Home Forums Melanoma: Newly Diagnosed – Stages I & II Pathology report, doctor seems confused

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  • #22380
    mstellato
    Participant

    So happy I found this site. I had a very small mole removed by a shaved excision by a physician assistant during a body scan examine at my dermatologist. I received a phone call from the PA informing me that basically the pathology report recommended that I have a surgical excision because of “Changing cells”. I had many questions that she could not answer, so I insisted to speak to the dermatologist that I’m scheduled for surgery with, this Tuesday. I found her email address and emailed her various questions, she phoned me and basically read the pathology report to me. She inclined that “that doctors cannot predict melanoma and they treat these type of finding aggressively.” Because this mole, doesn’t seem to be the problem but the underlying tissue is appearing to be the concerns. I cannot help but to be extremely anxious, because I have several moles that looked like the one that was removed, I asked the doctor if there is something wrong with all of my dermis, and should I be concerned that of some type of strange melanoma or more importantly a test that would indicate if I have other areas in my body or on my skin, that indicate these unusual components of this pathology report. Her answer was, not to worry, and I was jumping the gun. 😳 Sorry Doctor, but now I’m out of my mind with worry.

    I insisted she email me my Pathology Report, this is what the findings are, if anyone out there understands basically what this is saying in laymen terms, I’d be very greatful. Also should I insist on my lymph nodes being biopsied. “In todays,managed healthcare” one needs to be their own advocate of their bodies and wellbeing”… Thank-you for any replies.

    Below is the pathology report.

    PATIENT HISTORY:

    The patient has a 3 mm dark brown irregularly pigmented papule on the right

    distal upper arm: Rule out atypia.

    _______________________________________________________________

    FINAL DIAGNOSIS:

    SKIN, RIGHT DISTAL UPPER ARM, SHAVE BIOPSY:

    A. COMPOUND, PREDOMINANTLY INTRADERMAL MELANOCYTIC NEVUS WITH UNUSUAL

    FEATURES (see comment).

    B. THE DEEP MARGIN IS BROADLY INVOLVED.

    COMMENT:

    SOX-10 confirms the distribution of melanocytes. Ki-67 proliferative index is

    not significantly increased within the dermal component.

    Due to some unusual features including mild sclerotic changes within the

    dermal component and the presence of scattered cells with enlarged,

    hyperchromatic, irregular and mildly pleomorphic nuclei within the dermal

    component, a re-excision to ensure complete removal and prevent recurrence

    and/or progression of this lesion is advised.

    #66449
    TreeFrog
    Participant

    Hi there!

    I understand your concern, as news like this is always a surprise. But your doctor is right – there’s no need to panic. If you get a wider excision around the site of this mole you should be good to go.

    The doc is also right that sometimes it is hard to tell if a mole is starting to move towards becoming a melanoma, in the very early stages. Thus, it’s usually recommended to do a wider excision around any mole with odd changes in the cells.

    So – it’s not a melanoma, but just a mole they want to be cautious about. You won’t need a lymph node biopsy. Just keep an eye on your skin, and let your doctor know any concerns now or in the future. It’s not a problem with your entire dermis – just an odd mole that cropped up in that one spot.

    Hope this helps!

    ~Wendy

    (I’m a layperson but have studied the subject since I had a Stage I removed in 2010)

    #66450
    mstellato
    Participant

    Thank-u Wendy,

    I was under the impression, from the doctor, that they really could not make a call yet if this was a melanoma. The mole actually was normal, but it was the tissue around and under the mole that the pathology report indicating the abnormal cells. This is what really complexes me. My doctor did explain that sometimes the tissue around moles will absorb the cellular changes as such instead of the mole. Nevertheless, this has me anxious and truly worried. Do they send the tissue off to the pathology again once they excise the area since the first biopsy was only a shaved mole? The reason I ask is I would assume since they are surgically going down deep into the dermis that they would have a better understanding as to these irregular and mildly pleomorphic nuclei.

    I really appreciate your reply

    Mechelle :(

    #66451
    TreeFrog
    Participant

    Hi Mechelle,

    Yes, when they do the excision around the original biopsy, they send the tissue away again to be examined, to ensure they got a good margin around any abnormal cells. Your doctor will get a pathology report on it.

    The only way to know whether a mole like this would become a melanoma, would be to let it grow … which of course is not practical. So, you and your doctor will never know for sure if this could have harmed you. But the good news is, it will be completely gone, and since it was not a cancer, it cannot have spread anywhere else.

    Worrying is normal and it will go away in time. Be careful not to read loads of, um, silly stuff on the internet … much of it is outdated an inaccurate. The information on this site can be trusted though. :)

    Best wishes,

    ~Wendy

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