This is not a death sentence! It states in the pathology report that the thickness of the melanoma is .4mm. Anything under 1 mm with a low miotic rate that isn't ulcerated is considered stage 1a. The basic thinking is the thinner the melanoma the better the outcome. 

I went to the Sloan Kettering Melanoma Clinic which is in Long Island, which might not be too far from you depending where in Jersey you are. They were really great. I would definitely ask about a Sentinal Node Biopsy, but I would be super surprised with how thin your melanoma is if it would be done. Always better to ask and see what they say. 

This is not a death sentence! It states in the pathology report that the thickness of the melanoma is .4mm. Anything under 1 mm with a low miotic rate that isn't ulcerated is considered stage 1a. The basic thinking is the thinner the melanoma the better the outcome. 

I went to the Sloan Kettering Melanoma Clinic which is in Long Island, which might not be too far from you depending where in Jersey you are. They were really great. I would definitely ask about a Sentinal Node Biopsy, but I would be super surprised with how thin your melanoma is if it would be done. Always better to ask and see what they say. 

This is not a death sentence! It states in the pathology report that the thickness of the melanoma is .4mm. Anything under 1 mm with a low miotic rate that isn't ulcerated is considered stage 1a. The basic thinking is the thinner the melanoma the better the outcome. 

I went to the Sloan Kettering Melanoma Clinic which is in Long Island, which might not be too far from you depending where in Jersey you are. They were really great. I would definitely ask about a Sentinal Node Biopsy, but I would be super surprised with how thin your melanoma is if it would be done. Always better to ask and see what they say. 

Also I would have no doubts about the accuracy of your pathology – Mihm is world renowned expert.  So, I'd be confident in the staging from the pathology.

Also I would have no doubts about the accuracy of your pathology – Mihm is world renowned expert.  So, I'd be confident in the staging from the pathology.

Also I would have no doubts about the accuracy of your pathology – Mihm is world renowned expert.  So, I'd be confident in the staging from the pathology.

I used to live in Lakewood! Small world.

Since you live in central Jersey you have a number of other options open to you if things don't pan out for you in Basking Ridge. When you have something like melanoma you want to make sure you see a physician who looks at these things on a daily basis and specializes in it. I'm not 100% sure that Sloan's facility in Basking Ridge has one of their melanoma specialists practicing there.

Abramson Cancer Center has a melanoma clinic and they are in Phillie. Traffic-wise it's a LOT less stressful to go to Phillie than NYC. And since you're probably not far from Interstate 195, it's a piece of cake to get to Phillie.

There's also the Cancer Institute of NJ in New Brunswick that has a melanoma clinic. I think they're part of Robert Wood Johnson. Don't know much about them, though.

St. Luke's in Bethlehem, PA is also doable for you.

I used to live in Lakewood! Small world.

Since you live in central Jersey you have a number of other options open to you if things don't pan out for you in Basking Ridge. When you have something like melanoma you want to make sure you see a physician who looks at these things on a daily basis and specializes in it. I'm not 100% sure that Sloan's facility in Basking Ridge has one of their melanoma specialists practicing there.

Abramson Cancer Center has a melanoma clinic and they are in Phillie. Traffic-wise it's a LOT less stressful to go to Phillie than NYC. And since you're probably not far from Interstate 195, it's a piece of cake to get to Phillie.

There's also the Cancer Institute of NJ in New Brunswick that has a melanoma clinic. I think they're part of Robert Wood Johnson. Don't know much about them, though.

St. Luke's in Bethlehem, PA is also doable for you.

I used to live in Lakewood! Small world.

Since you live in central Jersey you have a number of other options open to you if things don't pan out for you in Basking Ridge. When you have something like melanoma you want to make sure you see a physician who looks at these things on a daily basis and specializes in it. I'm not 100% sure that Sloan's facility in Basking Ridge has one of their melanoma specialists practicing there.

Abramson Cancer Center has a melanoma clinic and they are in Phillie. Traffic-wise it's a LOT less stressful to go to Phillie than NYC. And since you're probably not far from Interstate 195, it's a piece of cake to get to Phillie.

There's also the Cancer Institute of NJ in New Brunswick that has a melanoma clinic. I think they're part of Robert Wood Johnson. Don't know much about them, though.

St. Luke's in Bethlehem, PA is also doable for you.

I doubt you would need to see an oncologist at Stage IA, just someone to do the wide excision

I doubt you would need to see an oncologist at Stage IA, just someone to do the wide excision

I doubt you would need to see an oncologist at Stage IA, just someone to do the wide excision

Agreed about Mihm – from what my onc told me, he is one of 3 melanoma pathologist in the country.  I'm actually having him do a 2nd opinion on my SNB path right now. 

Agreed about Mihm – from what my onc told me, he is one of 3 melanoma pathologist in the country.  I'm actually having him do a 2nd opinion on my SNB path right now. 

Agreed about Mihm – from what my onc told me, he is one of 3 melanoma pathologist in the country.  I'm actually having him do a 2nd opinion on my SNB path right now. 

Brian is right, Janner is our melanoma guru especially for early stage melanoma like yours is. Hopefully, she will chime in soon.

In the meanwhile, let me put things in context. The three most important details in a path report are: 1) Breslow depth (how deep the melanoma is growing into your skin), 2) mitotic index (how fast the cells are dividing), and 3) ulceration (whether the lesion has ruptured). Your Breslow depth of 0.4 mm is thin. Most doctors don't worry about it until a lesion is at least 0.76 or 1.0 mm. Some people are diagnosed with Breslow >4.0 mm and some even > 8.0 mm. So yours is thin, which is good. Your path report does not mention mitotic index so I assume that they didn't see any actively dividing cells under the microscope. That is also good. And your lesion is not ulcerated. Again, good.

It sounds like you had what you might call a "funny-looking mole" (non-cancerous dysplastic nevus) that was just starting to turn cancerous. You acted quickly and caught it early. You will probably now have a "wide local excision" (WLE) to make absolutely certain that they got it all and then regular follow-ups with a melanoma dermatologist for quite a while. You and your baby will both be fine. 

Brian is right, Janner is our melanoma guru especially for early stage melanoma like yours is. Hopefully, she will chime in soon.

In the meanwhile, let me put things in context. The three most important details in a path report are: 1) Breslow depth (how deep the melanoma is growing into your skin), 2) mitotic index (how fast the cells are dividing), and 3) ulceration (whether the lesion has ruptured). Your Breslow depth of 0.4 mm is thin. Most doctors don't worry about it until a lesion is at least 0.76 or 1.0 mm. Some people are diagnosed with Breslow >4.0 mm and some even > 8.0 mm. So yours is thin, which is good. Your path report does not mention mitotic index so I assume that they didn't see any actively dividing cells under the microscope. That is also good. And your lesion is not ulcerated. Again, good.

It sounds like you had what you might call a "funny-looking mole" (non-cancerous dysplastic nevus) that was just starting to turn cancerous. You acted quickly and caught it early. You will probably now have a "wide local excision" (WLE) to make absolutely certain that they got it all and then regular follow-ups with a melanoma dermatologist for quite a while. You and your baby will both be fine. 

Brian is right, Janner is our melanoma guru especially for early stage melanoma like yours is. Hopefully, she will chime in soon.

In the meanwhile, let me put things in context. The three most important details in a path report are: 1) Breslow depth (how deep the melanoma is growing into your skin), 2) mitotic index (how fast the cells are dividing), and 3) ulceration (whether the lesion has ruptured). Your Breslow depth of 0.4 mm is thin. Most doctors don't worry about it until a lesion is at least 0.76 or 1.0 mm. Some people are diagnosed with Breslow >4.0 mm and some even > 8.0 mm. So yours is thin, which is good. Your path report does not mention mitotic index so I assume that they didn't see any actively dividing cells under the microscope. That is also good. And your lesion is not ulcerated. Again, good.

It sounds like you had what you might call a "funny-looking mole" (non-cancerous dysplastic nevus) that was just starting to turn cancerous. You acted quickly and caught it early. You will probably now have a "wide local excision" (WLE) to make absolutely certain that they got it all and then regular follow-ups with a melanoma dermatologist for quite a while. You and your baby will both be fine. 

" was just starting to turn cancerous"

I don't know that I agree with that, as this was invasive, not in situ.  Melanoma with any depth, such as 0.4mm, means it was invasive and penetrated the epidermis into the dermis.  Although thin, which is good, still invasive.  Severly atypical or in situ I might agree is "just starting to turn cancerous"

The other thing you might ask about if you don't see mentioned in pathology is regression.

" was just starting to turn cancerous"

I don't know that I agree with that, as this was invasive, not in situ.  Melanoma with any depth, such as 0.4mm, means it was invasive and penetrated the epidermis into the dermis.  Although thin, which is good, still invasive.  Severly atypical or in situ I might agree is "just starting to turn cancerous"

The other thing you might ask about if you don't see mentioned in pathology is regression.

" was just starting to turn cancerous"

I don't know that I agree with that, as this was invasive, not in situ.  Melanoma with any depth, such as 0.4mm, means it was invasive and penetrated the epidermis into the dermis.  Although thin, which is good, still invasive.  Severly atypical or in situ I might agree is "just starting to turn cancerous"

The other thing you might ask about if you don't see mentioned in pathology is regression.

To be accurate Breslow refers to the thickness of the tumor and the depth (or penetration into the skin) is the Clark level. In your instance both are at the lower (good) end of the scales. In spite of the early character of this melanoma I would not take it lightly. The descripton of the margins needs to be discussed. Sometimes a reexcision is done to ensure adequate margins.Thin melanomas in young individuals can sometimes be more aggressive. All the more reason to seek out a melanoma specialist. Martin Mihm is one of the best dermatopathologists in the world. You have started at a good place.

“Thin melanomas in young individuals can sometimes be more aggressive.”

More so, for some reason, than others?  Why would that be?

There has been debate in the literature about whether to do an SNB in thin melanomas (less than 0.76-1mm). However, some data have shown a positive rate as high as 5% in young patients with thin lesions. Attempts have been made to find distinquishing characteristics. The presence of a mitotic rate greater than 0, a vertical growth phase, clark level 4, male sex, and age less than forty years may all be factors. Below are two relevant references which support this counter intuitive phenomena.

Incidence of Sentinel Node Metastasis in Patients With Thin Primary Melanoma (#1 mm) With Vertical Growth Phase

Abstract

where do you see " age less than forty years"?

I think you will find the statistics in this reference.

Sorry the fiqure would not post. If you access the article it is figure 1a.

Sorry the fiqure would not post. If you access the article it is figure 1a.

Sorry the fiqure would not post. If you access the article it is figure 1a.

I think you will find the statistics in this reference.

I think you will find the statistics in this reference.

where do you see " age less than forty years"?

where do you see " age less than forty years"?

There has been debate in the literature about whether to do an SNB in thin melanomas (less than 0.76-1mm). However, some data have shown a positive rate as high as 5% in young patients with thin lesions. Attempts have been made to find distinquishing characteristics. The presence of a mitotic rate greater than 0, a vertical growth phase, clark level 4, male sex, and age less than forty years may all be factors. Below are two relevant references which support this counter intuitive phenomena.

Incidence of Sentinel Node Metastasis in Patients With Thin Primary Melanoma (#1 mm) With Vertical Growth Phase

Abstract

There has been debate in the literature about whether to do an SNB in thin melanomas (less than 0.76-1mm). However, some data have shown a positive rate as high as 5% in young patients with thin lesions. Attempts have been made to find distinquishing characteristics. The presence of a mitotic rate greater than 0, a vertical growth phase, clark level 4, male sex, and age less than forty years may all be factors. Below are two relevant references which support this counter intuitive phenomena.

Incidence of Sentinel Node Metastasis in Patients With Thin Primary Melanoma (#1 mm) With Vertical Growth Phase

Abstract

“Thin melanomas in young individuals can sometimes be more aggressive.”

More so, for some reason, than others?  Why would that be?

“Thin melanomas in young individuals can sometimes be more aggressive.”

More so, for some reason, than others?  Why would that be?

To be accurate Breslow refers to the thickness of the tumor and the depth (or penetration into the skin) is the Clark level. In your instance both are at the lower (good) end of the scales. In spite of the early character of this melanoma I would not take it lightly. The descripton of the margins needs to be discussed. Sometimes a reexcision is done to ensure adequate margins.Thin melanomas in young individuals can sometimes be more aggressive. All the more reason to seek out a melanoma specialist. Martin Mihm is one of the best dermatopathologists in the world. You have started at a good place.

To be accurate Breslow refers to the thickness of the tumor and the depth (or penetration into the skin) is the Clark level. In your instance both are at the lower (good) end of the scales. In spite of the early character of this melanoma I would not take it lightly. The descripton of the margins needs to be discussed. Sometimes a reexcision is done to ensure adequate margins.Thin melanomas in young individuals can sometimes be more aggressive. All the more reason to seek out a melanoma specialist. Martin Mihm is one of the best dermatopathologists in the world. You have started at a good place.

I guess I'm wondering what " careful follow up of patient" means. . many doctors wouldn't do bloodwork nor scans for your stage (1A), so other than dermatologist appointments and checking lymph nodes at physicals, what else is the followup?

I guess I'm wondering what " careful follow up of patient" means. . many doctors wouldn't do bloodwork nor scans for your stage (1A), so other than dermatologist appointments and checking lymph nodes at physicals, what else is the followup?

I guess I'm wondering what " careful follow up of patient" means. . many doctors wouldn't do bloodwork nor scans for your stage (1A), so other than dermatologist appointments and checking lymph nodes at physicals, what else is the followup?

Mart1 is essentially a stain – a method to make identifying melanocytes easier.  You are stage 1a.  You need a derm.  You need a wide local excision (WLE).  You don't need blood work, an oncologist or anything else.  You do need careful follow up because moles change during pregnancy.  Most melanoma warriors only have one primary melanoma.  Are your other moles similar to each other?  You are really looking for the ugly duckling.  Watch for CHANGE, that is the most important thing for your other moles.  In the meantime, try not to stress this.  (Not easy, I know).  But this is truly a very low risk lesion and your prognosis is extremely good.

Mart1 is essentially a stain – a method to make identifying melanocytes easier.  You are stage 1a.  You need a derm.  You need a wide local excision (WLE).  You don't need blood work, an oncologist or anything else.  You do need careful follow up because moles change during pregnancy.  Most melanoma warriors only have one primary melanoma.  Are your other moles similar to each other?  You are really looking for the ugly duckling.  Watch for CHANGE, that is the most important thing for your other moles.  In the meantime, try not to stress this.  (Not easy, I know).  But this is truly a very low risk lesion and your prognosis is extremely good.

Mart1 is essentially a stain – a method to make identifying melanocytes easier.  You are stage 1a.  You need a derm.  You need a wide local excision (WLE).  You don't need blood work, an oncologist or anything else.  You do need careful follow up because moles change during pregnancy.  Most melanoma warriors only have one primary melanoma.  Are your other moles similar to each other?  You are really looking for the ugly duckling.  Watch for CHANGE, that is the most important thing for your other moles.  In the meantime, try not to stress this.  (Not easy, I know).  But this is truly a very low risk lesion and your prognosis is extremely good.

Many oncologist won't even see stage 1a patients.  They treat active disease.   I prefer a good derm to work with.  One you have the surgery, you will be considered NED – no evidence of disease.  There really is no "cure" for melanoma as it could come back many years later.  But for stage 1a, the survival rates are in the high nineties – say 97% or thereabouts.  It isn't 100% and there isn't a five year "I'm free".  Your risk is extremely low, but not gone.  Your risk of getting another primary is higher, about 8-9%.  So the key is to be realistic about your odds.  They are good.  That is the main thing to live by.  But you also need to be vigilant..my motto is "vigilant but not paranoid".  This gets easier with time.  I have a private yahoo email list for stage one individuals if you are interested.  All have been in your shoes at one time.  If you are interested, click on my name and go to my profile and email me.

janner

Many oncologist won't even see stage 1a patients.  They treat active disease.   I prefer a good derm to work with.  One you have the surgery, you will be considered NED – no evidence of disease.  There really is no "cure" for melanoma as it could come back many years later.  But for stage 1a, the survival rates are in the high nineties – say 97% or thereabouts.  It isn't 100% and there isn't a five year "I'm free".  Your risk is extremely low, but not gone.  Your risk of getting another primary is higher, about 8-9%.  So the key is to be realistic about your odds.  They are good.  That is the main thing to live by.  But you also need to be vigilant..my motto is "vigilant but not paranoid".  This gets easier with time.  I have a private yahoo email list for stage one individuals if you are interested.  All have been in your shoes at one time.  If you are interested, click on my name and go to my profile and email me.

janner

Many oncologist won't even see stage 1a patients.  They treat active disease.   I prefer a good derm to work with.  One you have the surgery, you will be considered NED – no evidence of disease.  There really is no "cure" for melanoma as it could come back many years later.  But for stage 1a, the survival rates are in the high nineties – say 97% or thereabouts.  It isn't 100% and there isn't a five year "I'm free".  Your risk is extremely low, but not gone.  Your risk of getting another primary is higher, about 8-9%.  So the key is to be realistic about your odds.  They are good.  That is the main thing to live by.  But you also need to be vigilant..my motto is "vigilant but not paranoid".  This gets easier with time.  I have a private yahoo email list for stage one individuals if you are interested.  All have been in your shoes at one time.  If you are interested, click on my name and go to my profile and email me.

janner

" it could come back many years later"

Is that because it never really left to begin with after surgery?  Or because in a small % of people cells broke off and traveled before the WLE?

" it could come back many years later"

Is that because it never really left to begin with after surgery?  Or because in a small % of people cells broke off and traveled before the WLE?

" it could come back many years later"

Is that because it never really left to begin with after surgery?  Or because in a small % of people cells broke off and traveled before the WLE?

Is that to say 97% are cancer free "cured" after surgery, but about 3% aren't?  Or is that to say 100% aren't cancer free "cured" after surgery, but in 3% what has been left behind goes on to cause problems later?  I'm confused.

Is that to say 97% are cancer free "cured" after surgery, but about 3% aren't?  Or is that to say 100% aren't cancer free "cured" after surgery, but in 3% what has been left behind goes on to cause problems later?  I'm confused.

Is that to say 97% are cancer free "cured" after surgery, but about 3% aren't?  Or is that to say 100% aren't cancer free "cured" after surgery, but in 3% what has been left behind goes on to cause problems later?  I'm confused.

If it can come back many years later, 10 years, 15 years, etc. . then what it the point of a 5 year survival rate?  Sure, maybe it's high, but that's because it takes longer than 5 years to come back, seems like a misleading stat.

Survival curves always get better over time.  So yes, there is a small percentage that have their melanoma return years later.  There is no "you are cured after 5 years".  Again, the curves improve over time.  The further out you are, the better your odds.  Nothing is a guarantee.

Survival curves always get better over time.  So yes, there is a small percentage that have their melanoma return years later.  There is no "you are cured after 5 years".  Again, the curves improve over time.  The further out you are, the better your odds.  Nothing is a guarantee.

Survival curves always get better over time.  So yes, there is a small percentage that have their melanoma return years later.  There is no "you are cured after 5 years".  Again, the curves improve over time.  The further out you are, the better your odds.  Nothing is a guarantee.

If it can come back many years later, 10 years, 15 years, etc. . then what it the point of a 5 year survival rate?  Sure, maybe it's high, but that's because it takes longer than 5 years to come back, seems like a misleading stat.

If it can come back many years later, 10 years, 15 years, etc. . then what it the point of a 5 year survival rate?  Sure, maybe it's high, but that's because it takes longer than 5 years to come back, seems like a misleading stat.