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Treatment for malignant melanoma on neck and toe?

Jan 2014
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Practicing since : 2002
Answered : 7377 Questions
Hello I have written before on another topic but I was seeing a breast surgeon for suspected Fibroadenemas ( Upper Right quadrant) as I was concerned I had a 3cm axillary lymph node and the drrecommended I go see a Dermatologist asap. I did and they took three biopsies and I received a call late last night that left me a little stunned so I am not sure it registered. Here are the notes I took; of the 3 two have come back with malignant melanoma. One is on the neck and one is on the toe. I thinkshe said the neck was.4mm and the toe .2mm so the prognosis was good and i have an appointment in a week for a consultation with an oncologist . So, Im a little dazed. Was planning on calling them back but I dont know what to say . What questions should I ask, do you have any oipinion on the thickness - ive looked and that seems good ? Does it matter that they are on my neck and toe ? Does it matter that I have two at the same time, is this common does it change anything ? I am getting a breast biopsy done Monday - and the only reason for this is because I am insisting , they think they are benign and because of that they are not concerned about the lymph node - but I havent a virus etc and I know it wasnt this large in July 2103 ( it has gone from 1.3 - 2.99cm ) so I needed to be sure they hadnt got it wrong ... but could this melanomas be the reason for the lymph nodes ? Confused a litlle, looking for gudiance thank you
Posted Sat, 8 Mar 2014 in Skin Hair and Nails
Answered by Dr. Kakkar S. 51 minutes later
Brief Answer: I would have adviced lymph node biopsy Detailed Answer: Hi. Thanks for posting your concern at HCM Melanoma is less common than other skin cancers. However, it is much more XXXXXXX if it is not found early. If melanoma is found early, while it is still small and thin, and if it is completely removed, then the chance of cure is high. Early signs of melanoma are changes to the shape or color of existing moles. At later stages, the mole may itch, ulcerate or bleed. Early signs of melanoma are summarized by the mnemonic "ABCDE": --Asymmetry --Borders (irregular) --Color (variegated) --Diameter greater than 6 mm (0.24 in): Diameter is the weakest sign in this system is the diameter. Many melanomas present themselves as lesions smaller than 6 mm in diameter; and all melanomas are malignant on day 1 of growth, which is merely a dot --Evolving over time Five year survival rates depend on the size, lymph node involvement and presence or absence of distant metastasis (TNM Staging). It is not dependent on the number of melanomas and site of melanomas. Size of the Melanoma is a favorable one in your case e.g a tumor ≤ 1.0 mm without ulceration; no lymph node involvement; no distant metastases has >95% five year survival rate as compared to a tumor > 4.0 mm without ulceration; no lymph node involvement; no distant metastases, which has 63%-67% five year survival rate. Lymph node involvement does lowers the five year survival to 30%-59%, thus even i would advice a biopsy from the enlarged lymph node no matter how less likely it is to be due to Melanoma. Hope this helps you take care regards
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Follow-up: Treatment for malignant melanoma on neck and toe? 2 days later
Hello Can you tell me what you know about wide Excission. I am most concerned about the one on my tow. It is only .2mm so not very deep at all but it is to the left of my nail bed about 4-5mm from the bottom edge. Do you know this works ? If they do a 1cm margine around that it would impact my nail bed ... is this correct what I am thinking ? I have read amputation is very common in toes but I assume not for .2mm ? Have you any advice on what questions I should ask Thank you
Answered by Dr. Kakkar S. 1 hour later
Brief Answer: Lymph Node Biopsy Detailed Answer: Hi. Adequacy of surgical resection margins for primary melanoma and the best approach regarding regional nodes are the two most important issues. A 1-cm margin appears to be adequate for melanomas less than 2 mm and a 2-cm margin for thicker melanomas. For the Melanoma on your toe which measures .2 mm a 1 cm margin would be done to stay clear of the tumor, which would involve a portion of the nail bed. Sentinel Lymph Node (SN) status is the most powerful prognostic indicator in melanoma patients. The approach among surgeons differs in that whether they would do a sentinel Lymph node biopsy+staging and later Total lymph node dissection depending on whether sentinel lymph node is positive OR would they go directly for Total lymph node dissection? Hope this answers your query. I am here to help you out with any further clarifications take care regards
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