Newly Diagnosed

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4/27/2014 10:52pm
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Replies: 5

Hello everyone. Thank you all for your efforts and support here. I apologize for the long post...

On 3/14/14 my GP noticed that I had a "dirty area" on my foot and didn't make much of a fuss about it. I had, on that day, a basal skin cell carcinoma that was on the back of my neck shaved off as well by the dermatology department. About three weeks later I got concerned about the discolored patch of skin on the sole of my foot because it didn't wash off and so I did a google search. I found similar pictures with those who were diagnosed as melanoma so I immediately contacted my doctor and they had another doctor look at it who was filling in for my doctor who was away on some continued educaton or training conferences. I do not know how long the patch of spotty brown/black areas have been on my foot. They are not raised or ulcerated.

My father died of metastatic melanoma in 1991 at the age of 61. I am now 54.

After the second visit and some photos they sent to the dermatology department, I received a call from the dermatologist the next day who wanted to see me immediately. I went in and she biopsied two spots on my foot with a 4mm hole punch. She punched and got most of the darkest spot, but left some behind because it was larger than 4mm, and another site nearby that had a different look to it, more like tar stains from the beach.

I received the biopsy results two weeks later and it came back as melanoma. I don't entirely understand the report. My BIL who is a doctor has told me that it's not in-situ, but it's about as good as it can get without being in-situ and that it looks like it's in my favor of being treated.

The dermatologist told me (and it's mentioned in the report along with a SLNB discussion) they would remove the area and graft some thigh skin off if it came back as melanoma (she's away right now too!) so I haven't spoken with her in a few days. She said I should be getting a call from the plastic surgeon to schedule the surgery, but I have yet to hear from that person. Do things normally take this long to get done? I'm going through Kaiser Permanente...and their seeming lack of aggressiveness is worrying me. They may be awaiting the results of a PET scan that I had done just two days ago to determine the timing for the surgery too. The Oncologist seemed to suggest that when I met with him.

I don't yet know what stage I'm in and am, obviously, worried given my family history and the large area on my foot that's discolored (about 2" x 2").

Here's what the pathology report says:

"The overal impression is that of a melanoma, which is Clark's level II, Breslow epth of 0.4mm, non-ulcerated with a tumor mitotic index of <1 per mm2. The in situ component and the invasive component are transected at side section epidermal and dermal margins. The diagnosis was rendered due to many atypical features seen in part B, and they include variation in nest sizes, confluence, adnexal involvement, diffuce pagetoid spread, and cytologic atypia. Part A is characterized by increased single units of atypical melanocytes with focal crowding/confluence. The proliferation is also transected at side section margins. Part A likely represents the edge of the melanoma.

In part A, there is an increased number of si ngle melanocytes along the junction. The meanocytes display hyperchromatic nuclie with irregular contour. Immunostains with Melan-A and MiTF highlight the slightly increased number of melanocytes along the junction with rare suprasal melanocytes. Nested forms are not seen.

In part B, there is an atypical meanocytic proiferation. There is a predominant junctional component wich is comprised of variably sized nests with bridging between the nests leading to confluence. The meanocytes are also involving acrosyringium. Pagetoid upward migration of single meanocyutes is seen across a broad front. The melanocytes display peomorphic nuclei with cherry red nucleoli and meanized cytoplasm. Similar atypical melanocytes are focally invading the dermis, and extend to the maximal depth of 0.4mm. Careful search reveal junctional mitotic activity; however fails to reveal conspicuous dermal mitoses. Melanin pigment is also seen difusely in teh conrified layer. Prominent pigment incontinence is also seen at the base."

Thank you for your help and support. I've not been able to go back to my day job because I'm just so depressed and can't focus. A 54 year old man should be such a cry baby!!!

Momrn5 - (4/27/2014 - 11:26pm)

Sorry for your diagnosis. I was diagnosed last September stage 3A at age 53.  I was so shocked. It was supposed to be a seborrhic keratosis.  I know exactly what you mean about not being able to focus at work.  But I forced myself too, I would have gone absolutely bonkers staying at home and stressing over it.  I did my fair share of crying too. I am still anxious when just sitting around " thinking. "  It gets easier but still not easy.  It's better for me if I keep my mind occupied with something other than melanoma so I try to keep really busy living my life.  With your small depth, no ulceration, low mitosis and Clark's level, I agree with your doctor, it couldn't get much better if you have to have Melanoma.  25 years ago my husband had a melanoma resulting in a very large skin graft on his back, they grafted a 5 inch by 5 inch area and took the tissue almost right down to his spine. So it's a deep graft.  He is still here with no other treatment.  As are many, many others.  

Janner - (4/28/2014 - 12:04am)

Yes, things often move this slow and it rarely affects prognosis.  Your BIL is correct.  It looks like this is a stage IA lesion.  Not in situ but the next best thing.  Typically a SNB or scans aren't done for this thin a lesion but since the biopsy is incomplete and given your family history, they appear to be treating this more aggressively than they would do for other stage IA lesions.  This really does have an excellent prognosis given what you know so far.  Remember this, every moment you let melanoma steal time away from your life, it wins!  Why let melanoma have that control over you?  Chances are good that after this surgery stuff, you will be fine.  There is nothing to indicate that you will share you fathers fate.  One day at a time, but try to live life and spit in melanomas face!  A new diagnosis is hard but try not to let it overwhelm you.  It gets easier when you have the surgery scheduled and not in limbo.  Everything does get better with a little time.  Hang in there!

janner

AnitaLoree - (4/28/2014 - 12:58am)

Hello R Grand: Good for you for paying attention to your foot discoloration and insisting on a followup.  We have been w Kaiser since leaving the Army in '63.  Lots of changes for the better over the years.  They have mostly (but not 100%) excellent doctors. If you think you are not currently with a proactive dermatologist, request a 2nd opinion and start seeing someone else.  If you don't understand your pathology report, your dermatologist owes it to you to go over it in language you understand. If there is a reason to think that you might have any metasteses (or risk of), request a medical oncologist consult.  This will benefit you in understanding your own inherited risk factors and lifestyle changes you can make if needed.  The resources are there within the Kaiser system.  With Kaiser it is absolutely essential that you advocate for yourself.  To be a good advocate for yourself you must be informed.  To be informed you are going to have to come up to speed on malignant melanoma.  The computer at your fingertips is your best friend for acquiring knowledge and, yes, it will take some time.  You will learn a lot from the folks who post here.  Wikipedia can be helpful, altho' not always 100% correct. Googling melanoma and 'xxxxx' will give you many links. Kaiser has a good basic melanoma patient pamphlet.  Ask your dermatologist/oncologist for melanoma info resources.  Most Kaiser Medical Centers have a library. One website I use is Medscape.com. Registration is simple and you can then select from a long list the subject(s) about which you would like to receive daily, weekly or monthly email updates.  From the Medscape web page you can access journal articles using search terms.

Re my husband's cancer management post op: after weeks of delays, cancellations, no significant treatment plan and our having to ask for radiation and chemo options, we got a new oncologist.  Right away the new oncologist got things rolling.  So, don't sit still for inadequate care.

I believe you will be energized and strengthened by learning all you can about melanoma.  It is normal to feel apprehension as you approach the age your Dad passed from melanoma since you now also have it.  But so much more has been learned and much better treatments are available.  Best wishes that the coming weeks are more hopeful and your medical team more helpful.  //anitaloree

 

 

rgrand - (4/29/2014 - 7:54pm)

Well, the PET scan results were negative. Tomorrow I meet with the surgeon to discuss the removal and graft on my foot tissue.

Is a SLNB something they always do? Does this procedure require hospital stay time? What about the skin graft, do I go home after surgery or do they keep me in the hospital? The area they will remove will probably be about 2" x 3". What kind of questions should I be asking my surgeon tomorrow about the next step?

Thank you all for your support!

JerryfromFauq - (5/12/2014 - 7:13pm)

I haven't been on much the past month, but am wondering how things are going with you?

I'm me, not a statistic. Praying to not be one for years yet.