Blond and fair

I got the results… unfortunately it is a malignant melanoma. Here is the path report…

Breslow depth: 5mm 

histological subtype: spitzoid

clark level II

ulceration = not identified

dermal mitotic index (per 2mm) = 0

Tumor infiltrating lymphocytes: present, focally brisk

regression: not identified

vascular or lymphatic invasion: not identified

perineural invasion: not identified

microsatellites: not identified

predominant cell type: epithelioid

solar elastosis: present (mild)

nearest lateral margin to in situ component: 0

margins: melanoma in situ involves the lateral margins

pathalogic staging: pT1a pNx (AJCC 8th edition)

next step is a consult with a surgeon and a subsection is being sent for another test by Castle (testing company) called Decision Dx which is supposed to help figure out how aggressive it is which would inform whether or not a SLNB is needed in addition to the re-exision. Since it is on my shin, they may have to do skin grafting…

I'm also getting a second opinion at UCSD…well, hopefully. I want their cancer center to read the pathology too. it seems like there is a lot of subjectiveness involved.

Thank you so much for the feedback and sharing your daughter's experience. That's really helpful. I think now I understand much more about the genetic testing piece. the tumor supressor gene makes complete sense. Yep, patience and just wait to find out more!

I got the results… unfortunately it is a malignant melanoma. Here is the path report…

Breslow depth: 5mm  

histological subtype: spitzoid

clark level II

ulceration = not identified

dermal mitotic index (per 2mm) = 0 

Tumor infiltrating lymphocytes: present, focally brisk

regression: not identified

vascular or lymphatic invasion: not identified

perineural invasion: not identified

microsatellites: not identified

predominant cell type: epithelioid

solar elastosis: present (mild)

nearest lateral margin to in situ component: 0

margins: melanoma in situ involves the lateral margins

pathalogic staging: pT1a pNx (AJCC 8th edition)

next step is a consult with a surgeon and a subsection is being sent for another test by Castle (testing company) called Decision Dx which is supposed to help figure out how aggressive it is which would inform whether or not a SLNB is needed in addition to the re-exision. Since it is on my shin, they may have to do skin grafting…

I'm also getting a second opinion at UCSD…well, hopefully. I want their cancer center to read the pathology too. it seems like there is a lot of subjectiveness involved. 

Can't thank you enough for this information. I feel much better equipped with at least some basic knowledge now. I don't want to find myself sitting in a dermatologist's exam room and being told to just do something without any understanding of what my actual options are or what to ask. I will come back and post when I find out more information. I really appreciate the input here! 

Thank you. That's interesting to hear you went with an SLNB. I'll be curious to see if that's something they discuss with me depending on the final findings. My sense is that even with the final molecular study there won't be a 100% certainty. once they did the SLNB, were you staged? Or was it just deemed very early and you caught it in whole by doing the CLND? Also, in deciding whether to do the SLNB, did you have any genetic testing (as the next poster mentioned)?