart 09-10-2009 12:55 PM

Re: New Melanoma Diagnosis
Hi All,

Chele and Oleander, I want to take a moment to thank both of you for sharing your knowledge and experiences with me and my husband thus far. The information and support from both of you has been a true blessing.

As you might remember from my last post, the surgeon was having her lab review the slides to make sure they agreed with the dermatologist's path report. The surgeon called this morning and said (good news!) that her lab does agree with the original report of Breslow .7, Clark Level II. The only thing they found to be slightly different was that "focally" it might be a Clark Level III. I asked what this meant and was told that for the most part we are looking at a Level II but in a small, microscopic area it might be a Level III. Anyway, the treatment option of doing only the WLE remains.

Now we are faced with the question of whether or not my husband should have the SNB. The surgeon said she does not see any adverse prognostic factors that makes her feel it is necessary, however she said it might be wise for him to have one just for our (i.e. the nervous wife's) peace of mind. She went on to explain in detail how the procedure is done, and that since the melanoma is on the left calf, she would likely find the sentinel nodes in the left groin and/or behind the left knee, but most likely the groin. She also said there is a 95% chance that the biopsy would come back negative. The surgeon said she doesn't have any strong feelings one way or the other and the decision is up to us at this point. To me, this seems like a rather invasive procedure for something with those kinds of odds.

I understand that many people with melanoma are not given the option of an SNB, they just have to have one. I would love to hear from anyone who has had one as far as how the procedure was for you and any long term side effects. Also, if anyone was given the option of having it, as my husband has been, what factors helped you in your decision?

At this point my husband doesn't have any strong feelings one way or the other, but he is concerned about how the removal of these lymph nodes will affect him the rest of his life (will he experience swelling when he stands for a long time, etc). We are researching this on our own the best we can and would appreciate input from anyone who cares to chime in. Thanks so much!

Chele60 09-10-2009 03:22 PM

Re: New Melanoma Diagnosis
That is good news from the surgeon! I'm happy for you and your husband!

As far as the SNB, it really does sound as if the surgeon is ambivalent, doesn't it? It was not offered to me, although I have to admit if it was, I was so panicked, I probably would have gone through with it. Thinking back, I'm glad I didn't. But, everyone is different.

I'm not sure about here, but I know there are sites where people visit and can give insight on their experiences regarding an SNB.

1sweetheart 09-17-2009 05:01 AM

Re: New Melanoma Diagnosis
Hi All,

Just a quick husband has decided not to do the SNB and go with the local wide excision only. He is scheduled for the LWE on Oct. 6th. I will keep you posted.

Chele60 09-17-2009 09:00 AM

Re: New Melanoma Diagnosis
For the depth of his melanoma, this is probably the best decision. I'll be wishing the best for both of you!

Good luck, and yes, keep us posted!

1sweetheart 09-28-2009 05:29 PM

Re: New Melanoma Diagnosis
Hi Chele,

Just wanted to let you know that the surgeon had a cancellation in her schedule and my husband is now having his WLE done tomorrow. Wish us luck! I will post in the next couple of days to let you know how it goes.

Oleander53 09-28-2009 07:21 PM

Re: New Melanoma Diagnosis
Good luck and let us know how it goes....!!!!!! Sincerely, Oleander

Chele60 09-29-2009 07:38 AM

Re: New Melanoma Diagnosis
You and your husband are probably having this done as I write this, so I want to let you know I'm thinking of you two today and hoping everything turns out flawlessly!

Clear margins, clear margins, clear margins!

I'll be looking forward to an update!

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