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July 19, 2013 at 9:20 pm #21461
Hi everyone, forgive me for posting in this section, but I wasn’t sure where I should post my question. My question pertains to my daughter who is 7 years old, and as you all know, there isn’t much information out there for young ones. To give you a little background..this past June I noticed a new black mole on my daughter’s back while applying sunscreen. I’m almost 100% certain it wasn’t there last summer, as it is quite different looking than all her other “beauty marks” or moles so I’m sure I would have noticed it. The mole is on her upper left back and it definitely looked suspicious: asymmetrical, black with some lighter brownish color off to one side, seemed to suddenly appear, raised a bit, etc. The biopsy came back and the nurse’s assistant called to tell me that my daughter needed to have a wide local excision done to remove it so we can get clear margins, and that it came back as an atypical mole with “very severe abnormal cells”. The suggested I go to a plastic surgeon given the location of the mole and my daughter’s age. I asked to have the report mailed to me and this is what it says:
“the biopsy specimen reveals mild elongation of rate ridges with atypical melanocytic lesion both as single units and as nests along the dermoepidermal junction. Small nests of melanocytes are focally noted in the papillary dermis. Basal pigmentation is prominent. Most melanocytes are spindled with hyper chromatic nuclei. There is a patchy lymphocytic infiltrate mixed with melanophages in the dermis. The histological findings are most consistent with a pigmented spindle cell nevus of reed. The nevus approximates the inked margin of the biopsy specimen. Clinical correlation is necessary. If pigmented lesion persists on clinical exam, re-excision is recommended to ensure complete removal and histological evaluation of the entire lesion. Diagnosis: SKin 7.5 cm left upper spine. Biopsy—Consistent with a pigmented spindle cell nevus of Reed.”
None of this language makes any sense to me, but my question is this: should I have the WLE done on my daughter who is only 7, and what are the chances that this could be misdiagnosed and actually be melanoma? Is there a possibility that the diagnosis could change to melanoma after the WLE? I’m freaking out a little simply because she’s so young and this came out of nowhere. Thanks so much for your time and help!!
LisaJuly 19, 2013 at 9:49 pm #61878cohanjaParticipant
Sorry you’re having to deal with this. Your daughter is lucky you were vigilant about getting her checked. I’m not a doctor, but I believe the difference between severely atypical and melanoma in situ is a matter of degrees. While each of them may have some of the same factors, melanoma in situ will have more of them. Neither can really metastasize – melanoma in situ has basically a 100% cure rate. It’s confined to the epidermis with no access to blood or lymph vessels that take the cells elsewhere. Both are treated the same, however, with 5mm margins. The differentiation between the two is best left to an experienced dermatopathologist who sees lots of melanoma – as it’s a judgement call to make the final diagnosis.July 19, 2013 at 11:53 pm #61879 I would get another opinion on the pathology from an expert, at a teaching university such as UPENN, Hopkins, Sloan Kettering or expert Dr. Mihm, http://www.drmihm.com. I would make sure what it is and get their opinion. Melanoma is highly unlikely in children, but you want to be certain someone experienced is looking at her slides. Just the slides are shipped and it is an easy procedure. Let us know how things go.July 20, 2013 at 12:08 am #61880 thank you both for your replies. This may be a dumb question, but how do I go about asking for the slides to be sent to another lab at one of those hospitals mentioned? Do I contact the dermatologist’s office and would they be responsible for sending the slides? We live in Buffalo, NY…..
Thanks again for your help.July 20, 2013 at 12:33 am #61881cohanjaParticipant
You should be able to have the pathology lab that currently has the material send it to where you want to go for a 2nd opinion. They might have a form for you to fill out or something, but it should be a pretty standard thing for them, many people seek additional opinion. If you choose Dr Mihm, this may be handy:
Contact Mihm’s office first before sending your slides, though, I think there is a form to also fill out with demographics, billing info, etc…
Martin C. Mihm Jr., M.D., F.A.C.P.
Cambridge, MA 02142
You might have better luck and a quicker response by sending an email directly to this person:
Assistant to Martin C. Mihm Jr., M.D.
Director, Melanoma Program
Department of Dermatology
Brigham and Women’s Hospital
41 Avenue Louis Pasteur
Alumnae Hall, Room 317
Boston, MA 02115
firstname.lastname@example.orgJuly 20, 2013 at 1:23 am #61882 Thank you so much… I will email her!July 20, 2013 at 12:23 pm #61883 Yes, the lab/and or the derm office should readily ship the slides (not the material) to the requested site. Your insurance should also cover the second opinion. Let us know if you need further assistance with this.July 20, 2013 at 2:21 pm #61884 Thank you Catherine….just curious, what do you make of the pathology report?
LisaJuly 20, 2013 at 9:57 pm #61885
A spindle cell nevus of Reed is a type of a Spitz nevus which is what is commonly found in children and is benign. But it is rare enough to get a second opinion to verify. I would definitely err on the side of it being benign and not a risky lesion, but let an expert weigh in by looking at the slides.July 21, 2013 at 12:25 am #61886 thank you very much. Another quick question… do you think a WLE is necessary for a pigmented spindle cell nevus of Reed? If so, should I just wait and send those pathology reports for a second opinion? I have a consultation scheduled with a plastic surgeon on July 30th…
Thanks for all of your help.
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