Dermal mitotic rate - 1291107

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pattiathome
Dermal mitotic rate - 1291107

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

catdander
Hi Patti,

Hi Patti,

Except for stage I 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

pattiathome
Thank you Janine for the

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?

JimC
Hi Patti,

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

<p>I began visiting GRACE in July, 2008 when my wife Liz was diagnosed with lung cancer, and became a forum moderator in January, 2010. My beloved wife of 30 years passed away Nov. 4, 2011 after battling stage IV lung cancer for 3 years and 4 months</p>

catdander
The reason to check mitotic

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