Home Forums Melanoma: Newly Diagnosed – Stages I & II Probable 1b diagnosis- pathology unclear

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    I’ve been reading this forum and it has helped me to hear other people’s stories–so thank you.

    My sister was diagnosed with a probable superficial spreading melanoma, stage 1b about two weeks ago. I’ve been very upset and anxious. She happens to be a student at a university with a melanoma center of excellence, and her pathology comes from a dermapathologist there. However, he seems unsure about the diagnosis in the report.

    Her mole was 4mm, symmetrical, dark, and appeared on her buttock in the past year.

    The details from the pathology are:

    .9mm Breslow Depth

    Clark level IV

    no ulceration

    mitosis: 1 per square mm

    vertical growth: present

    consumption of the epidermis: not identified

    regression: not identified

    (It was a punch biopsy–the pathology says that margins were clear at the base but that “melanoma in situ extends close to the peripheral edge”)

    However, the text says:

    While the pagetoid scatter is not seen in a Melan A immunostain , HMB-45 labels some of the dermal component and ki-67 shows a 5% proliferation rate. This is a very challenging lesion where the differential diagnosis includes a compound dysplastic nevus with atypical features; however, given the dermal mitosis and atypical cytologic changes, I believe this lesion should be regarded and treated like a melanoma.

    Does this mean it might not be a melanoma? I’ve been doing some research and it seems like nearly all melanomas would stain for Melan A? What do you make of this? Should she get a second opinion? Since this comes from a melanoma center of excellence, I’m not sure.

    As it stands, my sister is having a WLE and SLNB next week anyway, which I guess would be appropriate if it is indeed melanoma. I’m just really scared the SLN will have melanoma and that it has spread.

    The SLNB is expected to be in the groin. Should my sister be able to go back to class within a few days?

    Thanks for any thoughts.


    Yes, it absolutely warrants a second opinion. What is the university? I would not want to undergo an SNB for a lesion that may not be melanoma. That is step one. If the next pathology comes back uncertain, then I’d go ahead (better safe than sorry) but a second opinion is the first step that I would take asap. They are usually pretty prompt with second opinions.


    It is at UNC-Chapel Hill. I think they are supposed to be good?

    Thanks for the advice–I think she may go through with the procedure since they were apparently strongly recommending it and it is next week anyway–but maybe she should still get a second opinion, even if it comes back after the procedure has been done.

    Catherine Poole

    The depth and mitotic factor would indicate the SLNB for this lesion. UNC is a good place, but a second opinion never hurts. You could try Duke.


    Just wanted to give an update–my sister had her SLNB and WLE and got the results–both were clear. So that is a relief! I’m still going to suggest a second opinion on the original lesion since it not being a melanoma would impact follow up.

    I also noticed that on the original pathology, it said that there were no identified tumor infiltrating lymphocytes. Should we be worried about that? I read some articles that indicated not having TILs was a very bad sign, but I’m not sure if it matters as much now that the lymph node biopsy came back clear? Or possibly, if it wasn’t an actual melanoma, that would mean the body wouldn’t be producing TILs? Does anyone know if no TILs in a IB melanoma is something to be concerned about? In terms of a possible reoccurrence?

    Also, to anyone reading this and worried about the SLNB, my sister’s (two nodes in the groin) went very well–she was able to go on a short walk and out to dinner the next day. She did not have much pain at all.

    Catherine Poole

    This pathology definitely indicates a melanoma. I’m happy she had the SLNB and it was negative. She most likely won’t deal with this again! The absence of TILs isn’t a negative factor but a positive one if they were present. So no worry about that. A second opinion on the pathology can’t hurt. Let us know how things go.

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