Home Forums Melanoma: Newly Diagnosed – Stages I & II pathology report melanoma in situ, lentigo maligna type

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  • #21659
    rcheek
    Participant

    pathology report states: in this biopsy specimen, there are numerous atypical melanocytes arranged in crowded single units, as well as in small collections along and above the dermoepidermal junction. Similar melanocytes are also sen along the basal layer of the adnexal structures. In the dermis there is solar elastosis and patchy chronic inflammatory infiltrarte including melanophages.

    I had a shave biopsy done before this report by a dermatologist. It was a tiny freckle the size of a sharpened pencil tip on my right cheek. A little lighter patch was next to it about the size of a pencil eraser.

    I’m 51.

    I had a full body scan by same derm a month before. He saw spot and said it wasn’t anything. I asked about shaving off spot for cosmetic reasons. A month later I did it, and the report resulted.

    I had previously treated the spot with atralin from another derm where I had lived before.

    The spot is less than a year old.

    The derm cauterized the shaved spot before sending to lab.

    The derm referred me to a plastic surgeon who wants to do a wide excision on my face.

    I have read about Mohs, Aldera as alternatives possibly.

    Does the pathology merit having my face cut drastically with a scalpel?

    A tiny scab was on my face from the shave biopsy by the derm wwhen I went to see the plastic surgeon. It came off when he looked at the area. You really can’t see anything now.

    Help.

    Thanks.

    #62921
    Catherine Poole
    Keymaster

    I would get another opinion for certain, possibly from UPENN dermatology? They have a branch at Radnor with excellent docs. I’m a little confused by your biopsy results as they don’t seem to indicate anything for a wide excision. If it is insitu/lentigo maligna than there are less drastic ways to treat. The slides can be sent to Penn or to http://www.drmihm.com for another opinion as well. No need for a second biopsy. I hope this helps you..

    #62922
    rcheek
    Participant

    At the top of my pathology report the comment states, “the proliferation extends to the periphery of the specimen, and re excision with appropriate margins is advised.

    I understand from some literature that sometimes a lm and lmm diagnosis is challenging.

    I have also read that some reports will always advise as such for safety – malpractice and health wise.

    I also read that a clinical exam is sometimes important to prevent a possible misdiagnosis with actinal keratosis? Sun damage.

    Is there a delineation between a lm and lmm diagnosis, ie the number and grouping of atypical melanocytes? This could be critical for me as it could mean the difference in treatment options.

    I have read about aldera etc. as a first step.

    Is it possible to learn more if a darmascope? Was used in a clinical exam?

    The plastic surgeon wants to do a wide local excision because as he explained to me he can’t close a circle – he wants to go way around and up and down.

    I have left a message for dr. Mihm at the number on your web site and will call mon.

    I already called the lab to have the specimen sent to another dr. In my town who does MOHs. I called them back – they just have an answering machine yesterday to see if it wasn’t mailed out yet to have it sent to dr. Mihm. I guess I could have it sent again from the MOHs dr too.

    Is there any contamination in this. Chain of custody?

    Thanks for the response too. It has eased me a bit that someone is out there like your organization. I hope to pay it back.

    Any more input is appreciated. Oh, and I’ll check out upenn. I made an appointment with the dr who signed pathology report – he works in a couple of offices not to to far away.

    #62923
    Worrywart
    Participant

    Hello Rcheek,

    I am sorry you’ve been diagnosed with melanoma, and esp on your face. I agree with Catherine, a second opinion on pathology is crucial due to the location of the lesion, and the dx of LM.

    To answer your questions – the different between LM and LMM is depth. LMM (lentigo maligna melanoma) is an invasive melanoma, whereas Lentigo Maligna is an in situ melanoma.

    I was dx with melanoma in situ, lentigo maligna subtype, 5.5 yrs ago, when I was 34. It was on my arm – so I had a wide excision.

    The problem with Lentigo maligna is that it has a high local recurrence rate, so really is best to excise it widely.

    Thinking of you! Let us know how that second opinion goes.

    #62924
    rcheek
    Participant

    Worrywart wrote:

    Hello Rcheek,

    I am sorry you’ve been diagnosed with melanoma, and esp on your face. I agree with Catherine, a second opinion on pathology is crucial due to the location of the lesion, and the dx of LM.

    To answer your questions – the different between LM and LMM is depth. LMM (lentigo maligna melanoma) is an invasive melanoma, whereas Lentigo Maligna is an in situ melanoma.

    I was dx with melanoma in situ, lentigo maligna subtype, 5.5 yrs ago, when I was 34. It was on my arm – so I had a wide excision.

    The problem with Lentigo maligna is that it has a high local recurrence rate, so really is best to excise it widely.

    Thinking of you! Let us know how that second opinion goes.

    Sorry for the dribs and drabs on my pathology report. It also says, ” malignant melanoma in-situ, lentigo maligna type (172.3)

    The specimen measure 3x1x1 mm.

    I will let you know. It’s therapeutic writing here. Tnx

    #62925
    rcheek
    Participant

    I am thankful I found this site & organization as a resource.

    I am thankful for many things.

    The advice and direction I received have been invaluable.

    I obtained a second doctors opinion and a second pathology opinion that confirmed original diagnosis.

    I will receive treatment from a wonderful doctor who cares.

    On a similar note. While watching tv this evening while preparing dinner I saw that an actor, Hugh jackman, was treated for a skin cancer, basal cell, on his nose. He was grateful that his wife told him to get it checked out.

    #62926
    rcheek
    Participant

    Update. The day before Christmas Eve I had surgery at upenn. MOHs for melanoma in situ. Removed first go around and only on surface. Long scar already healing.

    #62927
    Worrywart
    Participant

    Thank you for the update! I am glad you got that done. I am sure it’ll heal nicely. Happy New Year!

    #62928
    Catherine Poole
    Keymaster

    I’m glad you have this behind you. I didn’t realize they were doing MOHS for melanoma insitu. Did you get referred for that? Or was that a second opinion?

    Happy New Year and thanks for keeping in touch!

    #62929
    rcheek
    Participant

    Catherine Poole wrote:

    I’m glad you have this behind you. I didn’t realize they were doing MOHS for melanoma insitu. Did you get referred for that? Or was that a second opinion?

    Happy New Year and thanks for keeping in touch!


    I was initially referred to a plastic surgeon by a dermatologist ( the one that did the initial biopsy – btw – he initially also told me that the procedure was cosmetic and didn’t schedule me until a month after a body scan to have the shave biopsy) . I asked the plastic surgeon a few questions about treatment modalities ( please reference Catherine’s recent blog dated dec 31 st regarding physician choices etc.) and he told me that he would get back to me. He never did. In the mean time I got a second and eventually a third pathology report and had a consult with a university of Pennsylvania dermatologist. This dermatologist, who i very much like and feel comfortable with, referred me to a MOHs colleague for surgery. An excellent physician and surgeon with outstanding credentials and experience. Maybe because it was on my face it was done via MOHs. But from what I gather the surgery would be similar, I.e. Excision to fat layer with margins. Advantage was having pathology and lab determine while you wait for wound to be closed and reconstructed

    That all is clear – my case, or in some others maybe a second or a third excision.

    So, it was a second opinion. And it was a referral – from you on this site actually. So I am very grateful and happy to let others know of the help I received from you.

    Happy new year to all

    Also thanks worrywart too.

    The cancer is all gone and the healing has commenced!

    #62930
    RandyGordon
    Participant

    rcheek wrote:

    solar panel elastosis and patchy chronic inflammatory infiltrarte including melanophages.

    I had a shave biopsy done before this report by a dermatologist. It was a tiny freckle the size of a sharpened pencil tip on my right cheek. A little lighter patch was next to it about the size of a pencil eraser.

    I’m 51.

    I had a full body scan by same derm a month before. He saw spot and said it wasn’t anything. I asked about shaving off spot for cosmetic reasons. A month later I did it, and the report resulted.

    I had previously treated the spot with atralin from another derm where I had lived before.

    The spot is less than a year old.

    The derm cauterized the shaved spot before sending to lab.

    The derm referred me to a plastic surgeon who wants to do a wide excision on my face.

    I have read about Mohs, Aldera as alternatives possibly.

    Does the pathology merit having my face cut drastically with a scalpel?

    A tiny scab was on my face from the shave biopsy by the derm wwhen I went to see the plastic surgeon. It came off when he looked at the area. You really can’t see anything now.

    Help.

    Thanks.


    I think you need to worry a lot if you are not facing any issue.. To much scans are not good for body.

    #62931
    Catherine Poole
    Keymaster

    By full body scan he is talking about an examination of his skin, not a CAT or PET scan.

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