MPIP: Melanoma Patients Information Page

The MPIP is the oldest and largest community of people affected by melanoma hosted through the Melanoma Research Foundation. It is designed to provide support and information to caregivers, patients, family and friends. Once you have been touched by melanoma—either as a patient or as a family member or friend of a patient—you become part of a community. It is not a community anyone joins willingly. But if you must be part of this group, you will find no better place to find the tools you need in your journey with this cancer, and the friends who can make that journey more bearable.

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Clinicopathologic Predictors of Sentinel Lymph Node Metastasis in Thin Melanoma

 

J. Clin. Oncol 2013 Nov 04;[EPub Ahead of Print], D Han, JS Zager, Y Shyr, H Chen, LD Berry, S Iyengar, M Djulbegovic, JL Weber, SS Marzban, VK Sondak, JL Messina, JT Vetto, RL White, B Pockaj, N Mozzillo, KJ Charney, E Avisar, R Krouse, M Kashani-Sabet, SP Leong

Research · November 15, 2013
 
 
 

TAKE-HOME MESSAGE

  • While SLNB is considered standard for management of melanoma with > 1 mm Breslow thickness, it is unclear whether patients with thinner melanomas should undergo this procedure.
  • This retrospective review finds that Breslow thickness > 0.75 mm predicts for +ve SLNB in this cohort and argues that this should be used as the sole deciding factor of whether to proceed with this procedure.

- Richard Bambury, MD

 
ABSTRACT

Purpose: Indications for sentinel lymph node biopsy (SLNB) for thin melanoma are continually evolving. We present a large multi-institutional study to determine factors predictive of sentinel lymph node (SLN) metastasis in thin melanoma.

Patients and Methods: Retrospective review of the Sentinel Lymph Node Working Group database from 1994 to 2012 identified 1,250 patients who had an SLNB and thin melanomas (≤ 1 mm). Clinicopathologic characteristics were correlated with SLN status and outcome.

Results: SLN metastases were detected in 65 (5.2%) of 1,250 patients. On univariable analysis, rates of Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, ulceration, and absence of regression differed significantly between positive and negative SLN groups (all P < .05). These four variables and mitotic rate were used in multivariable analysis, which demonstrated that Breslow thickness ≥ 0.75 mm (P = .03), Clark level ≥ IV (P = .05), and ulceration (P = .01) significantly predicted SLN metastasis with 6.3%, 7.0%, and 11.6% of the patients with these respective characteristics having SLN disease. Melanomas < 0.75 mm had positive SLN rates of < 5% regardless of Clark level and ulceration status. Median follow-up was 2.6 years. Melanoma-specific survival was significantly worse for patients with positive versus negative SLNs (P = .001).

Conclusion: Breslow thickness ≥ 0.75 mm, Clark level ≥ IV, and ulceration significantly predict SLN disease in thin melanoma. Most SLN metastases (86.2%) occur in melanomas ≥ 0.75 mm, with 6.3% of these patients having SLN disease, whereas in melanomas < 0.75 mm, SLN metastasis rates are < 5%. By using a 5% metastasis risk threshold, SLNB is indicated for melanomas ≥ 0.75 mm, but further study is needed to define indications for SLNB in melanomas < 0.75 mm.

Journal of Clinical Oncology
Clinicopathologic Predictors of Sentinel Lymph Node Metastasis in Thin Melanoma
J. Clin. Oncol 2013 Nov 04;[EPub Ahead of Print], D Han, JS Zager, Y Shyr, H Chen, LD Berry, S Iyengar, M Djulbegovic, JL Weber, SS Marzban, VK Sondak, JL Messina, JT Vetto, RL White, B Pockaj, N Mozzillo, KJ Charney, E Avisar, R Krouse, M Kashani-Sabet, SP Leong

 

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tarheel4242's picture
Replies 6
Last reply 11/18/2013 - 3:19pm
Replies by: Anonymous, sbrooks90, POW

Hi, I have been reading this site for a few months.Being diagnosed has hit me extremely hard. I was diagnosed at 37 with a lesion on my back. I want to share my path report and hope some can help me make better sense of it.

My Derm says this is extremely low risk, but in general its low risk to get....like 1 in 50 or so, so very small percentages don't give me too much confidence.

Hist type: SSM
Max tumor thickness: 0.27mm
Anatomic Level: 2
Ulceration: not identified
Periphial margins: uninvolved by melanoma in the plane sectioning
Deep margins: uninvolved by melanoma
Mitotic index: 0/mm2
Microsatellitosis: not identified
Lymph-vascular invasion: not identified
Perin.Invasion- not identified
Tumor infiltrating lymphocytes- present, non brisk
Tumor regression- not identified

Microscopic exam:

There is a circumscribed but asymmetrical compound melanocytic neoplasm, the epidermal component of which reveals focally markedly atypical epitheiloid melanocytes with abundant melanin throughout all epidermal layers. There is only a very focal invasion of the papillary dermis by few single and one small island of atypical melanocytes. There is a dense perivascular and nodular superficial lymphocytic infiltrate with numerous melanophages.

What do I make of this? Never makes note of growth phase. Also, is this saying that a large part of this was in situ?

Any and all help understanding this would really help. This has obsessed me to the point where it's all I think about. I am married with 2 kids and want to be around for a while. Thanks in advance for replies!

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Amanda's picture
Replies 9
Last reply 11/18/2013 - 11:03am

So my boyfriend Randy go the results of his 24 weeks scans and all his tumors continue to shrink, and nothing new!!  Also his vitiligo is showing up more. First his forearms, and now his shoulders have white patches, and the majority of his beard and mustache is white.  Hopefully Lambrolizumab will work so well for all of you as well.  Prayers to all.  

-Amanda-

"Give thanks in all circumstances"

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Jaryllane's picture
Replies 6
Last reply 11/18/2013 - 11:01am

I have been on the Lambrolizumab trial (MK3475) at The Angeles Clinic for four infusions now and had my first CT scan today.  My lungs, which previously had 5 small tumors, are clear; the tumors are gone!  This is such great news.  I hope the results are as good for others on this trial. 

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Anonymous's picture
Anonymous
Replies 3
Last reply 11/17/2013 - 9:01pm
Replies by: Tina D, Linny, washoegal

Hi,

Has anyone ever had a bump that looks like a white head or a pimple on the scar where the sentinal lymph nodes were removed? I have what looks like a pimple and a bump underneath. It's white and shiny. Can Melanoma ever be these colors?

Thank you

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MattF's picture
Replies 6
Last reply 11/17/2013 - 9:00pm
Replies by: Tina D, 94z28joe, Anonymous, MattF, noisy77

So i got the scans and tests done for the Ipi v Interferon clinical Trial at UCLA for my head melanoma....

 

PET Scan verbal report came back with 2 hot nodes...one directly under the dissection site and the other behind my clavacle. 

I am only 5 weeks out of surgery....this of course put me on hold for that trial and we await the complete PET-CT report.

5 weeks after they remove my parotid gland and 60 lymph nodes....I get two things that prelim reports show as hot perfectly round nodes....is this normal wierd etc?

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There is a melanoma conference in Philadelphia this week.  I believe that there will be an annoucements from Merck an GSK.  More on Merck below.

 

WHITEHOUSE STATION, N.J., Nov 15, 2013 (BUSINESS WIRE) -- Merck MRK +0.52% , known as MSD outside the United States and Canada, will present additional data from patients with advanced melanoma from the Phase IB trial of MK-3475 on Monday, Nov. 18 at the 10th International Congress of the Society for Melanoma Research in Philadelphia. MK-3475 is Merck's investigational anti-PD-1 immunotherapy. The additional data are from PN001, an ongoing multi-center, single-arm open-label study evaluating MK-3475 monotherapy in more than 1,000 patients with diverse late-stage cancers (metastatic carcinoma), predominantly lung and melanoma. The data to be presented are for patients in the melanoma cohort.

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Anonymous's picture
Anonymous
Replies 2
Last reply 11/17/2013 - 2:22pm
Replies by: Anonymous, POW

I don't think these numbers can be right.  50,000?  20,000?  One post with today's date has 6000 views?

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Anonymous's picture
Anonymous
Replies 2
Last reply 11/16/2013 - 8:31am
Replies by: nightengale, Mazz

Hello my sister is currently taking Zelboraf and thanks God for the past 4 months she has been Ned. I have read a lot of success stories of patients taking Anti Pd1 and and lately I read that if you pass the three year mark as Ned doctors are confident that maybe one is clinically cured, Since in our country is very difficult to get into a trial I am eagerly waiting and praying  for Anti PD1 to be FDA approved. Has anyone got any approval dates ?

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geminilion's picture
Replies 28
Last reply 11/16/2013 - 6:43am
Replies by: Mat, Anonymous, Janner, POW, geminilion, casagrayson

Hello all! I haven't been on this forum for a few years. Had my melanoma (stage 1) diagnosed in 2002, wide local insicion, satellite nodes removed and benign.

 

In July I had a chest x-ray as part of my  yearly physical. X-ray showed a 5mm nodule. My doctor ordered a CT scan and nodule showed up again. He decided because of my symptoms and the fact I was a smoker he should have do a PET scan.

 

Results came back and they weren't good. Showed a 3.5cm soft tissue mass, a 1cm pulmonary nodule and right paratracheal and hilar lymph nodes suspicious for metastases. Both the mass and nodule are suspicious for malignancy.

 

I went to a thoracic surgeon today and he told me he didn't think it was lung cancer but melanoma as it didn't look like the  mass was the primary. I had a fear that the melanoma would come back but because initially it was stage 1 way back when I didn't obsess over it.

 

I have to have a series of tests of course to see what's going on. I'm really scared! I got so much encouragment here in the past and hope of course. God bless you all brave warriors! I am praying that all of this will have a positive outcome but if it's spread I'm afraid it wont be.

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bethwkiss's picture
Replies 10
Last reply 11/15/2013 - 9:44pm

 Wait and see was what my doctor said I have a 60% chance it will come back and at stage 2b its really all we do so just wait humm I am new to melanoma had my surgery October 2 nothing in the limp nodes and got clear margins it was the thickness of the cancer that put me at stage 2b 8 mil I guess I am at a loss of what I should be doing other then going to the doctor and where he sends me to go I feel like I do not have the knowledge as of yet on how or what I do other then making sure I  keep a eye out for new things on my body or the old moles looking strange I will say I am concerned because the we just wait to see was told to my brother and when it came back it took him with in 2 years he past in 2005 I would like to not follow him at this time not that I wont love to see him when my time comes I'm just not ready for that for a long while some days I just go around like it was nothing and others Its there big as a bus I know my body and I feel tired all the time and my bones hurt and I just feel like crap all the time but still I work and keep going I just don't want melanoma to take someone els in my family and need more research that don't confuses me even more feeling overwhelmed 

Lisa Newcomb  

Never give up !!!!!!

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noisy77's picture
Replies 2
Last reply 11/15/2013 - 9:17pm
Replies by: noisy77, awillett1991

Hello -

My mom is on the ipi / anti-pd1 trial (given sequentially).

After 3 months of anti-pd1 my moms tumor (in her thigh) grew 29percent .  She is now on IPI.  Has anyone been on Pd-1 and had an increase in tumor size followed by a decrease?

Thank you!

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Anonymous's picture
Replies 3
Last reply 11/15/2013 - 8:22pm
Replies by: POW, Anonymous
Mutation Landscape in Melanoma Patients: Clinical Implications of Heterogeneity of BRAF Mutations
Br. J. Cancer 2013 Nov 05;[EPub Ahead of Print], L Heinzerling, M Baiter, S Kühnapfel, G Schuler, P Keikavoussi, A Agaimy, F Kiesewetter, A Hartmann, R Schneider-Stock
Research · November 14, 2013
 
 

TAKE-HOME MESSAGE

  • BRAF analysis from the primary tumor and multiple metastases showed a high degree of heterogeneity among patients with melanoma, with almost 20% having discordant BRAF-mutation results among different metastases.
  • This heterogeneity may have far-reaching clinical implications for treatment planning using molecularly targeted therapy. A single biopsy may be insufficient to determine BRAF-mutation status.

- Richard Bambury, MD

ABSTRACT

Background: The detection of V600E BRAF mutations has fundamental clinical consequences as the treatment option with BRAF inhibitors such as vemurafenib or dabrafenib yields response rates of ∼48%. Heterogeneity with respect to BRAF mutation in different metastases has been described in single cases. As this has important implications for the determination of BRAF status and treatment of patients, it is essential to acquire more data.

Methods: A total of 300 tumour samples from 187 melanoma patients were analysed for BRAF mutations by pyrosequencing. Equivocal results were confirmed by capillary sequencing. Clinical data with respect to melanoma type, tumour site and survival were summarised for 53 patients with multiple analysed tumour samples (2-13 per patient).

Results: BRAF mutations were found in 84 patients (44.9%) and 144 tumour samples (48%) with BRAF mutations in 45.5% of primary tumours and 51.3% of metastases, respectively. In 10 out of 53 patients (18.9%) where multiple samples were analysed results were discordant with respect to mutation findings with wild-type and mutated tumours in the same patient. Mutations did not appear more frequently over the course of disease nor was its occurrence associated with a specific localisation of metastases.

Conclusion: As heterogeneity with respect to BRAF mutation status is detected in melanoma patients, subsequent testing of initially wild-type patients can yield different results and thus make BRAF inhibitor therapy accessible. The role of heterogeneity in testing and for clinical response to therapy with a BRAF inhibitor needs to be further investigated.

British Journal of Cancer
Mutation Landscape in Melanoma Patients: Clinical Implications of Heterogeneity of BRAF Mutations
Br. J. Cancer 2013 Nov 05;[EPub Ahead of Print], L Heinzerling, M Baiter, S Kühnapfel, G Schuler, P Keikavoussi, A Agaimy, F Kiesewetter, A Hartmann, R Schneider-Stock

This abstract is available on the publisher's site.

Access this abstract now

 

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hdelancey23's picture
Replies 13
Last reply 11/15/2013 - 7:18pm

My Mom has been fighting Melanoma for two years now.  She has been so strong and brave through out this struggle.  We just got the news that there is nothing left to do and suggested she go into Hospice this last Sunday.  I am very sad about this news and am not ready to let my Mom go.  She is so young, she will be 48 on November 28th.  It hurts so bad knowing that our time is so limited.  I pray every day that God gives her peace in her heart and takes her pain and hurt.  I feel like I should have done more to be there for her and spent more time with her.  Our family will never be ready to lose my Mom, and I don't see how we are going to make it through this.  I just don't really know what to do.  My heart hurts right now but what keeps me going is that I know that God will take her home and that she will be looking down on us when she does go.  Please if any body has any advice on what to do, how to cope, encouraging words and most importantly what I can do to help my mom right now please comment. 

 

Thank You.

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