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April 18, 2013 at 9:09 pm #21200
Dr called today and said I have another Mel but was insitu (whew) thing is
It was at a previous biopsy site which concerns me because was that one misdiagnosed?
He didn’t have the full path report yet so I guess I will wait for that.
I suppose they will be able to tell if it was deeper ? A little nervous about this.April 19, 2013 at 11:44 am #60153
This is something I would definitely get a second opinion from an expert dermatopathologist. As we’ve mentioned here, this is the best way to get a solid opinion on things. Your slides can easily be shipped to a center such as PENN, Hopkins, UMASS, UCLA, etc. Also, http://www.drmihm.comis an online resource. It sounds like a second primary but still a good idea to get another opinion. Let us know how things turn out.April 21, 2013 at 1:07 pm #60154WorrywartParticipant I agree that a second opinion on slides is a good idea. It is hard to read pathology through scar tissue as it almost always looks suspicious. Good luck!May 2, 2013 at 3:48 am #60155 I guess better news than I thought.They downgraded the melanoma insitu to severely atypical on the full biopsy report. Dr said on scar tissue things can look worse than it is but after careful examination they went with the atypical dx.
I go tomorrow for the wle on that as well as a scrape and burn on the squamous cell on another biopsy.May 2, 2013 at 3:01 pm #60156
Ok, but scrape and burn for squamous cell? Squamous is potentially a recurrent cancer that does best with MOHS surgery. I am thinking you should get second opinions on both of these issues?May 2, 2013 at 8:32 pm #60157 Got the path report,on the squamous dx says in-situ transected margins positive and comments says extends to all surgical margins including deep surgical margins addition intervention required.The derm wanted to do mohs but I asked if there is a less costly way like excision because haven’t reached my deductible yet so he did the shave and burn.Do you think that’s not ok on a in-situ?
The dx on the other is: At least compound nevus w/ severe cytologic atypia and architectural disorder and reactive features,see comment.
Comments: This is a difficult case and a problematic lesion in many reguards.Not only is it a borderline process,there is scar present,and hence,there is a conundrum reguarding how much of the atypia is reactive and how much is de novo. As you are aware recurrent nevi may manifest features that are nearly indistinguishable for melanoma.In this case,it is difficult to parse reactive atypia from de novo atypia.What is clear is that the dermal component represents a banal nevus.The junctional component is rather atypical,and represents at least a severely atypical nevus ,if not evolving melanoma in-situ.we stongly suggest at least 5 mm margins in the re-excision.
Reviewed by Head Dermatopathologist for the University of Colorado cutaneous oncology tumor board as well as two other Doctors.
Should I get second opioinons on the path or derm or both?May 3, 2013 at 5:44 pm #60158
MOHS surgery is best as it gets rid of the squamous once and for all in most instances. They keep taking layers until there is no evidence of squamous cells. I would go for that or you might deal with it again. Second opinions are always good although it sounds like you had a good one review this.
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