So many questions
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So many questions

› Forums › Cutaneous Melanoma Community › So many questions

  • Post
    • March 5, 2017 at 7:00 pm
    messedmelanocytes
    Participant

      Hi Everyone,

      Firstly thanks to all of you for being here, you have anchored my sanity for the psat few weeks since hearing the words MM from my doctors office. I have been roaming around the internert but mostly on this site to reeducate myelf about MM.

      My first education on this subject was back in 1995 when my Father died of this illness. I was in my 30s then, I was told I have his skin so this disease will come one day for me too. So, I started visiting dermatologists annually and had many biopsies of moles, all of which were negative. After ten years of annual visits and negative biopsies I dropped off in both my visits to dermatologists and my attempts to understand MM. I had always been sun smart, wore sunsreen, knew the right ones to use, never had a sunburn, never visted a tanning bed, avoided mid day sun or prolonged exsposure. So, I fugured I had out smarted the threat.

      Fast forward to Jan 2017 at my annual physical my GP recommended i see a dermatoogsit for two moles she didnt like the look of. One biopsy came back as MM in situ and the other as dysplatic nevi. Wide excision was recommended for both. Last month, the wide excision showed them both to be MM in situ. I dont fully understand the pathology report which says:

      Microscopic:

      1) An increased number of abnormal melanocytes disposed as solitary units and in nests are present at the dermo-epidermal junction and above it.

      Diagnosis:

      1) Melanoma in Situ, residual, completely excised

      2) Scar tissue , Negative for Malignancy  

      Note: 1) This neoplasm is located 3.8 mm from the closest lateral margin 

      The plastic surgeon said I must go back to have more removed from #1 because the margin in not wide enough.

      My questions on the pathology report, if anyone knows are, 

      1)what does the residual term mean for #1 site?

      2) what is the refernce to scar tissue for #2 site? Why is it negative for malignancy? Does that mean the biopsy saying MM was wrong? Or is it possible that the biopsy reomved all of the malignant melanocytes? Why does it not say how wide the margins are and no mention of a neoplasm?

      3) why is there a microspcoic description for site #1 but not for site #2?

      4) does the reference to the dermo-epidermal junction mean that this was almost a stage 1 rather than an in situ?

      Outside of the pathology reports, I also have some in general sort of questions.

      1) Should I consider genetic testing, would that be of any benefit to me? My Father's father died of prostrate cancer and  he also had a brother die of pancreatic cancer. If I understand the genetic information on MM, these are all involving similar gene mutations.

      2) How can there be a link between MM and the immune system not recognizing the cancerous cells if the circulatory system does not meet the epidermis where the Melanoma in situ resides ?     

      3) Can the process of biopsy and excision introduce the malignant melanocytes to the circulatory system increasing the risk of them travelling to other organs?  

      4)  Going foreward what lifestyle changes do most patients make? Do you avoid all sun, pretty much avoiding going outside at all when it is sunny? Is it too late now to benefit from a change of habits for me?

      I am going back to the dermatologist this week to have more moles looked at and to take mole mapping pictures i have that were done 20 yrs ago. I will feel muich beter if she says she sees no additional sites of concern, somehow though, I think this is unlikely. So, then I will wait and hope that if they are biopsied there are no more mm in situ or worse found.  

      I know I am lucky because what has been found was caught early, I am worried though about a few other moles now, which I read is a common reaction at my stage in this situation. It is taking a really big toll on me mentally. If I didn't have the family history I would feel like I will be one of those people who deal with this and then never hear from MM again. But because of my genetics it is so hard to be optimistic, I feel like I'm stanidng in front of a firing squad just waiting to hear the guns fire.

      I want to exploit my good fortune in find this early, but im not sure how to best do that.

      Thank you all for being here, your electronic hand holding is increadibly valuable.   

        

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    • Replies
        • March 5, 2017 at 8:01 pm
        stars
        Participant

          It's a kind of inconsistent story – if both were completely excised, one diagnosed as dysplastic and teh other melanoma, then the diagnosis shouldn't change with a clean WLE. It's unclear whether the path report you posted is for #1 or #2, but no matter, the answers are the same:

          1) don't know what 'residual' means and it doesn't really matter, it's gone. Melanomas need a huge margin of healthy skin removed – 5mm minimum – I think it's just saying that the right amount of healthy skin is now gone.

          2) the WLE takes a safe margin of usually healthy skin – it's literally just carving out healthy skin on the off chance there is a few melanoma cells in there. It is saying, as you'd expect, that everything was excised with the first procedure and the WLE is clear. This is the usual result.

          3) microscopic description for 2 and not for 1 is what you'd expect if 1 was a simple dysplastic nevii that is no longer interesting to anyone.

          Short answer: I suspect you have had one dysplastic nevii (which can still need a further excision of skin, usually a 5mm margin, so if there's not enough margin they sometimes re-excise to 5mm) and one in situ melanoma whch always needs a 5mm excision margin – if it's only 3.8mm from the edge then more skin would have to be taken.

          As for general questions:

          1) No, in your situation genetic testing is not really warranted – you could get it done privately and pay for it but I think it will be of no avail

          2) IDK

          3) Some people would say that 'cutting' into cancer makes it spread – those same people would usually not vaccinate their kids and have a million other anti-science stances. It's gold standard, right now, in melanoma to not only excise the melanoma but a margin of healthy skin all the way around it. What's the alternative? Let the thing take root like a bit carrot growing into important parts of your body? Forget worrying about this, your treatment is gold standard.

          4) the biggest lifestyle change is mental – both appreciating your own mortality but not losing the plot – in my case I was already very 'sun safe' but still got melanoma thanks to a childhood in the sizzling sun – I just continue my normal level of sun safety – which in Australia means avoiding super hot midday sun, covering up and slapping on sunscreen.

          All you can and should do with an in situ diagnosis is go for those skin checks, yearly or perhaps 6-monthly if it makes you feel beter (not clinically justified, but if you are super keen you can do that).

           

          • March 5, 2017 at 8:41 pm
          messedmelanocytes
          Participant

            Thank you for your comments. I appreciate your taking the time to address my questions.

            I will try to clarify what I wrote in case others are confused.

            Pathology report is for two sites.

            Everything on the report referred to as 1) is for site one on my upper left arm. Site 2) refers to a second site on my right calf.

            Both sites were punch biopsied by dermatologist and sent for analysis. Results of biopsy said site 1 was atypical dysplastic nevi. Site 2 was mm.

            Dermatologis advises I get WLE by plastic surgeon.

            Plastic surgeon does WLE sends excised tissue off for analysis.

            Results of WLE, if I understand the report correctly, says sie 1 everything good and gone. Site 2, not atypical displastic nevi as reported adrer biopsy, it is mm also.

            Plastic surgeon says he did not take enough tissue becuse he thougth he was excising for an atypical nevi when in fact it was also mm. 

             

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