Home Forums Melanoma: Newly Diagnosed – Stages I & II Just diagnosed…please help with pathology report.

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  • #20780
    spschultz
    Participant

    I am a 41 year old male who was diagnosed 2 days ago with melanoma. I had a biopsy on a mole on my left forearm at the suggestion of a dermatologist who I was seeing for something totally unrelated. It really is a miracle that I was diagnosed at this time…God knows when I ever would have made an appointment to have anyone look at that mole. It had been there forever and it never occurred to me to get it looked at. Anyway, the pathology report in its entirety follows, and I’d appreciated your take on it, as my dermatologist was frankly a touch evasive when I began to question her.

    SKIN, FOREARM (PUNCH BIOPSY):

    -Invasive melanoma, Breslow thicknes approximately 0.54 mm, lesional cells extend to a peripheral edge of the biopsy (see comment).

    -No ulceration identified.

    -Mitotic activity: 1 mitotic figure/mm2

    -Tumor infiltrating lymphocytes: Focally present, non-brisk

    -No lymph/vascular or peri-neural invasion identified

    -No evidence of regression or satellite metastasis

    COMMENT:

    Sections of skin show a poorly circumscribed proliferation of atypical melanocytes, arranged in unequal sized, focally discohesive nests and as single lentiginous units, dispersed along the dermal-epidermal junction. These melanocytes contain enlarged, oval to spindal nuclei, and an abundant amount of “dusty” grey cytoplasm. Foci of Pagetoid scatter of single atypical melanocytes to the level of the granular layer are identified. In the dermis, the melanocytes are arranged in sheets and small nests that do not mature with depth of the legion. Careful search of many high power fields reveals a rare mitotic figure in the dermal component. Patchy, asymmetric pigment disposition is seen in the papillary dermis. A moderate to severe degree of solar elastosis is also noted in the background.

    Immunohistochemical stains for Mart-1 and S-100 are positive in the lesional cells.

    The overall histologic impression is that of invasive melanoma. The lesional cells extend to the peripheral edge of the biopsy. Therefore, complete excision of this lesion/lesion site with appropriate lesion free margins is advised.

    End pathology report.

    Obviously I’m freaking out a bit at this point, and would really appreciate a review of this report with some attempt at an initial prognosis. What are the chances that this has moved to the lymph nodes or beyond? Tomorrow, the dermatologist is going to schedule an appointment with a surgeon to have this removed. Thanks in advance for your help.

    Steve

    #57658
    Catherine Poole
    Keymaster

    I wouldn’t freak out. Your lesion is low risk. The only thing I didn’t see in your pathology was radial or vertical growth phase. You may want to get another opinion on the pathology (we always suggest it is a good dermatopathologist) You can do so at http://www.drmihm.com, he is world renowned and did our webinar on pathology (click on webinars above in BLUE. Also, any teaching hospital should have a dermatopathologist. What area of the country are you from? The other thing going for you is that the melanoma was found on an extremity and they have better outcomes You may elect to do a sentinel node biopsy because of the mitotic rate (cellular activity) but a re-excision is all that may be suggested with careful follow up. So congrats on finding this early and take some deep breaths.

    #57659
    Lisa P
    Participant

    Hi. I’m so sorry you are going through this and am all too well aware of how it feels to be diagnosed with melanoma, seemingly out of the blue. The great news is that yours was caught and, although the mole was there for a long time, a .54mm diagnosis means it’s fairly small. Catherine, who wrote to you earlier, is the expert and I would follow her advice, without question. In the meantime, I found this site very helpful when I received my bombshell news and encourage you to reach out with any questions you might have as well as any “talking” you need to do. There are a lot of caring people here who understand and will be there for you. Sending good thoughts — Lisa

    #57660
    cohanja
    Participant

    It’s confusing, isn’t it? On the one hand you will hear this is a low risk lesion, you caught it on the early side, etc. . . but on the other hand you will also hear of stories where supposed “low risk” lesions years later ended up causing more problems. I don’t say this to scare you, I say it because I’d want to know the truth about what this means. I was diagnosed a year and a half ago with a similar early stage lesion, and over the last year and a half I’ve read and researched and learned a lot. What I’d say it this is definitely a life-changing diagnosis, it’s scary, and there is some % of these early “low risk” lesions that can go on to be more trouble later. So, it means we have to be vigilant and pay attention to our bodies and hope it works out in our favor. But, it is a big deal – I think sometimes it can tend to be underestimated or downplayed, but it is a major thing. Like Catherine said, “I wouldn’t freak out. Your lesion is low risk.,” but like Lisa said it is “bombshell news.”

    #57661
    spschultz
    Participant

    All…thanks so much for your replies. I’ve learned more about melanoma in the last 48 hours than I ever cared to know. I’ve broken my pathology report down line by line on Google (don’t we all self-diagnose today?), and you have all confirmed what I thought it said…a generally low risk legion, which I think was caught relatively early, but when you see the 5 year survival rate for something like this is 95%…somebody has to be in the unfortunate 5%, which of course scares the hell out of me. I think my dermatologist wants to simply have the mole/tumor removed and then watch it. I am inclined to insist on a test of the lymph nodes. What is peace of mind worth?

    Catherine, my report didn’t include anything about radial or vertical growth phase…something new for me to obsess about on Google:) I am in the Richmond, VA area, by the way.

    Thanks again, and perhaps I’ll post an update or two as I navigate my new reality over the next couple months.

    Trying to keep my head up,

    Steve

    #57662
    cohanja
    Participant

    A negative sentinel node biopsy certainly is a good result and may give someone peace of mind. But, even that is not a guarantee – sometimes the cells have not traveled yet to the lymph nodes (or to different nodes), or sometimes they can travel in the blood, not in the nodes. The odds would certainly say from your path report that there would not be anything found in your nodes. Make sure you’re comfortable with whatever you decide – some have not done it & then wished later they had, etc. . .

    #57663
    krissy424
    Participant

    Get a second opinion on your slides, Steve. If you talk to some of the people here with deeper melanomas that have had extensive lymph node removal, complications in healing and extremity swelling is not unusual. With a Breslow .54 I wouldn’t be in a hurry to have any nodes removed unless suggested by a melanoma expert. My superficial spreading melanoma was Breslow .55, Clark 2, Radial growth phase, no ulceration. All i needed was the wide excision. i know how you feel about being told 95%. Somehow that’s never very far from my mind same as you. Keep in touch with us.

    Kris

    dx 6-15-12

    #57664
    cohanja
    Participant

    I believe Catherine has said something before along the lines of most of these early thin melanomas only metastasizing later in cases when the initial pathology was wrong and it wasn’t really an early thin melanoma to begin with. It’s hard to think that could be all the cases of early thin melanomas spreading – that they were all initial pathology errors, but I imagine some % of them might have been. So, maybe it’s actually a little better than 95%.

    #57665
    spschultz
    Participant

    Quick update…they just scheduled my surgery for a week from tomorrow. That will be 11 days after my diagnosis, which strikes this layman as being a little slow. Is there any reason to be concerned about the delay?

    Steve

    #57666
    goldengirl2011
    Participant

    11 days isn’t too long. I had to wait 34 days due to a family emergency. Please keep us posted, and do get a second opinion for ease of mind.

    #57667
    Catherine Poole
    Keymaster

    I know when I was diagnosed 24 years ago with a .76 lesion, with mitotic of 1 and ulceration, I thought 90% was too low for my survival rate. But then a second doctor raised it to 95%. And then you know life goes on. You can split hairs on statistics till the cows come home but you have to believe that your prognosis is excellent. There are no guarantees in life, ever! So get a second opinion on your pathology by an expert dermatopathologist, perhaps at UVA or Hopkins or by Harvard based http://www.drmihm.com. Just have your slides sent and find out their opinion, it is a great idea if you have worries. The time for the WLE is not worrisome. But you could be a squeaky wheel and get them to move it up!

    #57668
    AngelaM
    Participant

    I have had all 3 of my WLEs (for the 3 melanomas that I have had) within 2 days of the pathology report becoming available. My doctors prefer to do the WLE sooner rather than later becuase there is a theoretical risk of spread if a tumor was been intersected or ‘cut through’. They have assured me that this risk is theoretical only.

    #57669
    cohanja
    Participant

    Well, usually a thin lesion is completely removed with the biopsy anyway, so there shouldn’t be anything left in the WLE, so nothing left to theoretically spread. Plus, I think Catherine has said that is an old myth – that it spreads if cut through. .

    #57670
    Catherine Poole
    Keymaster

    Cohanja is correct. That is not the biology of melanoma. It spreads by growing and sending out satellites to establish colonies. Cutting a lesion would not do this. Full removal for thin lesions is normally handled by the biopsy. Going back for more skin and wider margins is old dogma but persists.

    #57671
    spschultz
    Participant

    Thank you for addressing the possiblity of the cancer spreading through the biopsy itself…I was just thinking about that yesterday. I had a punch biopsy and stitches and was suddendly consumed withthe thought that it would be the perfect path for the cancer to spread. Catherine, could you clarify what you mean when you say “Full removal for thin lesions is normally handled by the biopsy.”? How would a biopsy (again, in my case a punch biopsy) remove the entire tumor? Do you mean the WLE will remove the entire legion, with no further need to go in and cut again? I’m a little confused.

    On another note, and mostly just to vent, I fired my dermatologist. Long story short, I didn’t appreciate her responding to a couple simple questions with “I can’t teach medical school in this hallway” and “I didn’t have to give you that pathology report, I did so as a courtesy, not to be pinned down with a bunch of questions.” I’ve made my own arrangements for surgery and follow-up, and already feel much better about the way ahead. Thanks to all of you at least for your responses to my questions.

    Steve

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