Home Forums Melanoma Diagnosis: Stages I &II Differences in Path Reports?

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  • #20985
    spschultz
    Participant

    So two months removed from my .54 Breslow, 1 Mitotic forearm melanoma surgery, I can’t stop reading my pathology reports. I had a punch biopsy that produced the above numbers, followed by the pathology report of the full tumor taken in the WLE. That second pathology report reads as follows:

    Microscopic exam/diagnosis:

    LEFT FOREARM:

    -SCAR WITH ADJACENT MELANOMA, SEE COMMENT.

    – MARGINS APPEAR FREE OF MELANOCYTIC CELLS.

    Comment: Overlying and adjacent to a well-healed surgical scar there is intraepidermal melanocytic proliferation composed of single cells, scattered and contiguous, and nests of cells. Extension down follicular epithelium is present. Dermal invasion is not observed. In one tissue profile there is an incidental separate benign compound melanocytic nevus.

    End pathology report.

    No Breslow depth, no mitotic figure, but this interesting sentence: Dermal invasion is not observed. How is it possible that my punch biopsy states “invasive melanoma” and cites a mitotic figure of one, but a dermopathologist examining the entire tumor after the WLE states “dermal invasion is not observed?” Isn’t it an invasion of the dermis that makes all the difference in pronosis?

    Steve

    #58929
    cohanja
    Participant

    Isn’t the first path report from the biopsy? So, that is saying invasive, cause there’s depth (of 0.54mm). But the biopsy probably removed the entire malignancy. So, then when you get the WLE path report, it’s clean/clear and there is no more further melanoma found.

    #58930
    spschultz
    Participant

    I don’t think that is the case for a punch biopsy, is it? She punched a fairly small section of the legion out for that first biopsy, leaving the vast majority of the tumor behind to be excised later during the WLE. I was under the impression that it was an excisional biopsy, not a punch, that removes the entire tumor for testing. If anything, I think the 2nd dermopathologist (post WLE) had more tumor available to test than the one who looked at the initial punch biopsy.

    #58931
    chas66
    Participant

    The are alot of different punch biopsy tools by size. If they used one bigger than the tumor, it’s very possible to get the entire tumor.

    #58932
    Worrywart
    Participant

    If I am reading this post correctly, the above path report is from your Wide excision. Correct? If so, there is no invasive melanoma present in that specimen. The invasive component was evident in your first/initial biopsy. Even if Dr’s leave a lot of the tumor on your skin, they usually take the focal/darkest/deepest part of the lesion. Left behind was the outer edges of the lesion, which were not invasive and your depth remained at .54.

    #58933
    Worrywart
    Participant

    In response to your second comment, it does not matter if the second excision (WLE) had MORE tumor…the deepest portion is usually small (focal) and that was most likely taken in your first biopsy. Melanoma generally spreads across the skin before it goes downward, and that downward growth is usually just a small portion of the lesion.

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