Dermal mitotic rate

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This topic contains 4 replies, has 3 voices, and was last updated by catdander forum moderator catdander forum moderator 1 week, 1 day ago.

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July 17, 2017 at 9:33 am  #1291107    

pattiathome

I was wondering if there is a pathology report chart that can indicate stages of mucosal melanoma with (dermal) mitotic rates?

July 17, 2017 at 1:49 pm  #1291108    
catdander forum moderator
catdander forum moderator

Hi Patti,

Staging isn’t determined using mitotic rate. Mitotic rate or the rate at which mitosis (cell division) is happening in a tumor only suggest whether or not a melanoma might have metastasized, but it doesn’t inform staging. It might be useful as an extra piece to inform treatment planning such as if there was no clear standard you might ask how aggressive the cancer is but with time that is usually apparent. Below is a mucosal melanoma staging chart. A mucosal melanoma is considered T3 giving a stage of at least stage III.

http://emedicine.medscape.com/article/2047726-overview

Additionally I’ve found a list of specialists who see more mucosal patients than most. melanoma.org suggests seeing a specialist if you’re diagnosed with mucosal melanoma. FYI, if you live far from a specialist it’s common for someone to visit a specialist during transition times and be treated closer to home by a community oncologist. It’s becoming more common for these 2 oncologists to become a team to treat patients with the best available practices often not available to non specialized oncologists. Too, a specialist will be most familiar with appropriate trials.
This list shouldn’t be considered exhaustive but certainly a start.

https://www.melanoma.org/sites/default/files/MucosalMelanomaSpecialists.pdf

The next link is just an informative paper relevant to your cancer and is quite recent, jan 2017.

http://www.nature.com/labinvest/journal/v97/n6/full/labinvest2016147a.html

I hope you’re doing alright.
Janine

July 17, 2017 at 4:57 pm  #1291109    

pattiathome

Thank you Janine for the links & for the quick response.. My report classified the cancer as pT4a corresponding to stage IVA. Still with the questions & with the realization of how aggressive mucosal melanoma can be and that “0” rate is good, can you please help me understand where a rate of 15 mitoses per 2ml might be on a graph? Would that score lead to the reason they are saying the cancer is stage IVA?

July 18, 2017 at 9:19 am  #1291110    
JimC Forum Moderator
JimC Forum Moderator

Hi Patti,

The mitotic rate is not used in staging except perhaps for Stage I. The cancer would have been staged as IVa based on involvement of regional lymph nodes. A rate of 15 seems to be fairly typical for a mucosal melanoma staged at IVa.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

July 18, 2017 at 2:17 pm  #1291111    
catdander forum moderator
catdander forum moderator

The reason to check mitotic rate is to predict aggressive behavior. Cancer can do anything and any type of cancer can be much more or less aggressive than the majority of people with the same type of cancer. 15/mm 2 fits about in the middle of the graph in the following link.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654084/figure/F2/

Here’s another interesting table from the same study that shows “Primary tumor mitotic rates…are significantly associated with thickness and ulceration”. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654084/table/T2/

The study can be found here, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3654084/
The different figures come from different types of readings.

Staging cancers uses very specific guidelines. Staging head and neck mucosal melanoma doesn’t use mitotic rate so no your mitotic rate score wouldn’t have anything to do with staging. T4a is defined as, “Moderately advanced disease. Tumor involving deep soft tissue, cartilage, bone, or overlying skin.” Staging of IVa is T4A N0 or N1 (regional node involvement) and M0 no metastases.

http://www.downstate.edu/ajccstaging/09_MUCOSAL_MELANOMA.PDF

I hope this helps answer some questions.
Sincerely,
Janine

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