My diagnosis/pathology for my new friends to evaluate

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4/12/2018 2:22pm
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Replies: 7

Just got this Tuesday of this week. Will have wide excision within 30 days of biopsy as I saw a bit of data that odds go down 5% after 30 days, and my consult with my surgeon is this coming Monday. How am I looking experts in the group?  I think my only concern is that while I will be hyper prudent, (and vigilant going forward)  I'm not overly concerned. Also curious if anyone thinks I should have the Sentinel Lymph Node Biopsy. Thanks everyone, I am grateful to find this lace, even if we'd all rather not be here!

Skin, right posterior shoulder, shave biopsy:
-- Invasive malignant melanoma, completely confined within
representative tissue planes examined. (See Diagnosis Comment).


Procedure, specimen site and laterality: Right posterior shoulder,
shave biopsy.
Type: Superficial spreading.
Maximum tumor thickness: 0.41 mm.
Ulceration: Not present.
Margins: Melanoma in situ is less than 1 mm from biopsy margin.
Mitotic index: < 1/mm^2.
Microsatellitosis: Not present.
Lymph-Vascular Invasion: Not present.
Perineural invasion: Not present.
Tumor-infiltrating lymphocytes: Non-brisk.
Associated nevus: Present.
Tumor regression: Not present.
pTN: pT1a. 

Pretty low risk lesion.  A SLNB is not indicated for a lesion this thin.  Timing hasn't been shown to be an issue in the studies I've read, especially since you actually have clear margins with the biopsy itself.  Just get it done, be sun smart, watch the excision area for any pigment regrowh, watch existing moles for change or new moles for "ugly duckling". 

Thanks for this. I do get that mine is low risk ad appreciate the set of extra eyes on that, I just haven't unpacked all of the terminlogy yet to know if some of the other findings are in the "better" or "worse" category

Here are two recent articles that site studies on timing. I think they are important to share as they do source the studies and have impacted my expediency on this:

If it is stage 1a, generally the other factors are all considered good.  Nothing in your lesion is unexpected.  As for understanding every detail, it really doesn't help in terms of overall survival.  The factors that actually are used to stage you (depth, ulceration) have been shown to have the most statistically significant value. 

Thanks, Janner. I wonder why location isn't given greater emphasis or study? You'd think your head/face/neck area are so much more vascular they would have worse results than an extremety. 

They are considered to have worse prognosis in some studies, but they haven't shown the same statistical significance as the other factors used in staging.  Men are typically considered to have a worse prognosis too. The guidelines change every few years or so.  Previously, mitosis was considered significant enough to determine staging.  In the latest guideline, that has been removed. I think some of that revolves around mitosis being somewhat subjective - it depends on where you look.  This is evolving and as more data comes in, things are updated.  You can find studies about many of the different aspects but the data has to be large and telling to be adopted into staging.

Men probably have worse prognosis than women because men are generally stupid and slow. 

I'm not touching that one, lol!