› Forums › General Melanoma Community › pT2a pNx pMx – concern about delayed treatment at MD Anderson
- This topic has 36 replies, 7 voices, and was last updated 9 years, 8 months ago by
ed williams.
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- January 4, 2016 at 6:26 pm
My diagnosis from a shave biopsy preformed on 12/16/15:
Type: Superficial spreading
Tumor thickness (Breslow): at least 1.80mm (base transected)
Anotmomic level (Clark): at least IV
Ulceration: absent
Dermal mitotic rate: 3/mm2
Microsatellitosis: not evaluable
Vertical growth phase: present
Regression: absent
Angiolymphatic invation: absent
Neurotropism: absent
Tumor inflitrating lymphocytes: present, non-brisk
Precursor lesion: absent
Pathological stage: at least pT2a pNx pMx
Additional written comment on the Dermatopathology report: The in situ melanoma extends to one peripheral margin, and the invasive component is transected at the base, precluding accurate measurement for Breslow's depth and pathologic state (deferred to final excision). Sections show a proliferation of atypical melanocytes in the epidermis and dermis. The junctional component is disposed in a confluent fashion with pagetoid upward scatter. Ther dermal component is present in large aggregates without maturation.
MY COMMENTS/QUESTIONS/CONCERNS:
The Biopsy was done on 12/16/15 and the diagnosis was delivered to me on 12/22/15. While my Dermatologist offered to find a local Oncologist to refer me to, I told him that I preferred to have my treatment handled through MD Anderson, which is about a 3-4 hour drive for me.
Because of the holidays I did not hear back from MD Anderson until 12/29/15, and an appointment for 1/13/16 was the earliest I could get in to see a surgical Ongologist at MDA. I was also told that for the Oncologist I will be seeing, they were, as of 12/29/15, scheduling surgeries for the week of 1/25/16. This leads me to believe that by the time I am seen on the 13th of January, they would be scheduling surgeries for the middle of February.
This would be roughly two months since my biopsy was performed, which "feels" like a very long time before I will know officially what my diagnosis and stage is.
Questions that I have:
1. Is there a way to know if this is a slow-growing type of cancer?
2. What does a dermal mitotic rate of "3" mean? Is that good, bad, average?
3. Overall, the stage of "at least" pT2a is all we know since no surgery has been performed. Given the report indicates "at least", should I assume that surgery is imminent?
4. If surgery is required, would that be a wide local excision (WLE)?
5. At this point I only know that the Breslow's thickness is "at least" 1.80mm, and that the pathologic stage is "at least" pT2a pNx pMx. Does this mean that I should expect a Sentinel Lymph Node Biopsy (SLNB) at the same time I have the Melanoma surgery (WLE)? SInce the report says "at least", how can I know if that means the thickness is 1.9 or 2.9 or 3.9, etc.?
6. If surgery is imminent, then should I have to wait until my initial appointment at MDA on 1/13/16 before scheduling the surgery to occur after the initial appointment? I.E., could I go ahead and have my surgery scheduled for the week of 1/25/16 even though I won't have my initial appointment until 1/13/16?
As you can see I'm pretty anxious about waiting all of this time before I know something more definitive and my anxiety (and my family's) grows in proportion to the time I have to wait. If I had a better understanding of whether a couple of weeks or months matter that much, it would help me to either push for earlier appointments at MDA, or to relax and stick with the times that are available for me at MDA. Alternatively, should I go ahead and see a local Oncologist who may be able to see me sooner and perform the surgery sooner?
Thank you!
- Replies
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- January 4, 2016 at 7:39 pm
Hi,
i had my initial biopsy in October of 2011. It took a long time for the path to come back due to the indeterminate nature of the biopsy. It was finally determined in November that the lesion was melanoma and I had (which I believe will be your next step) a wide excision and at the same time a sentinel node biopsy. By mid Nivember I had a diagnosis of Stage 3a disease. It wasn't until February that I had my lymphnode,dissection? So, whereas upon hearing this type of diagnosis, we want everything to move fast, I don't think you should be overly concerned by a wait of a few weeks.
A mitotic rate of 3 is not ideal, but not terrible. In a paper written in 2010, mitotic rate of 3 taken n its own correlated with very high 5 and 10 year survival rates (again, excluding other factors).
as I mentioned above, the next step is the WLE and I would imagine,,given the depth, a sentinel node biopsy where they will be better able to stage you more accurately.
Again, I wouldn't be concerned about the few weeks in between. You're being seen at one of the most highly regarded treatment centers where you'll be in good hands and give yourself the best opportunity for a great outcome. This board is also terrific,as a sounding board and to get experiential feedback from others who are dealing with the disease.
Best of Luck,
Stan
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- January 4, 2016 at 7:39 pm
Hi,
i had my initial biopsy in October of 2011. It took a long time for the path to come back due to the indeterminate nature of the biopsy. It was finally determined in November that the lesion was melanoma and I had (which I believe will be your next step) a wide excision and at the same time a sentinel node biopsy. By mid Nivember I had a diagnosis of Stage 3a disease. It wasn't until February that I had my lymphnode,dissection? So, whereas upon hearing this type of diagnosis, we want everything to move fast, I don't think you should be overly concerned by a wait of a few weeks.
A mitotic rate of 3 is not ideal, but not terrible. In a paper written in 2010, mitotic rate of 3 taken n its own correlated with very high 5 and 10 year survival rates (again, excluding other factors).
as I mentioned above, the next step is the WLE and I would imagine,,given the depth, a sentinel node biopsy where they will be better able to stage you more accurately.
Again, I wouldn't be concerned about the few weeks in between. You're being seen at one of the most highly regarded treatment centers where you'll be in good hands and give yourself the best opportunity for a great outcome. This board is also terrific,as a sounding board and to get experiential feedback from others who are dealing with the disease.
Best of Luck,
Stan
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- January 4, 2016 at 7:39 pm
Hi,
i had my initial biopsy in October of 2011. It took a long time for the path to come back due to the indeterminate nature of the biopsy. It was finally determined in November that the lesion was melanoma and I had (which I believe will be your next step) a wide excision and at the same time a sentinel node biopsy. By mid Nivember I had a diagnosis of Stage 3a disease. It wasn't until February that I had my lymphnode,dissection? So, whereas upon hearing this type of diagnosis, we want everything to move fast, I don't think you should be overly concerned by a wait of a few weeks.
A mitotic rate of 3 is not ideal, but not terrible. In a paper written in 2010, mitotic rate of 3 taken n its own correlated with very high 5 and 10 year survival rates (again, excluding other factors).
as I mentioned above, the next step is the WLE and I would imagine,,given the depth, a sentinel node biopsy where they will be better able to stage you more accurately.
Again, I wouldn't be concerned about the few weeks in between. You're being seen at one of the most highly regarded treatment centers where you'll be in good hands and give yourself the best opportunity for a great outcome. This board is also terrific,as a sounding board and to get experiential feedback from others who are dealing with the disease.
Best of Luck,
Stan
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- January 5, 2016 at 12:48 pm
It seems like our reports are similar. I don't have any answers either, but I understand how the waiting can be nervewracking. I had the biopsy done before Christmas and then the diagnosis before New Years and now I'm waiting on what's next too.
But I'm sure if MD Anderson's staff is aware of why you're requesting a visit, they won't wait any longer than necessary. Good luck!
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- January 5, 2016 at 12:48 pm
It seems like our reports are similar. I don't have any answers either, but I understand how the waiting can be nervewracking. I had the biopsy done before Christmas and then the diagnosis before New Years and now I'm waiting on what's next too.
But I'm sure if MD Anderson's staff is aware of why you're requesting a visit, they won't wait any longer than necessary. Good luck!
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- January 5, 2016 at 12:48 pm
It seems like our reports are similar. I don't have any answers either, but I understand how the waiting can be nervewracking. I had the biopsy done before Christmas and then the diagnosis before New Years and now I'm waiting on what's next too.
But I'm sure if MD Anderson's staff is aware of why you're requesting a visit, they won't wait any longer than necessary. Good luck!
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- January 7, 2016 at 3:48 am
That is my hope as well. If they see that my Breslow's depth is "at least" 1.8mm then that means it could be anything, so I AM hoping that with that knowledge and with a mitotic rate of 3 they are taking all of that into consideration when they schedule my appointments. Thank you very much for your input.
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- January 7, 2016 at 3:48 am
That is my hope as well. If they see that my Breslow's depth is "at least" 1.8mm then that means it could be anything, so I AM hoping that with that knowledge and with a mitotic rate of 3 they are taking all of that into consideration when they schedule my appointments. Thank you very much for your input.
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- January 7, 2016 at 3:48 am
That is my hope as well. If they see that my Breslow's depth is "at least" 1.8mm then that means it could be anything, so I AM hoping that with that knowledge and with a mitotic rate of 3 they are taking all of that into consideration when they schedule my appointments. Thank you very much for your input.
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- January 5, 2016 at 4:21 am
I am no where near an expert on melanoma, but I can offer our story. My husband and I live in Oregon. He was diagnosed here and I immediately set up an appointment at MD Anderson. The appointment was set for two weeks later. I know the pain of waiting and not know what is going on. It’s scary. You can try to call and get a sooner appointment.His very first appointment was with the surgeon. He was in surgery the next day. They did a wide local incision and went in for four lymph nodes. They were the sentinel lymph nodes. We went home while they got the results. The results came back saying 2 of the lymph nodes had melanoma. We came back to Texas a couple weeks later for a surgery where they removed the lymph nodes on his right side.
So far, those were the only two surgeries. I do suggest having someone go with you in case you’ll need surgery. You will get sooo much information so it will help having someone there to absorb it with you. You may also want to take something to write on and with.
The hospital and is huge and overwhelming at first. You will get the hang of it though. Ask anyone for directions, they are very nice. Even patients.
While you wait for you appointment, write down any and all questions down and take them with you. You can learn everything you can about treatments and surgeries so it won’t be a huge shock.
My husband is still a patient and he gets a CT scan, MRI and restaging done every three months. After two years with good results, those appoints will go to every 6 months. Then it will go to once a year. It’s a long road, but we have no regrets getting treatment outside of our community.
I wish you the best of luck. It’s a hard pill to swallow. But the more you know about the treatment options they offer today, the easier it is to handle. Depending on your life situation, you may want to consider fertility storing. You may be on treatment sooner than you think. Last piece of advice, don’t look at statistics. They aren’t accurate considering the treatment options that are now available.
-Rebekah
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- January 5, 2016 at 4:21 am
I am no where near an expert on melanoma, but I can offer our story. My husband and I live in Oregon. He was diagnosed here and I immediately set up an appointment at MD Anderson. The appointment was set for two weeks later. I know the pain of waiting and not know what is going on. It’s scary. You can try to call and get a sooner appointment.His very first appointment was with the surgeon. He was in surgery the next day. They did a wide local incision and went in for four lymph nodes. They were the sentinel lymph nodes. We went home while they got the results. The results came back saying 2 of the lymph nodes had melanoma. We came back to Texas a couple weeks later for a surgery where they removed the lymph nodes on his right side.
So far, those were the only two surgeries. I do suggest having someone go with you in case you’ll need surgery. You will get sooo much information so it will help having someone there to absorb it with you. You may also want to take something to write on and with.
The hospital and is huge and overwhelming at first. You will get the hang of it though. Ask anyone for directions, they are very nice. Even patients.
While you wait for you appointment, write down any and all questions down and take them with you. You can learn everything you can about treatments and surgeries so it won’t be a huge shock.
My husband is still a patient and he gets a CT scan, MRI and restaging done every three months. After two years with good results, those appoints will go to every 6 months. Then it will go to once a year. It’s a long road, but we have no regrets getting treatment outside of our community.
I wish you the best of luck. It’s a hard pill to swallow. But the more you know about the treatment options they offer today, the easier it is to handle. Depending on your life situation, you may want to consider fertility storing. You may be on treatment sooner than you think. Last piece of advice, don’t look at statistics. They aren’t accurate considering the treatment options that are now available.
-Rebekah
-
- January 5, 2016 at 4:21 am
I am no where near an expert on melanoma, but I can offer our story. My husband and I live in Oregon. He was diagnosed here and I immediately set up an appointment at MD Anderson. The appointment was set for two weeks later. I know the pain of waiting and not know what is going on. It’s scary. You can try to call and get a sooner appointment.His very first appointment was with the surgeon. He was in surgery the next day. They did a wide local incision and went in for four lymph nodes. They were the sentinel lymph nodes. We went home while they got the results. The results came back saying 2 of the lymph nodes had melanoma. We came back to Texas a couple weeks later for a surgery where they removed the lymph nodes on his right side.
So far, those were the only two surgeries. I do suggest having someone go with you in case you’ll need surgery. You will get sooo much information so it will help having someone there to absorb it with you. You may also want to take something to write on and with.
The hospital and is huge and overwhelming at first. You will get the hang of it though. Ask anyone for directions, they are very nice. Even patients.
While you wait for you appointment, write down any and all questions down and take them with you. You can learn everything you can about treatments and surgeries so it won’t be a huge shock.
My husband is still a patient and he gets a CT scan, MRI and restaging done every three months. After two years with good results, those appoints will go to every 6 months. Then it will go to once a year. It’s a long road, but we have no regrets getting treatment outside of our community.
I wish you the best of luck. It’s a hard pill to swallow. But the more you know about the treatment options they offer today, the easier it is to handle. Depending on your life situation, you may want to consider fertility storing. You may be on treatment sooner than you think. Last piece of advice, don’t look at statistics. They aren’t accurate considering the treatment options that are now available.
-Rebekah
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- January 5, 2016 at 4:34 am
Oh, and I would shy away from having a local oncologist do the surgery. Its completely my opinion, but I would want someone who knows melanoma very well to be sure they get it all. Also, they may suggest radiation. If so, I would personally have the radiation done there. They are masters of their art. -
- January 5, 2016 at 4:34 am
Oh, and I would shy away from having a local oncologist do the surgery. Its completely my opinion, but I would want someone who knows melanoma very well to be sure they get it all. Also, they may suggest radiation. If so, I would personally have the radiation done there. They are masters of their art. -
- January 5, 2016 at 4:34 am
Oh, and I would shy away from having a local oncologist do the surgery. Its completely my opinion, but I would want someone who knows melanoma very well to be sure they get it all. Also, they may suggest radiation. If so, I would personally have the radiation done there. They are masters of their art. -
- January 5, 2016 at 5:17 am
I had my melanoma initially diagnosed at my local clinic and then insisted going to mayo in Rochester. My mitotic rate was 4. Dr Jacobsen said it could probably wait a month if I had a vacation planned. I had him do it the next day. I ended up stage 3b. I wouldn't want to wait but the Drs are ok with it
toby
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- January 5, 2016 at 5:17 am
I had my melanoma initially diagnosed at my local clinic and then insisted going to mayo in Rochester. My mitotic rate was 4. Dr Jacobsen said it could probably wait a month if I had a vacation planned. I had him do it the next day. I ended up stage 3b. I wouldn't want to wait but the Drs are ok with it
toby
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- January 5, 2016 at 5:17 am
I had my melanoma initially diagnosed at my local clinic and then insisted going to mayo in Rochester. My mitotic rate was 4. Dr Jacobsen said it could probably wait a month if I had a vacation planned. I had him do it the next day. I ended up stage 3b. I wouldn't want to wait but the Drs are ok with it
toby
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- January 5, 2016 at 5:29 am
The time from diagnostic excision biopsy to wide local excision for primary cutaneous malignant melanoma may not affect patient survival.
http://www.biomedsearch.com/nih/time-from-diagnostic-excision-biopsy/12100184.html
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- January 5, 2016 at 5:29 am
The time from diagnostic excision biopsy to wide local excision for primary cutaneous malignant melanoma may not affect patient survival.
http://www.biomedsearch.com/nih/time-from-diagnostic-excision-biopsy/12100184.html
-
- January 5, 2016 at 5:29 am
The time from diagnostic excision biopsy to wide local excision for primary cutaneous malignant melanoma may not affect patient survival.
http://www.biomedsearch.com/nih/time-from-diagnostic-excision-biopsy/12100184.html
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- January 7, 2016 at 3:54 am
Thank you so much for sharing your experience. When I spoke with my care coordinator and she set up my initial visit for the 13th, she also told me that surgery isn't being scheduled out any earlier than the week of 1/25, and that I would for sure not be in surgery on the 13th. I'm not really sure what to expect on that first visit and how they would determine when I would need to have surgery. Do you mind sharing with me what the factors were that played into the surgeon scheduling surgery for the next day? Do they run tests during that initial visit to help determine that?
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- January 7, 2016 at 3:54 am
Thank you so much for sharing your experience. When I spoke with my care coordinator and she set up my initial visit for the 13th, she also told me that surgery isn't being scheduled out any earlier than the week of 1/25, and that I would for sure not be in surgery on the 13th. I'm not really sure what to expect on that first visit and how they would determine when I would need to have surgery. Do you mind sharing with me what the factors were that played into the surgeon scheduling surgery for the next day? Do they run tests during that initial visit to help determine that?
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- January 7, 2016 at 3:54 am
Thank you so much for sharing your experience. When I spoke with my care coordinator and she set up my initial visit for the 13th, she also told me that surgery isn't being scheduled out any earlier than the week of 1/25, and that I would for sure not be in surgery on the 13th. I'm not really sure what to expect on that first visit and how they would determine when I would need to have surgery. Do you mind sharing with me what the factors were that played into the surgeon scheduling surgery for the next day? Do they run tests during that initial visit to help determine that?
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- January 7, 2016 at 4:08 pm
Dear anon, you might want to check out this video by Dr.Gershenwald of M.D.Anderson from 2015 on Melanoma International foundation webinar. The title is " Surgical Management of Melanoma" A 2015 Primer. I tried to put up the link both it won't allow it. Just go to youtube and type in title, should take you to it. You will see photos of leg and feet that have in- transit metastases. Wishing you the best!!! Ed
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- January 7, 2016 at 4:08 pm
Dear anon, you might want to check out this video by Dr.Gershenwald of M.D.Anderson from 2015 on Melanoma International foundation webinar. The title is " Surgical Management of Melanoma" A 2015 Primer. I tried to put up the link both it won't allow it. Just go to youtube and type in title, should take you to it. You will see photos of leg and feet that have in- transit metastases. Wishing you the best!!! Ed
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- January 7, 2016 at 4:08 pm
Dear anon, you might want to check out this video by Dr.Gershenwald of M.D.Anderson from 2015 on Melanoma International foundation webinar. The title is " Surgical Management of Melanoma" A 2015 Primer. I tried to put up the link both it won't allow it. Just go to youtube and type in title, should take you to it. You will see photos of leg and feet that have in- transit metastases. Wishing you the best!!! Ed
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