Follow-up to Bay Area Dr specialist includes Path report

Posted By
5/3/2014 12:25pm
Replies: 3

Thanks agin for the info on Dr's in Northern California Bay Area. My mom's HMO Dr is recommending she see an oncologist conncted with O'Conner hospital in San Jose. She was very insistent with my mom on this when my mom mentioned she would prefer Stanford and/or UCSF. I have called her insurance and it seems as though she can go out of network but procedures will need to be approved. Has anyone had problems with PPO and  getting approved for these services?

Am I right in thinking we need a melanoma specialist for this type of melanoma? This Dr was the same one who missed the mole last year and had to be very much asked for a referral this year to a skin clinic so my faith is minimal, but my mom said she was very convincing in trying to get her to see this particular oncologist who I can find no info on related to treatment of melanoma. 

I have included the path report and spent some time googling the resutls. From what I can tell it will the SNB that will give us more inforamtion. With these results is it worth it to push for the melanoma clinic? I am thinking for sure but this Dr has us second guessing. 

subtype- superficial spreading type...breslow thickness- 1.4...Clarks level-  IV

Ulceration- absent
Mitoses- 1 per square mm
tumor infiltrating lymphocytes- non brisk
regression- absent
microsatellitosis- absent
lymphovascular invasion- absent
margins- not involved
Thanks so much!!!

Do you know what the reasoning is behind the HMO doctor whanting your mother to see an oncologist?

If they're doing a SNB it sounds like they're figuring out how to stage (classify) it. I'm guessing that so far it would be some kind of stage 1 (if I am reading your message correctly) but they won't know for sure until they do an SNB to check whether they can see if it's spread to that lymph node? The SNB results if positive could change the staging, however. Do you think that is an accurate reflection of where things are at for your mother? 

I was also in an HMO at the times my stage I lesions were both detected. For both of those, I saw my dermatlogist, plus the surgeons who did the SNBs. But I was never referred to an oncologist either time. And my impression (right or wrong) is that's not particularly unusual for stage 1. I first saw an oncologist when scans (I had a chest XRay for an unrelated reason) picked up suspicious lesions elsewhere, i.e., not on my skin.

- Kyle


2 primaries; lung/brain mets in past; paratracheal lymph node currently; participating in  Opdivo/Lirilumab trial

Thanks  so much for your response Kyle. My Mom saw a Dermatologist who did the initial incisional biopsy. When he called to give my mom the news he said she would need further surgery. I am guessing the WLE and the Lymph biopsy.  HE referred her back to her primary who wants her to see this Oncologist. The thing is she actually has 3 tier insurance so we dont necessarly need to go threw the Medical Group associated with the HMO plan. Though would need approval. Trying to figure that  part out.  I am hopeful that if we go to stanford then the Drs and surgeons are part of the melanoma center so communicate. And also want to make sure they do addtional scans to check as from what I am reading the Lymph can be ok but lesions can exist elsewhere like in your case. Not sure on staging think we need more info. The Mole was very big.


Hope you are doing well with your situtation. 

Thanks again!!


I would recommend seeing a melanoma specialist.  In my opinion, the disease is tricky and you want the best available; especially if your insurance makes it a non-issue.  I'm not sure either why your primary would insist on this oncologist.  Seems a little odd (?).  I would at the least get a second opinion from a specialist.


good luck!

SA Stage 3a