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July 2, 2012 at 7:54 am #20427
I’m partly in denial and partly scared to death. My dermatologist excised a black mole from my upper back 6/15/12. I know i had several severe sunburns as a teen. Should say, I am 60 year old mom and grandmother- and by the way, i am uninsured. I understand clark, breslow and AJCC, but what do all the notes mean? I’ve looked up the unfamiliar words and I do have a medical background- but I’m lost and am feeling urgency to understand this report. The results are below. I see the general surgeon tomorrow to discuss the wider excision needed. What questions should i ask him? Thank you for any help or comments.
NOTE: A broad lentiginous and nested melanocytic proliferation exhibits severe cytologie atypia characterized by melanocytic cells with variable amounts of dusty granular cytoplasm and enlarged nuclei with coarse heterochromatin or prominent nucleoli. Many of the melanocytic nuclei are larger than the keratinocyte nuclei in the mid spinous cell layer. There are areas of confluent lcntiginous proliferation with areas of cellular dyshesion and focal pagetoid spread into the granular cell layer. There is also extension down adnexal structures. In some areas, the melanocytic nesting is more discrete with associated concentric eosinophilic fibrosis and scattered lymphocytes and pigment-laden macrophages. Occasional papillary dermal melanocytic cells exhibit severe cytologic atypia similar to the intraepidermal component. However, other melanocytic cells within the dermis do not exhibit significant cytologic atypia. No dermal mitoses are identified in multiple tissue levels. Well-controlled immunoperoxidase reaction for MART-1 confirms the broad lentiginous and nested melanocytic proliferation and highlights intermittent areas of high pagetoid spread into the upper spinous cell layer and into the granular cell layer focally. It also highlights areas of confluence within dyshesive nests and adjacent lentiginous proliferation. It also highlights the superficial dermal melanoeytic component. Finally, it confirms the lesion is narrowly excised.
MELANOMA SYNOPTIC DESCRIPTION:
Type: . Superficial spreading
Clark’s level: II
Breslow (geatest) depth: 0.55 mm
Growth phase: Radial
Cell type: Epithelioid
Mitotic count: None
Tumor infiltrating lymphocytic response: Not applicable
llistologic features of regression: Absent
Vascular invasion: Absent
Satellite metastases: Absent
Precursor lesion: Dysplastie nevus
Margins of excision: Narrowly excised
AJCC stage: IA;Tla Nx Mx VJuly 2, 2012 at 11:33 am #55222Catherine PooleKeymaster
Your pathology looks low risk and you are fortunate to have caught this early. The depth is the number one prognostic indicator and it is .55, no need for sentinel node biopsy. It is also in the radial growth phase which means it has little or no capacity to spread. So you should just need a wide excision and go back for regular check ups. Be sure to keep up your self exams too! This site has much information for you to. At the top of the page are several click thrus with further information about pathology and diagnosis.July 2, 2012 at 4:54 pm #55223
I thank you very much for your quick response and great news. Truth is I never have done self skin checks. My five year old granddaughter spotted this big mole and brought it to my attention. The doctor was quite dramatic, saying she was “an angel sent from heaven to save my life.” I will continue to read the forum. We never can be sure what the future holds.
My best wishes to you all.
Morro Bay, CA
I apologize if my post inappropriate, the “please read forum rules” link is down.July 2, 2012 at 5:59 pm #55224Catherine PooleKeymaster
Yes, children can be quite adept at finding things and this was a great find. Nothing inappropriate about your post but thanks for letting me know that link was down. We’re just getting the kinks out here. Let us know how you are doing! And start doing those self exams!July 3, 2012 at 6:48 pm #55225 Catherine was correct. I need the wider excision only. No need to test lymph nodes. The surgeon will schedule it as an office procedure in the next two weeks.The scar will be less than good cosmetics, i am warned. That’s okay with me. The type of melanoma and the breslow .55 are huge in expecting a great out come for my disease. Now i’m looking around my skin and seeing more atypical moles than normal ones. i see the derm in follow up very soon. I have many questions for him. I need to relax and stop obsessing.
Again, thank you very much, Catherine.July 4, 2012 at 5:26 am #55226
i thought i had an excision bx. Now that I’ve done some reading, not a bit sure. Husband said he thought the dermatologist removed the whole melanoma in one piece. Could someone look at these pics and tell what kind of bx was done? Sorry for the iPhone photography and sloppy Photoshop- i was in a hurry. Thanks in advance- KrissyJuly 4, 2012 at 10:34 am #55227cohanjaParticipant Looks like a deep shave?July 4, 2012 at 6:30 pm #55228 I’ll call the doc when they are back in the office. What I was told and what I see on the photos don’t seem to match. I basically walked in the office and said get this off of me. Doc agreed and 15 minutes later I walked out with it removed. I didn’t know I needed to research to find best methods. The second time it will be by a highly skilled surgeon.
Thank you for responding, cohanja.July 4, 2012 at 8:17 pm #55229casey188Participant
The path report does not say that there are any melanoma cells in the margins so nothing to worry about. The wide local excision will take extra margins as a precaution but should come up clean. As long as the shave is deep it usually gets all of the mel in the biopsy. Studies have shown deep shaves to be effective.July 4, 2012 at 8:44 pm #55230jameslukeParticipant Hi krissy424.This looks like a deep shave( saucerization)biopsy.unless theres a reason not to do one the biopsy recomended for excising melanoma tumours is excisional biopsy (elliptica) its done in the same way as your wide excision is going to be done.one of the problems that can arise with the shave type biopsy is they can leave some of the tumour behind leading to an under estimation of the breslow measurment.finding the correct breslow is most important, on its own it can tell if a sentinel lymph node biopsy needs to be done, it also determines how big the margins need to be for the wide excision.i think in your case they got all the tumor out because your path report does not mention the lesion being transected.your path report looks really good.
i think in a lot of cases the reason for the shave type biopsy s being done is they are quick and easy for the doctors to do,obviously a doctors convenenice should take second place when selecting a biopsy method.One reason for not using excisional biopsy (elliptical) is if a person presents with a large lesion in such cases an incisional biopsy may be done to see if what they are dealing with is in fact melanoma before commiting to removing the entire lesion.if you read any of the melanoma guidelines and there all the same no matter if they come from ireland, usa or the uk the recommend biopsy if it can be done is excisional biopsy(elliptical)Best wishes jamesluke.July 4, 2012 at 10:23 pm #55231WorrywartParticipant
The biopsy type only matters if the margins are involved. Yours are not involved so it does not matter. Yes, that looks like a shave biopsy. Excisional would have stitches, as would punch. You have a low risk lesion. Get a second opinion on pathology. Good luck.July 5, 2012 at 12:20 am #55232 James postedQuote:
if you read any of the melanoma guidelines and there all the same no matter if they come from ireland, usa or the uk the recommend biopsy if it can be done is excisional biopsy(elliptical)
that is exactly what i have read, James. My dermatologist is semi- retired only works four half days. i think he did that type of biopsy because he was comfortable doing it. i live in a town of 3,000. I had no clue when i phoned his office that i would be given an appointment in 48 hrs when i used the word melanoma. The other derms in our city, San Luis Obispo are 3-6 or longer for appointments. i didn’t know to use the “melanoma card”.
The pathologist used sounds very good.
Hugh Randolph Byers MD, PhD Dermatopathologist. Graduated from Harvard University School of Medicine. Twenty nine years experience.
My general (thoracic and vascular surgeon) surgeon, Howard Hayashi, Md is the guy all the doctors and other professionals chose for treatment. impeccable reputation and a legend with the nurses for saving the unsavable. If there’s any melanoma cells left Howard will get it done.
Being uninsured, driving to Stanford, UCSF or USC or UCLA are not options.
i’m rambling and abusing your time here. Thanks for the ear.July 5, 2012 at 12:34 am #55233
i understood that if a report states “narrow margins,” one has to assume the margins might be involved. yes? no?July 5, 2012 at 9:54 am #55234jameslukeParticipant Useing Narrow margins when excising a lesion is a good thing because it keeps the lymph system around the melanoma as intact as it is possible to keep them in case the patient needs a sentinel lymph node biopsy.if a person did happen to have some involvement at the margins the wide excision would take care of it.JameslukeJuly 5, 2012 at 2:27 pm #55235casey188Participant Krissy,
If the margins were involved, the report would say something like “melanoma extends to the ______ margin” and would name the specific margin area. Narrow margins are clear margins and it just indicates they do not meet the standard. That’s where the wide local excision comes in. The surgeon will take 1 cm margins as extra insurance it is gone. Since you don’t have a deep enough depth (.76 or greater), you won’t need a sentinal lymph node biopsy. In the future you can insist on an excisional biopsy if you have anything suspicious removed.
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