Husband Diagnosed with Melanoma

Posted By
3/18/2014 1:14pm
View other posts by
Activity
Replies: 4

Hi, my husband is 33 and was diagnosed a couple weeks ago with melanoma.  It was a mole I had noticed changing on his neck and took his to get seen about with a dermatologist. I just thought I might get a little more information from yall that have gone threw this.  We have no insurance so as of right now we cannot get the SNB, chest xray or ct scan done yet.  We are young with 2 kids and just the surgery for wide excision broke us.  He had a shave biopsy of the mole.  Here are the results.  

Malignant Mel: Margins involved, Thicknes: at least 0.90mm, At least clarks level 4, surface ulceration absent, surface erosion present, mitotic rat 1 permm, regression absent, tumor infiltrating lymphocyte absent, host response present, non brisk, microscopic satellites not identified, angiolymphatic absent, angiotropism absent, neurotropism absent, precussor lesion present dermal nevus remnant. 

Then had the wide exision and here are those results. 

residual malignant melanoma, margins free, thickness 1mm, clarks level 4. 

The dr wont say if we caught this in time.  To me if free margins, then hes cancer free right??  We are in process of trying to get some ins soon to get other test ran.  Whats the chance of this spreading if they did get clear margins from the last exision.  This was on his neck, goes in next monday to get stitches taken out.  Had about 50 stitches and about a 3.75" cut.  Thanks in advance for comments, suggestions and help!   

 

Unfortunately, clear margins aren't a guarantee of anything.  As the melanoma grows deeper, it has access to lymph vessels and/or blood vessels.  So a melanoma cell might escape into the lymph stream (typical scenario for spread) before you had the WLE.  Clean margins really only means the initial tumor has been removed.

Since your husband has already had the WLE, he really won't be able to have the SNB later.  The SNB really needs to be done first.  The SNB tracks the drainage path from the original lesion to the first lymph node in the chain.  Once you remove the tissue in the WLE, then it is possible for the drainage path to be altered rendering the SNB useless.  So ultrasound (cheaper alternative than the other scans), scans or manual monitoring by a specialist is really where you need to be.  Not all docs do scans - just so you know. 

Getting insurance is a big deal now.  Your husband needs good followup - hopefully from someone who knows a lot about melanoma.  He might consider ultrasound monitoring of the neck lymph nodes to monitor if some grow.  This is not a disease you want to deal with and not have insurance.  Treatments (if he happened to progress) are extremely expensive.  Since you don't know the depth of his original lesion (depth was cut in two and you can never determine the actual depth now), this makes things harder to stage.  I don't want to scare you here, that's not my intent.  But I think you do need to realize how serious this can be.  You do need to follow up with someone who understands melanoma - oncologist, not dermatologist.  Your husband may never deal with melanoma again, but you don't want to be caught without insurance if he does.

Best wishes,

Janner

Janner, thanks so much for your reply.  The Dermatologist is in a skin cancer institutution along with oncologist.  He never referred or told us we need to see an oncologist.  The dr has treated over 3000 skin cancers with Mohs also.  He really seems knowledgable, but he never said he needed the SNB before the WLE.  He just said the WLE needed to be done asap.  What confuses me is why the biopsy shows no sign of the cancer in the lymph nodes or vascular.  Is that just a guess?  Is it normal for the biopsy to show that, yet the cancer really has spread?  This is the most devastating thing I have ever gone threw.  We have been married 11 years and I never imagined at 30 years old, I would be told my husband has cancer :( I was hoping with the clear margins that we were done but i guess we are not done.  I have it stuck in my mind he is cancer free but honetly I guess we dont know.  We are trying to get some assistance from our local hospital or even see if they can preform the needed testing and set up payment plans.  We live in texas and are dealing with the Obama Care which is crap insurance untill you reach the 12k deductable.  He goes next monday to have stitches removed and I guess the dr will talk to him more about the next step.  Is the breslow and clarks level i listed, on a scale of 1-10 how severe is it?  I know its severe just wondering like how high risk that was. 

THe biopsy is only skin.  The lymph nodes are glands in the neck and are not included in the biopsy material.  Sometimes, you will see evidence that melanoma might be in the lymph/blood vessels from the biopsy, but most often that is not the case.  Lymph nodes are essentially garbage cans - collect and filter stuff sent to them.  So melanoma may go to the lymph node and take up residence there.  But again, it may leave no evidence that this has happened in the biopsy tissue.  Let's say this, it is more common to NOT have evidence of spread at the primary tumor but then see melanoma in a lymph node than it is to see some evidence of spread from the pathology.  That's the whole point of doing the SNB.  See if it has spread.  If that could be determined from the biopsy/WLE, there would be no need for the SNB.

Clarks Level goes from 1 (top of skin) to 5 (fat layer) and yours is 4.  However, Clarks Level wasn't found to be that great a determining factor in prognosis and has been replaced by Breslow depth as the key indicator.  So typically, the SNB is done if a lesion is deeper than 1mm or if the mitosis is > 0.  There is some variation on this depending on other factors and the institution.  Since your husbands lesion was "at least 0.9mm", I'm surprised the SNB was not discussed.  Maybe because of insurance?  The problem with your husband's lesion is you will NEVER know the original depth.  (Read my reply on the 2nd page in the thread titled "Another recently diagnosed" to help you understand lesions that have been bisected).  So it is really hard to comment on the depth because it really isn't known.  I can say his lesion is probably considered borderline intermediate thickness.  It could very well be he will never deal with melanoma again.  Yet there are people with similar lesions who do have a recurrence or find it in their lymph nodes.  He's in the depth region where it is honestly really hard to guess.  That's why I think it is important to be with a good doc.  Sorry I can't be more help.  Write down all your questions so you don't forget any when you see the doc!  And keep us updated on what happens.

Best wishes,

Janner

Hi Aundrea - I'm so sorry you are going through all of this.  All the folks on this site are very helpful and understanding.  Lots of good information.  We all know what you are going through.  Janner has given you some good advice.  Melanoma is a tricky beast and needs constant monitoring no matter what stage. 

I see that you live in Texas.  I know you are dealing with insurance issues, but wanted to suggest you go to MD Anderson in Houston.  They have one of the best facilities in the US for dealing with Melanoma.

Hang in there and try to stay positive.  You have probably already read this if you are visiting this site, but read the 'Newly Diagnosed' section under 'Understanding Melanoma.'  There's alot of good information there.

http://www.melanoma.org/understand-melanoma/newly-diagnosed

Wishing you the best - Julie