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Clark level 3,just diagnosed
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Clark level 3,just diagnosed

› Forums › Cutaneous Melanoma Community › Clark level 3,just diagnosed

  • Post
    • February 21, 2018 at 8:19 pm
    marls210
    Participant

      Hi my daughter has just been diagnosed early febuary with a Clark level 3 melanoma of superficial spreading type after having a shave biopsy. We have been able to get her an appointment for the 9th of march at the PA hospital. The histopatholgy report says that it requires complete and wide excision of the lesion. I am concerned because the mole is on her spine where her bra clips up, and she is skinny.

      Want to know what we should ask, what other tests may be involved, any advice really

       

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        • February 21, 2018 at 9:10 pm
        Janner
        Participant

          Clark's Level III is an outdated method of describing a lesion.  You really want to know the Breslow depth.  Ask for a copy of the pathology report.  A Level III lesion could cover a wide range of depths.   The fact that her lesion was a shave biopsy also means the lesion might have been bisected.  You will want to ask if the deep margin was clear or involved.  The WLE (wide local excision) is pretty standard.  They will most likely take 1cm margins around the entire lesion.  This will probably be a decent sized scar so they can close the wound.  Depending upon the depth of the lesion, they may recommend having a SLNB (sentinel lymph node biopsy).  This is where they inject a radioactive tracer into the center of the lesion (before the WLE) and follow the tracer to the first lymph node – the sentinel node.  There may be more than one node.  They remove the sentinel node(s) to see if they have any melanoma in them.  This is typically done if a lesion is over 0.8mm deep.  This is certainly something I would discuss with the docs.  If her lesion has been bisected with the biopsy, it is something I'd definitely consider because you will never know the exact depth of the lesion prior to the biopsy.  Without having the biopsy report to give us more info, this is probably the best we can do at this point. 

            • February 22, 2018 at 7:56 am
            marls210
            Participant

              I have the report and it says the breslow thickness of this lesion within this skin crettage speciman is at  0.7mm, it also says that this malignant melanoma extends to involve all of the margins of resection within this skin curettage specimen,,the specimen skin shave was 6 x 6 x 1mm

              Hope this may help,, I am still confused

              • February 22, 2018 at 7:56 am
              marls210
              Participant

                I have the report and it says the breslow thickness of this lesion within this skin crettage speciman is at  0.7mm, it also says that this malignant melanoma extends to involve all of the margins of resection within this skin curettage specimen,,the specimen skin shave was 6 x 6 x 1mm

                Hope this may help,, I am still confused

                • February 22, 2018 at 8:00 am
                marls210
                Participant

                  I have the report and it says the breslow thickness of this lesion within this skin crettage speciman is at least  0.7mm, it also says that this malignant melanoma extends to involve all of the margins of resection within this skin curettage specimen,,the specimen skin shave was 6 x 6 x 1mm

                  Hope this may help,, I am still confused

                  • February 22, 2018 at 1:41 pm
                  Janner
                  Participant

                    So basically, the lesion is "at least" 0.7mm deep.  You'll never know the full depth because the shave biopsy cut through the lesion.  (Many of us here don't like the shave biopsy technique for this very reason – you lose staging info if the shave doesn't go deep enough).  Even when they take more skin, you won't be able to just "add" any remaining melanoma (if it is found) to the 0.7mm because there is no way to match the samples from each biopsy and get an accurate depth.

                    This makes the next step a little clearer.  Since the lesion is close to the 0.8mm cutoff and melanoma was at the base of the sample, I'd definitely insist on having a SLNB.  Being younger is also a good reason to have the SLNB.  That will be done at the same surgical setting as the WLE because the SLNB has to be done first.  You want to make sure you are seeing a melanoma specialist – someone who does this type of surgery all the time.  For the moment, she is stage 1 but the staging is incomplete.  They will want to see the results of the SLNB to see if any melanoma is found there.  If nothing is found, she is stage I and will most likely just be monitored on a regular basis.  If melanoma is found in the lymph nodes, that jumps her to stage III and different options.  You can address that if you get to that point.  For now, it's just getting the next surgery taken care of.

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