Home Forums Melanoma Diagnosis: Stages I &II Benign Nevus on SNL (could it be metastasis in disguise?)

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  • #21390
    momo
    Participant

    My husband had a SLNB about a month ago. Doctor said both the node and the WLE came back clear….no Melanoma. I was over the moon but when we recieved the actual report there is something written on there that has been nagging me.

    It mentions that the markers identified a Nevus Cell Nest mostly in the capsule. When I asked the doctor he said that it was benign and nothing to worry about. I then asked him if someone who did not have a Melanoma could have a nevus cell nest on a thier lymph node and he said yes. I then asked him if that means it is completely unrelated to the Melanoma and he said that he couldn’t say that but that I shouldn’t worry and that nobody has every died from a benign nevus?!?!? That was the end of him wanting to talk about it. Can anyone here comment on this? Here is what the path. report said.

    “Right auxillary sentinal lymph node; biopsy: – One lymph node with nevus cell nests in the capsule but no melanoma, see comment.”

    And here is the comment….

    “Immunohistochemical study with melanocytic markers (S100 and Melan-A) on the sentinel lymph node did not reveal mestatic melanoma, but identified nevus cell nests located mostly in the capsule”

    I appreciate any feedback. Thanks.

    momo

    #61428
    cohanja
    Participant

    I’m not a doctor, but it sounds like what they are saying is they found melanocytes in the node. . an acutal mole. . but the melanocytes were normal looking, not malignant. .basically that there were no metastases in the node

    #61429
    Catherine Poole
    Keymaster

    This is perfectly harmless. Nevus means mole, and a cell nest means that a mole could possibly form but it would be perfectly benign. Therefore your husband has an excellent prognosis from this SLNB pathology report.

    #61430
    momo
    Participant

    Catherine – Thanks for taking the time to reply. I totally understand that the pathologist is saying it is benign and harmless.

    I guess where I get concerned is where I read stuff that talks about how difficult it is to determine the difference between a nevi and a metastatic melanoma in the lymph node and how the pathologist would need to look at the slides with a very critical eye. Here is just one thing that I have read that makes me nervous, of course I don’t understand all of the medical terms……

    http://www.medscape.com/viewarticle/777491

    This one specifically says:

    “One of the major diagnostic pitfalls in sentinel lymph node biopsies from melanoma patients is the presence of nodal melanocytic nevi.[7, 8] Benign melanocytic nevi are reportedly identified in 8–26% of lymphadenectomy specimens and occur more frequently in melanoma patients, specifically in sentinel lymph nodes.[8] Histologically, nodal melanocytic nevi consist of aggregates of cytologically bland melanocytes that reside in the lymph node capsule and trabeculae, whereas metastatic melanomas are predominantly subcapsular, sinusoidal and intraparenchymal, and show cytological features of malignancy.[9] Nonetheless, as melanomas often display a wide spectrum of cytological features and can be morphologically bland, as in nevoid melanoma, the distinction between benign nodal nevi and melanoma metastases can be difficult. To complicate the matter further, both metastatic melanomas and nodal melanocytic nevi can occupy unusual sites within the lymph nodes. It has been shown that melanoma cells can seed lymph node capsules,[10] and nevoid aggregates have been identified in the subcapsular space and even within nodal parenchyma,[7] mimicking metastasis. On the basis of morphological criteria alone, distinguishing nodal melanocytic nevi from nodal melanomas can be very difficult, especially when the melanocytic focus in question is small and lacks overt cytological atypia. In such histologically ambiguous lesions, care must be taken to avoid over-diagnosing nodal nevi as metastatic melanomas or under-diagnosing tumor deposits as nodal melanocytic nevi.”

    I was just wondering if anyone else has had a nevus in thier lymph node and what happened? Thanks again.

    Melissa

    #61431
    cohanja
    Participant

    those slides could be sent for 2nd opinion (the node slides)

    #61432
    marti
    Participant

    Momo, 4 years ago I was in the same boat; while the onc.surgean told me: SNB was clear- I was thrilled. Later in the report it said that “a few “loose cells where identified-not enough for micro met. I took it as it was, since the report came from one of the top P.A. in Amsterdam in a melanoma center.

    The P.A> report mentions: Node: The melan A coloring shows some loose cells ,fine grain immunopositivity in the cytoplasm. These cells are not found in the S100 immunocoloring, only macrofages en nerve cells.

    I feel very lucky- 4 years laters, and no signs of activity, but it kept puzzling me, just every now and then, so I asked questions on this forum: I was advised to send the slides to dr. Mihm, an authority in the US.

    Living in The Netherlands it sounded a bit complicated, and with my luck the slides even could go missing. Furthermore I have a history of finding incidents on my path with all kinds of mis happenings in medical care.Thats why I am seen in 2 centers presently -in one center by a great onc.surgeon, and in the other center by a great dermatologist.

    During the last routine check-up I mentioned my confusion to the derm. about the P.A.report. She totally agrees and will start with a “revision”of my case by a second opinion of the node , although clinically it would not make a difference any more. ( you see I am 4 happy years further) When she asked if I was in a hurry, I told her not, so on my check-up in coming November she will have this done, in the meantime she will gather the information.

    So my advice to you: , get a second opinion it will give you more information, and probably will send you back “over the moon”, maybe Dr. Mihm ?

    Sorry for my long letter, wanted to tell you my story, while I am still waiting for answers, but I live my life, even if I dont get a satisfying answer. And this is my second advice to you: try to find your answers- but if you dont get all the answers, dont let it overtake your life. It will get easier over time.

    Marti

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