A website to provide support for people who have or have had any type of cancer, for their caregivers and for their family members.
Results 1 to 6 of 6

Thread: New user.. questione on WLE

  1. #1

    New user.. questione on WLE

    Hi all,
    I have recently been diagnosed with a 0.4MM melanoma on my back, Clark level II, no ulceration, no regression, Mitotic rate=0, clear lateral and deep margins. it was classified as T1A.
    The doc still wanted me to have a WLE as that is what he defined as "best practice". I have read that there is a very good survival rate for this type of classification, but what do you think is the probability that they find anything in the tissue taken out by the WLE? I.e. that it had spread or metastasized? The margins in the original excision were clear but I read that doesn't necessarily mean that they haven't "jumped" elsewhere..
    many thanks to you all!

  2. #2
    Super Moderator Top User po18guy's Avatar
    Join Date
    Feb 2012
    Location
    Pacific NW, USA
    Posts
    7,965
    Welcome! 0.4mm? That is a tiny melanoma, unless we are talking depth, in which case it is still shallow. All indicators seem to be very good. "Best practice" is, by definition, potentially excessive as medicine wants to be certain. You may have already visited this site, but here is a link to the Aim at Melanoma Foundation.
    07/08 Age 56 DX 1) Peripheral T-Cell Lymphoma-Not Otherwise Specified. Stage IV-B, >50 ("innumerable") tumors, bone marrow involvement.
    08/08-12/08 Four cycles CHOEP14 + four cycles GND (Cyclofosfamide, Doxorubicin, Vincristine, Etoposide, Prednisone & Gemcitabine, Navelbine, Doxil)
    02/09 2) Relapse.
    03/09-06/13 Clinical trial of Romidepsin > long-term study. NED for 64 twenty-eight day cycles, dose tapered.
    07/13 3) Relapse, 4) Suspected Mutation.
    08/13-02/14 Romidepsin increased, stopped for lack of response. Watch & Wait.
    09/14 Relapse/Progression. Visible cervical nodes appear within 4 days of being checked clear.
    10/06/14 One cycle Belinostat. Discontinued to enter second clinical trial.
    10/25/14 Clinical trial of Alisertib/Failed - Progression.
    01/12/15 Belinostat resumed/Failed - Progression. 02/23/15
    02/24/15 Pralatrexate/Failed - Progression. 04/17/15
    04/15 Genomic profiling reveals mutation into PTCL-NOS + AngioImmunoblastic T-Cell Lymphoma. Stage IV-B a second time. Two dozen tumors + small intestine (Ileum) involvement.
    04/22/15 TREC (Bendamustine, Etoposide, Carboplatin). Full response in two cycles. PET/CT both clear. Third cycle followed.
    06/15-07/15 Transplant preparation (X-rays, spinal taps, BMB, blood test, MUGA scan, lung function, CMV screening, C-Diff testing etc. etc. etc.) Intrathecal Methotrexate during spinal tap.
    BMB reveals 5) 26% blast cells of 20q Deletion Myelodysplastic Syndrome MDS), a bone marrow cancer.
    07/11-12/15 Cyclofosfamide + Fludarabine conditioning regimen.
    07/16/15 Total Body Irradiation.
    07/17/15 Moderate intensity Haploidentical Allogeneic Stem Cell Transplant receiving my son's peripheral blood stem cells.
    07/21-22/15 Triple dose Cyclofosfamide + Mesna, followed by immunosuppressants Tacrolimus and Mycophenolate Mofetil.
    07/23-08/03/15 Marrow producing zero blood cells. Fever. Hospitalized two weeks.
    08/04/15 Engraftment occurs, and blood cells are measureable - released from hospital.
    08/13/15 Day 26 - Marrow is 100% donor cells. Platelets climbing steadily, red cells follow.
    09/21/15 Acute skin Graft versus Host Disease arrives.
    DEXA scan reveals Osteoporosis.
    09/26/-11/03/15 Prednisone to control skin GvHD.
    11/2015 Acute GvHD re-classified to Chronic Graft versus Host Disease.
    05/2016 Tacrolimus stopped. Prednisone from 30-90mg daily tried. Sirolimus begun.
    09/16/16 Three skin punch biopsies.
    11/04/16 GvHD clinical trial of Ofatumumab (Arzerra) + Prednisone + Methylprednisolone begun.
    12/16 Type II Diabetes, Hypertension - both treatment-related.
    05/17 Extracorporeal Photopheresis (ECP) begun in attempt to control chronic Graft-versus-Host-Disease (cGvHD.
    06/17 Trying various antibiotics in a search for tolerable prophylaxis.
    08/17 Bone marrow biopsy reveals the presence of 2% cells with 20q Deletion Myelodysplastic Syndrome, considered to be Minimum Residual Disease. Active surveillance is the course of choice.
    To date: 18 chemotherapeutic drugs in 9 regimens (4 of them at least twice), 5 salvage regimens, 3 clinical trials, 4 post-transplant immuno-suppressant drugs, the equivalent of 1,000 years of background radiation from scanning from 45+ CT series scans and about 24 PET scans. Two lymphoid malignancies plus a myeloid malignancy lend a certain symmetry to the journey.

    Believing in the redemptive value of suffering makes all the difference.

  3. #3
    Senior User
    Join Date
    Jan 2014
    Location
    Colorado
    Posts
    317
    Not sure what the chances the are, but for a melanoma of 0.4 mm, I would have the WLE and be glad it was not thicker and be done with it, other than sunscreen and sun protection. : ) With melanoma, you never know, so it is always best to be on the safe side, and that may be why wider clear margins are always best. Happy for you that your news was good, as melanoma goes!

    Best wishes!

    Cheri
    Vulvar mucosal melanoma, superficial spreading type, stage I-II, depth 1 mm with regression
    Radical right-sided hemivulvectomy, clitorectomy and bilateral sentinel lymph node biopsies, May 2013, lymph nodes clear
    PET CT, NED, July 2013
    Partial left hemivulvectomy/reconstructive surgery Oct 2013, found melanoma in situ on pathology, out to margins
    November/January - Underwent 9 vulvar biopsies to try to locate the MIS for surgical excision, unsuccessful
    May 2014 - Third vulvectomy/second left hemivulvectomy for wide local excision of MIS, MIS not identified on pathology
    PET CT, still NED, June 2015
    PET CT, NED, June 2016

  4. #4
    Newbie New User
    Join Date
    Jun 2017
    Posts
    3
    Hi Millanello
    As the 4 Yorkshiremen in Monty Python's sketch would say " I used to DREAM of having a melanoma only .4mm deep". The one I've got is 1.1mm deep and I thought I was lucky (though that just gets me into the stage 2 category). So your chances of a "cure" are very good. However, it's probably a good idea to examine your lifstyle (diet etc) because your immune system might be weak and you might get another one.
    I've just joined this and wonder what Cheri and po18guy have to say if they've got melanomas. I'm looking for encouragement too.
    Barry

  5. #5
    Newbie New User
    Join Date
    Jun 2017
    Posts
    3
    Hi Cheri
    You seem to have experienced quite bit of melanoma grief + complications. How are you now and how did you get there? My depth was 1.1mm, no ulceration and mitotic index less than 1 so I'm fairly optimistic but the CT scan tomorrow will be important. Are you on a diet of any kind.
    All the best
    Barry

  6. #6
    Senior User
    Join Date
    Jan 2014
    Location
    Colorado
    Posts
    317
    Quote Originally Posted by barryl View Post
    Hi Cheri
    You seem to have experienced quite bit of melanoma grief + complications. How are you now and how did you get there? My depth was 1.1mm, no ulceration and mitotic index less than 1 so I'm fairly optimistic but the CT scan tomorrow will be important. Are you on a diet of any kind.
    All the best
    Barry
    Hi Barryl, apologies for not seeing this sooner. Lots of family issues and have not had a chance to visit the forum as often as I used to. How did your scan come out? It sounds from this post like you have good reason to be optimistic.

    Thank you so much for asking about me. I am a little over 4 years out and still free of recurrence, knock on wood.

    Speaking of diet, did you know there is really no way to strengthen an immune system, contrary to a lot of misinformation on the Internet? What we can do is undermine its effectiveness, i.e. weaken it. Talking to an immunologist, I was told the major way we weaken it is with stress and that scientific evidence has repeatedly shown that to be true.

    So to allow our immune systems to function optimally, we can try to reduce the negative stress we put on our bodies. From there, I sort of speculate on my own what stresses the body and I come up with lack of sleep, poor diet that is harder to digest/processed food/junk food, stress that raises our blood pressure or gets us upset, sitting for too long, and so on.

    Ideally I have been trying to limit that type of stress by eating a diet higher in fiber and lower in processed foods, getting enough sleep, scheduling in some laughter and fun, staying active on my days off. I say ideally because the last few years have brought problems that have been some of the most stressful of my life. Not much we can do about those, though, except cope the best we can. Unfortunately, that type of stress can sabotage my efforts to follow the healthy diet, sleep well, etc, but I am still trying! : )

    I guess my philosophy could be summed up with reduce stress, wear sunblock, and be diligent with followup and skin checks. In the case of mucosal melanoma, sun is not actually a factor, but I recently had a mole that biopsied as dysplastic show up on my lower back, not that my lower back sees a lot of sun. But I wear the sunblock anyway, and my poor kids have grown up white as ghosts.

    Anyway, all is well with me, and I think you have lots of reason to feel encouraged that you have seen the last of melanoma.

    All the best to you too!

    Cheri
    Vulvar mucosal melanoma, superficial spreading type, stage I-II, depth 1 mm with regression
    Radical right-sided hemivulvectomy, clitorectomy and bilateral sentinel lymph node biopsies, May 2013, lymph nodes clear
    PET CT, NED, July 2013
    Partial left hemivulvectomy/reconstructive surgery Oct 2013, found melanoma in situ on pathology, out to margins
    November/January - Underwent 9 vulvar biopsies to try to locate the MIS for surgical excision, unsuccessful
    May 2014 - Third vulvectomy/second left hemivulvectomy for wide local excision of MIS, MIS not identified on pathology
    PET CT, still NED, June 2015
    PET CT, NED, June 2016

 

Similar Threads

  1. WLE and SNB - How painful?
    By cusmith1975 in forum Melanoma and Skin Cancer Forum
    Replies: 1
    Last Post: 07-30-2012, 10:36 PM
  2. Spots on WLE scar
    By natasha in forum Melanoma and Skin Cancer Forum
    Replies: 7
    Last Post: 06-10-2012, 12:32 AM
  3. Freckles in wle scar?
    By mlbjab in forum Melanoma and Skin Cancer Forum
    Replies: 2
    Last Post: 07-29-2010, 02:25 AM
  4. question Re WLE & SNB
    By Jilly in forum Breast Cancer Forum
    Replies: 1
    Last Post: 10-06-2007, 06:02 PM

Posting Permissions

  • You may not post new threads
  • You may not post replies
  • You may not post attachments
  • You may not edit your posts
  •