Prognosis

[StevElse]

Monday this week my husband saw a report on FoxNews about skin cancer and decided to check himself.  Found a suspicious mole on the left side of his face that wasn't there 9 year ago when we got married from looking at pictures.  It was there 2 year ago but definitely smaller.  Went to the dermatologist same day and they did a shave biopsy.  Today Thursday the doctor called us back and told us that it was in fact Malignant Melanoma.  

Next step he said would be to go to a surgeon and have a larger excision, wider but not deeper he said, to make sure all malignant cells are removed.

Here is the report....

Diagnosis: Skin, L Preauricular Area, Malignant Melanoma, Clark's Level II, Breslow Thickness 0.2 MM, Biopsy.
Ulceration is absent.
Associated Intradermal Melanocytic Nevus.

Clinical Impresion was: L Preauricular Area - R/O anm, shave, hyperpigmented macule with irreg color and border.

Gross Description: A 0.6 CM Tan Irregular Skin Segment. TS 2.

Microscopic Description: Original and deeper sections are evaluated. There is a broad, poorly circmscribed, nested, and confluent solitary junctional melanocytic proliferation of atypical epithelioid melanocytes. Pagetoid melanocytes are present above the basal cell layer. Focally there are melanoma cells in the pappillary dermis. There is slight solar elastosis. There also appears to be a benign intradermal nevus in some sections.

We have done a lot of reading this week and even more today.  And we have some more questions...

1. Do they always refer you to a surgeon when they find melanoma? If not what would be cause to?  Should we be alarmed?

2. In regards to Breslow Thickness 0.2 MM - does this mean that there was a clear layer of benign cells seen below 0.2 MM?  Or is this just the size of the sample?

3. Does this make him more susceptible to other cancers?

4. What will the surgeon do exactly? Will they remove just more skin or lymphnodes to? Is it done under local or general anesthesia?

5. What happens after the surgery? What is the general prognosis and 10-20 year outlook?  Will it shorten lifespan?

Any and all input appreciated.

Thank you and God Bless :-)

[Alan Rockoff, MD]

1. Do they always refer you to a surgeon when they find melanoma?
Yes.
2. In regards to Breslow Thickness 0.2 MM - does this mean that there was a clear layer of benign cells seen below 0.2 MM? Or is this just the size of the sample?
It's the thickness.  Melanomas that thin have an excellent prognosis.

3. Does this make him more susceptible to other cancers?
No.

4. What will the surgeon do exactly?
Cut it out.  Local anesthesia.
5. What happens after the surgery?
When the surgeon removes the whole thing with clear margins, the pathologist will check to see whether the whole specimen is as thin as the biopsied part was.  If it is that thin, then prognosis for long-term survival is excellent--if not 100% then at least nearly that.

Good luck--and good for both of you for noticing it and taking prompt action.

Dr. Rockoff

[StevElse]

The Dermatologist did remove the entire visible mole.  How much more will the surgeon remove?  

When you say yes it's the thickness, did you mean the thickness of the sample or the thickness of the melanoma??  And if it is the thickness of the Melanoma does that mean that there was then a layer of benign cells underneath?

Will the surgeon run any other tests or does the removal = cure?

Thanks again :-)

[Alan Rockoff, MD]

It means the thickness of the melanoma.  Below that is normal skin.  No other tests are needed.  There is very good prognosis, but with cancers, it is not possible to speak of a certain cure.

For more information tailored to your specific case, you will need to ask your dermatologist and surgeon.

Dr. Rockoff