husband newly diangnosed with melanoma

[hockeymom]

My husband had a mole removed from his thigh and it came back positive for melanoma. Although it appears he caught it at an early stage,I know how unpredictable cancer can be so I am still uneasy. On the Breslin scale it was .39mm,Clark stage III,markers clear,no ulceration. He is going to have more tissue removed next week and then follow up with an Oncologist. Both his Primary and the plastic surgeon are very optimistic.
My friend is a nurse in an Oncology office. She said we should demand a sentinol node biopsy. I did not get the impression that based on the pathology that they would be doing one. Unless the Oncologist my husband is seeing recommends it,should we insist? My husband does not want to have one unless his Dr. says.
Thank you in advance.

[HaoleBoy]

HockeyMom, I'm sorry to hear about your husband's diagnosis but thrilled to hear that it was caught so early. At .39MM Breslow thickness and Clarke's Level III (even though Clarke's Level is not used much nowadays as a prognosticator), he has an excellent prognosis and outlook. At .39MM thickness and non-ulcerated, a Sentinel Node Biopsy (SNB) would not be required. Please note that a SNB is not protocol or standard of care for lesions under 1MM Breslow thickness in the US. Some US National Cancer Institute designated Comprehensive Cancer Centers will offer a patient an SNB for lesions greater than .75MM thickness, but I have not heard of anyone having an SNB for a primary lesion as thin as your husband's.

That said, there IS a member of this board who had a very shallow, equally low risk lesion (.40MM) which unfortunately did metastize to a lymph node soon after his Wide Local Excision (was probably there before his WLE), but his primary lesion was on his chest (trunk lesions are relatively higher risk in terms of anatomical location) and I don't know what other pathological factors may have been in play....

Do you happen to know what is your husband's mitotic rate (should be on the biopsy pathology report) ? ...Mitotic rate is the measurement of mitoses = the rate of malignant cellular division and its a marker of tumor aggressiveness. If it is 0, "none", "not observed", etc., (which is a good thing/prognosticator) then the only other box to be checked off is whether or not there was any sign of tumor "regression" -- meaning that the tumor's thickness was reduced by the host's immune system response (i.e., your husband's immune system recognized the tumor as "foreign" and his T-cells attacked it which caused its thickness to dissapate)....If there is no evidence of regression and no mitoses (and I'm assuming that there was no evidence of lympho-vascular spread on the pathology report), then your husband's lesion is very low risk for metatases/ recurrence and no SNB would normally be required.

Look's like he is most likely going to be Stage IA under the forthcoming, revised AJCC Staging Criteria for Melanoma.... Stage IA is a good place to sit if one has to have melanoma.

Prayers and Blessings,

Haole Boy (Bob)
Stage IIA
2.40MM thick SSM on bottom of Left Foot 2nd Toe
WLE (toe amputation) and SNB negative for mel Aug 21, 2008
Almost 1 year No Evidence of Disease (NED)

[hockeymom]

Thank you for that reassuring reply. My husbands report said no mitosis and no regression. It also said TILS present and brisk,whatever that meant. I'm feeling much more confident now.
Thanks again

[brainman]

hockeymon, that report is excellent . TILS stands for "tumour-infiltrating lymphocyte", a type of immune system cell that attacks cancer cells. That the are there and "brisk" is good.

[koikkeril]

Excellent news for you and me and others.
Reading this, I will now be getting off my butt and checking out that thing growing on my leg!
Some of us are lazy in our health whilst others are more realistic and get on and do something about it...

As they say, the early bird catches the worm it seems to me you caught it in time.

God Bless you and your hubby...Koik

[clinlabtech]

Hi
I understand what you are going through. My husband was recently diagnosed with melanoma. He had a mole on his back that over the past couple of years, several doctors had told him "we normally don't remove those, it's nothing to worry about." After his insistence, one doctor finally sent him to the derm clinic. They removed the mole/growth and called and told him it was melanoma. He had the wide excision which has left an 8-inch scar on his back. Then the sentinal node biopsy. One of the four lymph nodes came back positive for cancer. So then another surgery to remove more nodes. All those were negative. Now he is in his first month of interferon. These past several months have been such a nightmare. It is so hard on all of us. I am currently carrying the burden of raising 2 young teenagers, working full time, working on my master's degree and in the middle of buying a new house thrown into the normal daily chores that family requires. For me, it is very hard. I am a lab technologist with a strong background in hematology and very knowledgable in what cancer entails and what the treatments entail. Sometimes that information is not so good to have. My best wishes and prayers go out to you and your husband. Stay strong.

God Bless
Tina