Questions – so many questions

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    • #24802

      I have an ability to detect cancerous spots – myself, my daughter and my husband time and again. My 73 yo husband has had several basal cells removed. Seven years ago he had surgery for a melanoma on his back, ending with a 4-5 inch scar. It was Stage 1A. In 2016 he came down with a brown spot about 1/2″ under his eye, slightly closer to the nose, than being centered. He was told at every checkup that it was nothing to worry about, even though it continued to grow. Recently it was biopsied and it is a melanoma. Location: left inferior orbital rim; Pathology: AT LEAST a Stage 1B, depth: at least .8mm; TIL: Non-brisk; Mitotic rate: 1/mm2;
      Clark’s Level: IV; Growth: Vertical; no ulceration. peripheral margins: involved;
      Deep margin: Moderately involved; co-existing nevus: equivocal. Everything else was either absent or not identified. Positive for MART-1 and SOX-10.

      Questions: Could this be a recurrence of the one he had removed from his back? Can they tell if it is? Is the SOX-10 positive good or bad? I feel certain he will need a SLN biopsy – right? Could this have been a melanoma overlooked for three years? I’m beside myself with worry. Appointment June 11th with Melanoma Clinic and a surgeon. I’m the kind of person who needs to be prepared…

    • #24804

      First of all, thank you for reaching out and I commend you for being so diligent for your entire family. The statistics prove that family and patients are the best line of defence and for catching these things.
      I am sorry to hear that he has yet another melanoma – and around his eye. That is such a vulnerable area as the skin is so thin and delicate around the eyes and lips. I am not a doctor and so am unable to advise, but can share my thoughts. That it presented as another brown spot likely indicates that it is a second new primary and not a recurrence. Change is a good indicator that something should be removed, and I hear this so very often unfortunately. Sometimes melanomas are hard to diagnose, but given his history of skin cancer, melanoma and a changing elevated spot, that should be a concern and if viewed by a doctor trained in the use of dermoscopy.

      It is something to ask the oncologist or surgeon, but what you describe sounds like a new one. Also, generally if it is a recurrence they don’t report on necessarily all these details. It is early stage, which is good, but head and neck cancers are always a bit more of a concern due to location. Low mitotic rate and no ulceration is also generally good. They may have to do some additional surgery or radiation to get clear margins – something I am sure you will discuss with the doctors. It is quite likely he will need a SNB to rule out potential spread as it indicates .8mm – they will discuss that with you likely as a recommendation. Sox-10 is a stain used to show melanocytes present to confirm melanoma. It does not confirm metastatic disease.

      I am hoping you will be able to read through our melanoma booklet, perhaps before you go to you next appointment, which may help prepare you with questions to ask. If you need any support during this stressful time, we are here to help. We may be able to answer some questions for you, provide some peer support or direct you to a local support group. Let us know.

      Annette Cyr

    • #24805

      Thank you Annette, for your prompt response and for answering every question. I will definitely be reading all of your resources, which I am assuming includes the melanoma booklet. I want to be prepared to ask the appropriate questions and understand what they are talking about. This is a great site and reading people’s stories helps tremendously at this scary and worrisome time.

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