Melanoma staging question.

[rockit]

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This is both an academic and personal question.

My dad has a melanoma and his surgeon described it as a Clark's Level I. My reading tells me that Clark's staging has been replaced by TMN and Breslow (measured with mm depth) stagings. I believe that Clark's I and Breslow I are the same.

This has also been referred to as a superficial spreading melanoma. I understand this to be a a level I (in both systems) that is confined to the epidermis. The surgeon told my dad that Clark's I do not become Clark's II. This confuses the hell out of me. Again, my reading implies that superficial spreading melanoma is (1) confined to the epidermis (2) a premalignant condition that can transform to an invasive melanoma.

So, my questions are...am I getting the staging conversions correct? What is the current standard for melanoma staging? Can the superficial spreading melanoma/Clark's I lesion transform to an invasive melanoma?


I'm sure my dad will be fine but I'm confused about the staging and haven't been able to find a good resource. Thanks.

 

[pathgrrl]

Caveat - I'm not a dermatopathologist, and your best bet would be to get a copy of the path report and take it to your local dermpath doc. Better yet, ask your dad to get his slides and ask for a second review, it is worth it to have the piece of mind, and his insurance will probably pay for it.

I believe that Clark's I and Breslow I are the same.

Sort of, especially in this case.
Clark's level of invasion = how far does the melanoma invade (in this case, it is confined to the epidermis,
Breslow depth= measurement of thickness of invasion from the epidermal granular layer (in this case, it is likely <1mm since it is confined to the epidermis)
In the "new" staging system, Breslow depth is the key player, and Clark's level only comes into play in T1 cancers. However, this is a T1, since it is confined to the dermis. The big question is, is there ulceration present? Ulceration divided T1s into T1a (without ulceration) and T1b (with ulceration). T1 tumors with ulceration behave like T2 tumors.

The surgeon told my dad that Clark's I do not become Clark's II. This confuses the hell out of me. Again, my reading implies that superficial spreading melanoma is (1) confined to the epidermis (2) a premalignant condition that can transform to an invasive melanoma.

Superficial spreading melanoma is malignant melanoma, not a premalignant condition. Most cases have some degree of superficial invasion. If you think your Dad's surgeon is blowing this off as no big deal, then make sure it is no big deal with a second opinion. Make sure the margins are negative! On the other hand, sometimes patients don't get the facts straight when they are getting a diagnosis without an advocate present -- again read the path report yourself!

I'm sure my dad will be fine but I'm confused about the staging and haven't been able to find a good resource. Thanks.

The information I gave you here is from the AJCC Staging Manual. Get your Dad's path report and take it to your Path sign-out room -- they will have a copy and you can reference it. Or, PM me and I can send you a PDF of the Melanoma staging guide.
Best wishes for your Dad -- he will need lots of surveillence (and maybe a new surgeon?)

 

[rockit]

Thanks. I actually know the surgeon and have had multiple other attendings give him the ok. I think there were communication issues and misunderstandings.

Thanks for the info. I'll PM you for the pdf.

 

[yaah]

Superficial spreading melanoma is invasive. It can invade as deep as it wants and metastasize. There are different overall growth patterns to melanoma, this is one of them. If there is no invasion it is "Melanoma in situ," for the most part, although there are some other terms depending on the circumstances.

Clark's I becomes Clark II by invading deeper.

 

[Dral]

I remember discussing why Breslow is more reliable than Clarks. I believe Clarks is good if you can make a solid call, but I think that's difficult to do sometimes if you have Pagetoid spread or when it's difficult to determine how much of a majority of the dermis determines a III vs IV call.

Breslow has difficulties too since skin thickness varies by body location. I'm not sure if superficial spreading automatically implies radial growth phase. I know from reading a few papers that radial growth phase does not rule out metastatic potential. Although the tendency is way way lower than vertical growth phase.

Just a bit I picked up from some research and a few weeks sitting in on derm path sign out. Although the main thing I learned from derm path sign out is how much more complicated the field is than I had originally expected.

 

[blessedrosary]

Good day to you. I am recently treated for cancer of the tonsil. I have my pathology report with me as I requested a copy. My question is this: The immunoperoxidase stains performed show the tumor cells are positive for cytokeratin and CK5/6 and negative for CK7 AND CK20, what type of cancers would you suggest this could be or would these indicators be limited to only one specific type of cancer?

I will appreciate your help to offer possible cancer types these findings could suggest.

 

[yaah]

These forums are not intended for patient consultation - there are other venues for this. Am going to close this thread now as the original question was answered. You can always contact the pathologist who signed the report if you have questions about it and your own physician is not helpful.