Stage 1a Melanoma

Hello @dave62 and welcome to Mayo Clinic Connect. Thank you for joining to connect with members as you are on your melanoma journey. Sharing experiences with one another and trading support is the hallmark of Connect.

I would like to introduce members @herbert1 @grandmar and @birdman518 who have all mentioned experiences with Melanoma and who many be able to come into the discussion and provide you support based on their personal journeys.

While we wait for members to join, I thought this information may be of interest to you.

- Melanoma: Diagnosis & Treatment:
https://www.mayoclinic.org/diseases-conditions/melanoma/diagnosis-treatment/drc-20374888
How recent was your diagnosis?

@dave62 I wanted to share some experience with melanoma. My husband had melanoma on his hand that had been there a year, and we found it when it had ulcerated through the skin. It did not start from a mole; instead it began under the surface of the skin as a spherical bump that was growing in size. It was the diameter of an eraser on a pencil and the same color. It was Stage 2a and was surgically removed with a wide margin and a skin graft was done moving a round patch of skin from his belly. Prior to surgery we were given papers that discussed statistics which gave him an 80% probability that the cancer had not spread. The sentinel lymph nodes in the arm pit were mapped first with a blue dye so the surgeon would know where they were, and immediately afterward he was in surgery for the melanoma and removal of some sentinal lymph nodes. Those nodes came back clean. We were very lucky that the cancer had not spread. They did a genetic test from Castle lab to predict future cancer risk and that showed he was predisposed to a high cancer risk. He has had several abnormal moles and a large one between toes that was removed during the cancer surgery which needed a skin flap closure. That required a plastic surgeon for both the grafts. We have to be vigilant now with dermatology exams every 3 months and they keep finding, and removing abnormal moles. Your surgeon would have received a pathology report that would say if the entire cancer had been removed and if the margins were clean. If the cancer was spreading, the margins would have been irregular with cells breaking off. The report should indicate if that was observed. If your margins were clean, that is great. Another cancer can also appear independently of the first lesion. Your surgeon is probably telling you to have dermatology exams every 3 months for the first 2 years, and probably annually after that as well as other screenings like MRI and CT scans as routine follow up. Melanoma is very easy to miss, so you will need to be vigilant. My husband also gets opthalmology exams every 6 months because melanoma can happen in the eye. Your surgeon needs to answer if a sentinal node biopsy is required. They may have done it already without your knowledge during your surgery.

Dave62
I am now at about 3 weeks after my melanoma excision on my scalp. They told me it was stage 2a but only 1.2mm deep I did have an SLN done, and fortunately everything came back from the lab as clear (both SLN and surroundings). My two wounds (the excision site and the skin graft site) are both healing well. I do have a big "hole" in my head, but the surgeon says that over time it will fill in and be less noticeable. I guess Hollywood won't be calling me now.

I will now be on quarterly exams for any recurrence or other sites popping up.

Obviously I feel like I have dodged a big bullet, but this is my story. I hope that yours turns out equally well.

Hi Dave,
I was diagnosed with stage 1 melanoma in 2015. I had a very teeny, tiny spot on the inside of my right big toe. I noticed a spot during a pedicure but just thought it was one of many beauty spots I have.
My brother had melanoma, too, stage 2-3 on his back over 20 years ago and I promised to be checked yearly. When I went for my yearly exam, the doctor didn't even notice it until I pointed it out. It didn't look or feel odd at all. However, because of my age (over 60) she said I shouldn't be getting any new beauty marks in that area.
I had the spot removed. I had a 1 inch incision on my toe and it went deep to the bone. The pathology report came back with all clear margins. I needed to use antibiotic ointment and bandage it (and keep it dry) for a couple of weeks. It was sore, but healed. I started with a new dermatologist this year. She couldn't even see where the incision was.
Other than follow ups every 6 months, I haven't had to do anything more.
Good luck!

Hey Jennifer,
Thanks so much for the information. When I had my wide excision done, the dermatologist (surgeon) said I had the option to do a sentinel lymph node biopsy trace. She said since I was stage 1a and the melanoma was .7mm, it was very borderline as to whether it was necessary. She said the odds of it having spread to the lymph nodes might be one out of close to 300 (odds), but if I chose to do it, they would. I stated that I would wait to see if my margins were clear this upcoming Monday or Tuesday, and if they are clear, would decide. My question is, what are the chances (odds) that a wide excision surgery (1cm margins) would clear my .7mm un-ulcerated melanoma? And if the report does indicate clear margins, would I need a lymph biopsy for stage 1a? They did say that I should be evaluated every 3 months the first year, then 6 months for the second year, and at least once every year after that. There is no indication in my family of anyone else being diagnosed with melanoma. Thanks for any suggestions!?
Dave

hi Dave...I also had a .7mm stage 1a on my scalp.....the mole was originally removed with a punch biopsy...and then when the melanoma was confirmed a further wide incision was performed.(fortunately they could close the wound with a primary closure without needing a skin graft) in both cases margins were clear which was a good sign....as I understood stage 1a with no ulceration and with the proper wide excision has a good prognosis....it was nerve-wracking waiting for the results of the excision, but fortunately it was also clear....have been having regular dermatologist visits every three months for last two years....a stage 1a diagnosis is potentially a good outcome, as at this stage the excision is potentially curable..... however need to stay vigilant .... continue to self examine yourself as well have regular derm visits. from what I have read, most recurrences are captured early by the patient's own body examination.....wishing you the best....

hi Dave..wanted to add, my doc said same thing.. 0.7mm is borderline for sln..especially with no ulceration and no mitotic figures..after consulting a number of other recognized experts in the field , it was decided we did not need to do the sln....we did have an ultra-sound of the lymph nodes performed.....

Many, many years ago when I was very young, I had a stage 2 Melanoma. They removed a large area at the site, my lymph nodes and 2 sites for skin graphs. Then I recently had another Melanoma removed, but just a stage 1.
In between these cancers, I had 2 major and rare sarcomas removed, plus several other serious cancers & dozens of basal cell skin cancers removed. I go to my dermatologist twice a year.
It isn't just the sun to blame, I have an errant gene lurking in my DNA somewhere. But no dr, has bothered to follow up and I feel somewhat medically neglected, especially after reading about some other people's experiences on this site. Oh well, I am still kicking & kvetching!!!!

@dave62 As much as we as patients want clear cut answers, sometimes those answers come as a reduction of risk rather than an absolute answer. Doctors can't give us an absolute promise that there will never be another cancer re-occurrence, but we do have choices that can lower our risks. There are many studies on melanoma cancer in regard to the size and depth of a lesion and the mortality statistics in relation to the size of the excision margins. I am not a medical professional and don't have the training to advise your best course of action. I did look up some studies and found this:

Quoted from this link about sentinal lymph node biopsy " SLNB" which does support yours at .7mm as borderline
https://emedicine.medscape.com/article/854424-overview
"Indications for SLNB
SLNB should not be offered for melanoma in situ, where the cancer cells are confined to the epidermis.
SLNB should not be recommended routinely for thin melanomas that are T1a (nonulcerated lesions < 0.8 mm Breslow thickness).
SLNB should be considered for thin melanomas that are T1b (0.8 to 1-mm thickness or < 0.8 mm with ulceration).
SLNB should be recommended to patients with a clinically negative nodal basin and intermediate thickness primary melanomas (T2 or T3; >1 mm to 4 mm).
SLNB should be considered for thick melanomas (T4; >4 mm) and clinically negative nodes.
SLNB may be considered for melanoma that exhibits regression (controversial).
Potential contraindications for SLNB
SLNB is unnecessary if systemic disease is present.
SLNB may not be reliable if there has been previous extensive surgery in the targeted lymph node basin."

Quoted from this link about excision margin size:
https://link.springer.com/article/10.1245/s10434-015-4950-0
"Simply stated, for melanomas <and> 2 mm, 1-cm and 2-cm margins respectively appear to be wide enough, with still some lingering uncertainty about the appropriate margin in 1- to 2-mm subgroup"

As the spouse of a patient with a melanoma that was close to 7 mm in diameter (pencil eraser size), I worried too. I can't specifically remember the depth, but it was around 4mm and the biopsy done by the dermatologist did not get all the margins. The dermatologist sent him to a surgical oncologist and his surgery and skin graft was done at the hospital. Perhaps that is standard when a sentinal lymph node study is required. I looked up his notes and they said it was a 1 cm excision size around the lesion. They took all the skin layers right down to muscle and bone, and the resulting skin graft is about an inch and a quarter in diameter on his hand. I really don't think of him as being different after this, but because we have the knowledge that he is a high cancer risk because of the Castle test, we know that for the rest of his life, frequent visits to the dermatologist are necessary to catch any skin issues right away. Still, there is the risk of melanoma occurring internally or some other kind of cancer. There was no evidence of any spread on the pathology report, so there was no further treatment beyond surgery needed. He was offered a study if he wanted to pursue an IV cancer drug to be administered at stage 2. It would be standard treatment if this was stage 3. He decided against it because of needing to drive to downtown Chicago to participate and right when the pandemic was starting with the risk of crowded facilities and people all around us. I do also have a friend who had melanoma taken off her leg twenty years ago, and has never had another problem with it since, so that is good news that this can be cured and over with the help of a surgeon and timely intervention. It all comes down to advocating for yourself and getting suspicious growths checked out early. My husband had melanoma on his hand for a year thinking it was a wart. That was a serous mistake, but it seems that it was caught in time. We don't have any family data to rely on as he is adopted, but the Castle test indicated a genetic risk of cancer.

Here is the Castle lab information. Do you think this could help you with your decisions?
https://castlebiosciences.com/

I truly APPRECIATE Everyone's insight as to my melanoma concerns. I just learned today that all my margins were clear of melanoma. Therefore, the final prognosis is melanoma was excised. That is certainly great news to me! This is a relief to me, as my last 3 weeks have been highly challenging, and I had been overwhelmed with anxiety! Although I realize that there is no 100% guarantee that melanoma could not develop on or in my body again, I am encouraged, with the odds being heavily in my favor, that it will NOT return. However, I WILL stay vigilant and minimize sun exposure by covering up as using UV protection whenever exposed to sunshine. The dermatologist told me that there is only a 1.5% chance that my melanoma somehow escaped detection and has invaded or potentially could invade a sentinel lymph node. She said it was an option for me to pursue, but even IF it were to test positive for melanoma, it would not change any future prognosis. Since it would entail more surgery under anesthesia this time and the potential risk was low, I have decided to go with the plan to see a dermatologist every 3 months for a year, and every 6 months after a year for a couple of years, and do full monthly bodily self-checks and lymph node self-examinations frequently. The bottom line is, at least as of now, this was GOOD NEWS! Thanks again to everyone who posted! I wish you all future good health and a promising future!
Dave62