Diagnosed Stage 1A, next steps

Posted By
8/21/2011 8:46pm
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Replies: 5

I recently had WLE and SLNB; thankfully nodes were negative and margins are clear.  My surgery was preformed by surgical oncologist and plastic surgeon.

I am in the Hampton Roads area of Virginia (Newport News/Williamsburg) and my surgeon, Dr. Michael Peyer is the melanoma specialist in our area.  He recommends that I see him every 6 mos for 5 years as well as every 6 mos for skin checks with dermatologist.  This is the second time in 4 years this has melanoma has come back to the same spot and I'm concerned about reoccurrence, not in the same area as they took out alot of tissue, but in other areas of my body.

Any feedback of anything else I should do would be greatly appreciated.  I'm very diligent about sunscreen use now (I was not in the past), however at 44 years old this is a little late as I know I did alot of damage when I was younger.

As always, thanks for all your input.

What your Dr has suggested sounds normal. If you have many moles you ought to take digital photos of them so you can watch for change.  Many clinics do this now and they can refer to them, having a set at home gives you something to refer to.

While you have to be vigilent with 2 melanoma's you also need to remember to live life to the fullest  I've had 6 primaries and many dysplastic nevus. I have gone to the derm every 3 months for years. I am now stage IV but still enjoying and starting new adventures.

Linda  Stage IV since 06, currently NED,  dealing with mel since 1979

DonW - (8/21/2011 - 10:48pm)

Hi, Nicole. What did you mean by it being the second time melanoma has come back in the same spot? If it was exactly the same spot, I would be concerned that this was a skin recurrance, not a primary. Did they check carefully in the the pathology for that? It's not common for melanoma to come back in the same spot and be two different primaries.

Can you be a little more specific?  You've had an original primary with a WLE, and a local recurrence with a WLE previously, and now a WLE/SNB for another local recurrence?  Since you haven't created a profile, it's hard to know exactly what you've gone through.

To date, surgery is still the best choice.  It sounds like you've had plenty of surgeries so far.  Hopefully, since your SNB was negative, you are still dealing with localized disease.  Other than surgery, there's not a whole lot you can do at this point.  If they still consider you stage I, you wouldn't qualify for any clinical trials either.  There is really nothing else you can do but see your doctors and monitor your scar area and other moles.

Best wishes,

Janner

Sorry I wasn't clear...here's the whole story...

In 2005 I had a mole removed from my left calf, it was early stage melanoma (in situ) and my derm said it was gone, not to worry.  She did not recommend skin checks and unfortunately I didn't think about it again.

This December (2010) I noticed a mole coming back in same area, it itched and bled.  I didn't get in to derm till April 2011 and they did punch biopsy - first path said malignant melanoma & they sent to UVA for another opinion, which was atypical nevi.  I had a conservative excision done by plastic surgeon (May 2010)  and he sent out for path report (different pathologist) and molecular testing.  Path came back malignant melanoma and molecular testing cam back abnormal.  This was all sent back to UVA (Dr. Patterson) who stayed strong with his diagnosis of atypical nevi.  At this point, my derm sent me to surgical oncologist (July 2011).  Once I got to him and he realized it was a reoccurrence, he recommended PET scan, SLNB and WLE to get to the bottom of this.  I have to say, I've felt much better under the care of the surgical onc as he is taken this much more seriously and has been more proactive than any other dr I've seen.

Janner - (8/22/2011 - 12:13pm)

It is extremely difficult to read pathology through scar tissue - that is probably the biggest problem you've encountered and the reason for different diagnoses.  Any melanocytes will appear like melanoma through scar tissue, and it is almost impossible to differentiate between benign, atypical and melanoma at that point.  The scar tissue confuses the issue.

So now, you continue to watch the scar area for pigment regrowth.  New pigment doesn't have to mean melanoma.  I have several freckles that have grown through a couple of WLEs and we know they are just that - freckles.  But any pigment regrowth should be shown to a doctor.  Continue to watch your other moles for change as well.

Best wishes,

Janner